Why was my claim rejected?

Submitting claims can be a frustrating process, especially when they're rejected for missing information. drchrono now offers tips to get your claims back on track. 

Hover over the "Rejection info" to learn why a claim was rejected and how you can fix it.

ACK/Reject Inval Info - Principle Diagnosis Code

Meaning

The principal diagnosis code which you have entered on the claim is not specific on the patient condition. If you have entered a 3 or 4 digit diagnosis code, then please find a more specific 5 digit diagnosis code. (Ex. Need to use 280.00 instead of 280.0)

How to fix it

"E" codes cannot be the first code in box 21. Need to switch the "E" code with another diagnosis code in box 21. Go to the appointment details screen and delete the E code and re-enter again, it shouldn't be the first > check the box "Resubmit claim" > "Verify and Save".

ACK/Reject Inval Info - Diagnosis Code

Meaning

Diagnosis code which you have entered on the claim is not specific on the patient condition. If you have entered a 3 or 4 digit diagnosis code please find a more specific 5 digit diagnosis code. (Ex. Need to use 280.00 instead of 280.0)

How to fix it

Go to appointment details screen and correct the diagnosis code towards the left > click on "Resubmit claim" and hit "Verify and save".

COB information (service line)

Meaning

If the sum of Primary Insurance payment, Adjustment, and the Patient Reasonability amount is not equal to the Billed Amount, the claim will get rejected as COB information is invalid.

How to fix it

For example, the billed amount is $100.00, the adjustment, paid amount & patient responsibility posted should equal $100.00 to get successfully transmitted to the secondary insurance.

Tally EOB Transaction (Unmatched)

Meaning

drchrono now cross checks the EOB check amount vs. the payment transaction posted using the check numbers. If the numbers do not match our system will show a warning message as "Unmatched". You can see this in Billing > Remittance Report. 

How to fix it

Review the EOB and make sure that all of the transactions are posted correctly.

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