Common claim rejections and options to correct

RC-07 Duplicate Claim

You will want to turn off the duplicate claim filter setting on Office Ally Here is a link to the help article with the steps to turn this off.

LC1123 - Modifier 1, on line 01 is invalid.

The modifier you have entered is either missing a digit or is incorrect. To update the modifier:

Select the client > Go to the Billing tab > Click on the DOS > Click on the CPT code description Scroll down to Modifiers Enter/correct the modifier in the first box Save

SERVICE FACILITY ZIP CODE INVALID OR DOESN'T MATCH STATE CODE

This could be that you have your state abbreviation incorrect, but normally it is that your city name is too long and the last part of the zip code is not transmitting. To fix this:

Go to your Settings (on the top right) Locate your addresses click List

Abbreviate your city name Ex: East =E, Springs = SPRGS Save

Depending on where your address is pulling from, you may also need to update Your Profile

Click your initials on the top right Click Your Profile >Locate Mailing Address> Click Edit > Update the City name Save

Claim REJECTED via ERA

If your claim was rejected via ERA, you will want to review the Text file for more information.

Display the claim > Click the claim button with the gear on the right  > Click Office Ally ERA (text) - XX/XX/XXX > Locate the client and Review the rejection reason

Payer Message: RENDERING PROVIDER TAXONOMY (PVR03) IS REQUIRED WITH RENDERING PROVIDER NPI

You will want to update the insurance settings to pull the taxonomy code.

Click Settings on the top right > Click Billing and Ins > Click List under Insurance Features

Select the Payer > Click Edit Custom Settings next to the provider name (If more than one provider)

Go to CMS 1500 Box 24J top- Select Individual Taxonomy > Click Save and Done

Payer Message: BILLING PROVIDER TAXONOMY (PVR03) IS REQUIRED WITH BILLING PROVIDER NPI

You will want to update the insurance settings to pull the taxonomy code.

Click Settings on the top right > Click Billing and Ins > Click List under Insurance Features

Select the Payer > Click Edit Custom Settings next to the provider name (If more than one provider)

Go to CMS 1500 Box 33b- Select Group Taxonomy > Click Save and Done

Payer Message: MISSING RENDERING PROVIDER TAXONOMY CODE

To update the insurance settings to pull the taxonomy code.

First make sure you have your taxonomy code listed

Click Settings on the top right > Click Staff > Select the Provider > Click Edit on the License and Identification Section > Add the Individual Taxonomy > Click Save

To find the Taxonomy you can search the NPI registry with the NPI I of the provider.

Once that is updated You will need to add the Rendering taxonomy code to the claim.

Click Settings on the top right > Click Billing and Ins > Click List under Insurance Features

Select the Payer > Click Edit Custom Settings next to the provider name (If more than one provider)

Go to CMS 1500 Box 24J top- Select Individual Taxonomy > Click Save and Done

RC55 - Payer Requires Pre-Enrollment for Electronic Claims Submission. Provider is not yet approved to submit claims electronically to this payer.

You will need to complete the EDI enrollment paperwork on Office Ally. This can take up to 45 days for approval, depending on the insurance.

Payer Message: DIAGNOSIS CODE 6(F) NOT EFFECTIVE FOR THIS DOS

This rejection means there is a medical diagnosis code listed on your claim form that was not active, valid, or billable on the specific Date of Service (DOS) submitted. You can check the ICD-10 data base

If the claim is already locked, you will need to correct this directly on the claim

Missing, incomplete, invalid, or inappropriate place of service.

Select the client > Click the Billing tab > Click on the DOS > Click on the description >  Scroll down to Modifiers or Place of Service Make corrections as needed > Save

Medicare rejecting for Box 11

Medicare Group Number (NONE) Medicare does not use or assign patient group numbers but they require the ‘Group Number” field to be completed on all claims. The fix is to enter the word NONE as the Group Number. You'll find the Insurance Group Number field in the patient's Edit Info screen under the [Primary Insurance (Policy Information)] tab.