Rejection due to NPI cross walk, Data element missing

Crosswalk did not give 1 to 1 match for NPI 

What this means: The payer does not recognize the provider matched to the NPI tax ID combination in thier system.

Provider action: Check your NPI and tax ID numbers, are you sending the claim how you are credentialled with the payer, verify this provider is credentialled under the Billing NPI or individual provider NPI.  You may need to contact the payer to retrieve this information?

Rejection Removal: Rejections will not be removed by   EDI as they are valid.

Re-filing: Once this is corrected, you would want to re-file any claims that rejected for this reason.



A data element with 'Must Use' status is missing. Element CR104 

What this means: Some claims submitted October 29, 2012 through November 6, 2012 erroneously rejected with the message, “A data element with 'Must Use' status is missing. Element CR104 (Ambulance Transport Reason Code) is m".

Provider action: No provider action is required.

Rejection Removal: Rejections will  be removed by   EDI as they are invalid.

Re-filing:   EDI will re-process the affected claims.


ACKNOWLEDGEMENT RETURNED AS UNPROCESSABLE CLAIM

What this means: Our trading partner invalidly rejected claims between the dates of 02/24/2012-06/04/2012.

Provider action: Check your tricare claims and verify if they rejected for this reason.

Rejection Removal: Rejections will not be removed by   EDI.

Re-filing: You would want to re-file any claims between these dates that rejected for this reason.








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