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eClaims - Common Rejections - Eligibility

Eligibility
Rejection Message:

Payer/Trading Partner REJ Payer Response ACK/RETURNED - ENTITY NOT ELIGIBLE FOR BENEFITS FOR SUBMITTED DATES OF SERVICE. - PATIENT

This rejection shows that the claim was rejected because the patient did not have active insurance for the submitted dates. Often times a patient is issued a new insurance card that has a different subscriber ID or group number, which in turn deactivates their old card. It is also possible that the patient no longer has coverage. The best thing to do would be to call the payer and verify eligibility for the patient. 

It is also worth noting that and eligibility rejection could also be related to patient demographic information on the claim. It would be good to verify that information entered in MacPractice matches that of the insurance card. This information would include:

  • Subscriber ID
  • Group Number
  • Patient/Subscriber First Name
  • Patient/Subscriber Last Name
  • Patient/Subscriber Middle Initial (if applicable)
  • Patient/Subscriber Birthdate

Note: Please direct any questions regarding patient eligibility to the insurance company as MacPractice EDI Support has no way verifying this information. MacPractice cannot call payers on behalf of offices or patients to verify eligibility information.

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