Prior to transmitting claims to the payer, the clearinghouse runs a series of checks for missing or invalid payer-required information. When detected, the claim will be rejected so that you can make the necessary corrections. The clearinghouse report includes both rejections and acknowledgements. For the most common rejections and resolutions, see the Claim Rejection Troubleshooting Guide.
Note: If a claim is rejected from the clearinghouse, all claims associated with the encounter are rejected.
Example of Clearinghouse Checks:
- Missing or invalid Practice or Service Location primary and secondary IDs
- Missing or invalid ID qualifiers
- Missing submitter IDs when payer requires a unique submitter ID
- Missing or invalid payer ID
- Missing or invalid procedure, modifier, or diagnosis code
- Missing or invalid adjustment code
- Missing or invalid subscriber’s identification number (policy number)
- Missing provider specialty code
- Click to access the encounter record.
- Reason for rejection.
- REJ = claim rejected; make corrections and rebill.
- ACK = acknowledged; claim forwarded to payer.