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Rejected by Jopari. Status Message: A7 - Acknowledgement/Rejected for Invalid Information - The claim/encounter has invalid information as specified in the Status details and has been rejected.; 364 - Is accident/illness/condition employment related

 

Rejection Message

Rejected by Jopari. Status Message: A7 - Acknowledgement/Rejected for Invalid Information - The claim/encounter has invalid information as specified in the Status details and has been rejected.; 364 - Is accident/illness/condition employment related?

Rejection Details

This rejection indicates that the claim failed Jopari's validation. The insurance program on the claim does not match the condition.

Resolution

Verify the condition in the patient case for the claim matches with the insurance program.

If the condition is related to "Employment", the insurance program will need to be WC - Workers Compensation Health Claim.

If the condition is related to an "Auto Accident", the insurance program will need to be AM - Automobile Medical.

If the practice submits claims for both Workers Compensation Health Claim and Automobile Medical, please ensure that separate insurance companies and insurance plans are created for each. One specifically for Workers Compensation and one specifically for Automobile Medical.

Follow the instructions below to verify the condition:

  1. Click Encounters > Track Claim Status. The Find Claim window opens.
  2. Look for and double-click on the encounter that needs correcting. The Edit Claim window opens.
  3. Double-click on the Case. The Edit Case window opens.
  4. Click on the Condition tab.
  5. Click the appropriate condition checkbox in the Condition related to section.
    • Auto Accident? = AA
      • Select a State from the drop-down menu.
    • Employment? = EM
  6. Add the accident date for an auto accident:
    1. In the Date Type drop-down menu, select the Accident Date.
    2. In the Start Date field, enter or select the date in the drop-down menu.
    3. In the End Date field, enter or select the date in the drop-down menu (if applicable).
    4. Click on the Add button to populate the date to the field below.
  7. Or add the date of injury for employment:
    1. In the Date Type drop-down menu, select the Date of Injury.
    2. In the Start Date field, enter or select the date in the drop-down menu.
    3. In the End Date field, enter or select the date in the drop-down menu (if applicable).
    4. Click on the Add button to populate the date to the field below.
  8. Click Save all the way out (multiple saves may be required). 
EditCase_ConditionWC.png

Then follow these instructions to verify the insurance program:

  1. Click Encounters > Track Claim Status. The Find Claim window opens.
  2. Look for and double-click on the encounter that needs correcting. The Edit Claim window opens.
  3. Double-click on the Case. The Edit Case window opens.
  4. Double-click on the appropriate Insurance Policy. The Insurance Policy window opens.
  5. Double-click on the Insurance Name. The Edit Insurance Plan window opens.
  6. Double-click on the Insurance Company 
     name. The Edit Insurance Company window opens.
  7. Click the Insurance Program drop-down to select the  correct insurance program code.
    1. If the condition in the case was marked as "Auto Accident", select AM - Automobile Medical.
    2. If the condition in the case was marked as "Employment", select WC - Workers Compensation Health Claim.
  8. Click Save all the way out (multiple saves may be required).

Then, rebill and resubmit all affected claims.

InsuranceComp_InsuranceProgramWC.png