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eClaims - Common Rejections - Missing/Invalid Subscriber ID

Missing/Invalid Subscriber ID
Subscriber rejections can come in many forms, but normally point to the same issue. Rejection messages include, but are not limited to the following: 

  • REJ Payer Response The claim/encounter has been rejected and has not been entered into the adjudication system. | Entity's id number.
  • ACKNOWLEDGEMENT/RETURNED AS UNPROCESSABLE CLAIM^Subscriber and subscriber id not found
  • ACKNOWLEDGEMENT/REJECTED FOR INVALID INFORMATION^Subscriber and subscriber id not found
  • Rejection: SUBSCRIBER PRIMARY ID# MUST BE BETWEEN 9 AND 11 CHARACTERS. (Bad Data: XX )
  • RCategory- Acknowledgement/Returned as unprocessable claim The Claim/Encounter has been rejected and has not been entered into the adjudication system Status- Missing or invalid information Entity- Payer\\\\RCategory- Acknowledgement/Returned as unprocessable claim The Claim/Encounter has been rejected and has not been entered into the adjudication system Status- Subscriber and policy number/contract number not found Entity- Payer
  • REJ Payer Response ACKNOWLEDGEMENT/REJECTED FOR INVALID INFORMATION^Entity's contract/member number.^Insured or Subscriber
  • REJ Payer Response SUBSCRIBER PRIMARY IDENTIFIER- INVALID; MUST BEGIN WITH CORRECT PREFIX
  • ACK/RETURNED - ENTITY NOT FOUND. - PATIENT

The best way to explain this rejection is that the insurance company does not recognize the subscriber on the claim as being covered by their benefit. This can be for many reasons including:

  • Subscriber ID
  • Group Number (if applicable)
  • Patient First Name
  • Patient Last Name
  • Patient Middle Initial (if included on insurance card)
  • Patient Birthdate
  • Eligibility for submitted Date of Service (DOS)

Anytime a Subscriber rejection is received it is important to check MacPractice and the Patients' insurance card to be sure they match. It can also be beneficial to run an eligibility check for the patient to verify that the patient has active coverage, or to see if a new insurance card may have been issued. This can also be done by calling the insurance company directly to verify patient information.

If the aforementioned steps have been followed, please contact MacPractice EDI Support with a copy of the patient's insurance card and a research case can be opened with Change Healthcare.

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