Claim rejected

This type of response may be generated if the insurance company is unable to respond electronically to your payment or predetermination request. If the claim is rejected, you will need to ask your patient to pay you the full claim amount and submit the claim directly with their insurer.

A note is displayed at the bottom of this section, requesting that you submit a paper claim (or to submit manually). Some insurance companies may also give you the option to call.

Claim rejected response

From the Insurer response (PDF) section, you can view or save the Claim Rejection Notice, or email it to the patient. You can also copy the claim to a new claim, as described in Submitting a claim by copying a previous claim or predetermination.

Following is an example of a reason that a claim may be rejected.

A reason that a claim may be rejected

Note: A VALIDAT (validation issue) response may be generated for providers using the services of a software vendor when the claim’s primary coverage insurer does not support the 999001 service code, which is used for Personal Protective Equipment (PPE). The error code NL39 is displayed.

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