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eClaims - Common Rejections - Medicare Dependent Information

Rejection Message:

  • Emdeon Reject SUBSCRIBER AND PATIENT MUST BE THE SAME. RELATIONSHIP MUST EQUAL SELF.
  • DEPENDENT LEVEL INFORMATION IS NOT ALLOWED FOR THIS PAYER.

The only relationship of patient to subscriber that Medicare allows is 'Self'. If the relationship of the patient to the subscriber is anything other than 'Self', the clearinghouse will reject the claim.

To fix claims with this rejection, the patient will need to be added to a guarantor tab in the patient record. If there is already a record for someone else (a spouse or a parent) in the Primary tab, add the patient information to the Secondary tab.

Within the Insurance box at the bottom of the Secondary tab, add the Medicare insurance. Within the new insurance record, add the appropriate subscriber ID for the patient.

In the Patient tab of the patient record, uncheck the box for the other subscriber's Medicare and leave the box checked for the patient's Medicare. You will also need to go to the patient record for the other subscriber and uncheck the newly added Medicare within the Patient tab of their patient record.

Be sure, after the new Medicare record is added to the patient record, to arrange the insurances in the proper order, so that the appropriate payer is billed as the primary and secondary, if there is insurance in addition to Medicare for the patient.

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