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eClaims - Common Rejections - Institutional Claims: Group Name

Institutional Group Name
Rejection Message:

  • Emdeon Reject BILLING PROVIDER NAME ENTITY TYPE QUALIFIER IS MISSING OR INVALID (Bad Data: 1 )

This rejection is specific to claims sent on an Institutional Template. Claims can be billed one of two ways; as a group or as an individual. Claims billed as an individual will be denoted by a "1" in the claim file. Similarly, a claim billed as a group will be denoted with a "2" in the claim file. For institutional eClaims, only an entity type of "2" is valid. This means that a provider cannot bill as an individual. Providers must bill under the group for all institutional claims.

The checkbox for 'Bill as Individual" in the insurance reference will need to be unchecked for the 'Provider Shown on Claim'. This will tell MacPractice that group information should be shown on the claim over individual provider information for the purposes of billing.

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