Resolution steps will vary depending on the cause:
- If the practice is not credentialed or enrolled with the payer, please contact the payer for further assistance.
- Verify what Provider IDs the payer has on file to determine what information the claimed should be billed under.
- Is the Provider enrolled with their Group NPI or Individual NPI?
- Is the Provider enrolled with their Tax ID or SSN?
- Verify if there are any additional payer-assigned Provider IDs that also need to be submitted on the claims. If so, what loop and segment should the information be populated in?
- Verify the Payer ID used is correct/valid for the policy information submitted.
- If the claim was sent with different billing information than what is on file with the payer, verify and edit the billing information.
- If the claim is submitted to the wrong payer ID, verify and edit the payer ID.
When all corrective actions are completed, verify enrollment is completed (or not needed) before submitting e-claims. Then, rebill and resubmit all affected claims.