Prior to sending your claims to the clearinghouse for submission to the payer, they undergo a scrubbing process. If an issue is identified, the claim will be moved to the "Missing Information" status and populated with the specific error.
The messages you will see, along with the recommended next step are listed below. It's important to address these claims timely as they have not been sent to the clearinghouse/payer for processing.
- Provider account is Suspended: Your account is listed as suspended and as such is restricted from submitting claims. Please reach out to your Account Manager or support if you feel this is incorrect.
- Provider Plan Type Invalid: Your provider account is listed as light suspended and is restricted from submitting claims. Please reach out to your Account Manager or support if you feel this is incorrect.
- Clearinghouse setup is incomplete: Your connection to the clearinghouse is not complete. Please reach out to your Implementation Specialist or support for assistance.
- Billing Status and Payment Profile are contradicting: There is a contradiction between the payment profile and the appointment status. Please review the claim to ensure the payment profile on the claim reflects the type of claim you are billing.