Version 2 - Blue Cross Blue Shield of RI

[Pages:18]Blue Cross & Blue Shield of Rhode Island

Provider Control Report Error Message Code Guide

Version 2.0 Status: Published February 24, 2014

Blue Cross & Blue Shield of Rhode Island is an independent licensee of the Blue Cross and Blue Shield Association.

Blue Cross & Blue Shield of Rhode Island Provider Control Report Error Message Code Guide

This document may be revised and republished if and when Blue Cross & Blue Shield of Rhode Island makes improvements and/or changes to any referenced product, process or program. The information and contents of this document and any notes or handouts, if any (together "document"), contain confidential and proprietary information, and are not to be disseminated, reproduced, printed, translated or transmitted in any form, in whole or in part, without the prior written consent or express permission of Blue Cross & Blue Shield of Rhode Island. Use and distribution limited solely to authorized personnel. 2012 ? Blue Cross & Blue Shield of Rhode Island All Rights Reserved.

PREFACE

The BCBSRI PFEx Error Message Code Interpretation provides trading partners with information regarding the error codes generated by BCBSRI when P (Professional), I (Institutional) , D (Dental), and A (ALL) claims are rejected after electronic submission to Blue Cross & Blue Shield of Rhode Island (hereinafter "BCBSRI").

DISCLAIMER

This document is considered a living document, and as such, the information provided herein will be subject to change prior to and after July 1, 2011 in the event that BCBSRI revises its policies or HIPAA 5010 Transactions and Code Sets law is updated or amended.

Version: 2.0

February 24, 2014

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Table of Contents

1.0 Introduction ..................................................................................................................................1 2.0 Scope.............................................................................................................................................1 3.0 Contact Information .....................................................................................................................1 4.0 Error Message Codes ..................................................................................................................2 5.0 Document Version Control.......................................................................................14

Version: 2.0

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Blue Cross & Blue Shield of Rhode Island Provider Control Report Error Message Code Guide

1.0 Introduction

This document provides an interpretation of the error message codes returned to trading partners when submitted electronic claims transactions are rejected by BCBSRI.

2.0 Scope

The code/message explanations found in the table in Sections 4.0 are generated for BCBSRI Corporate Professional (P), Institutional (I), Dental (D), and All (A) Claim Types.

3.0 Contact Information

BCBSRI will work closely with its trading partners to establish effective communication protocols and to resolve any connectivity issues that may arise regarding the exchange of HIPAA-related electronic transactions.

The following contact information is provided to assist in the process of implementing 837 transactions:

Email Address: Applicable Web sites:

HIPAA.EDI.Support@

Support business hours are Monday through Friday, 8:00 AM to 4:30 PM.

For HIPAA EDI Production Support:

Contact the Information Technology (IT) Service Desk, which supports BCBSRI, at 401-751-1673 or 1-800-343-5743. The business hours are Monday through Friday, 8:00 AM to 4:30 PM.

Version: 2.0

February 24, 2014

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Blue Cross & Blue Shield of Rhode Island Provider Control Report Error Message Code Guide

4.0 Error Message Codes

Column "Applies to Claim Type" values => P-Professional, I-Institutional, D-Dental, A-All

Error Number

C401 C402 C403 C404 C405

C406

C407

C408 C409 C410 C411

C412

C413 C414 C415 C416 C417 C418 C419 C420 C421 C422 C423 C424 C425 C426

Error Message TOT CHG NOT = TOT LN CHG NO PROV ID FOR COVERAGE PROV ID INVALID COV TYPE BILL PROV TAX ID MISSING BILLPROV TAXID NOT 9 NUM

BLPROV NPI/TIN COMBO NOF

CALL 274-4848 BCHP TIN INV

PROV NOT AUTH BS CLAIMS PROV NOT AUTH BC CLAIMS PROV NOT AUTH DENTAL CLM NO BILL PROV LAST/ORG NM

NO BILL PROV FIRST NAME

BILL PROV ADDR MISSING BILL PROV CITY MISSING BILL PROV STATE MISSING BILL PROV ZIP MISS/INVAL PAYER RESP CODE MISSING PAYER RESP CODE INVALID PAYER NAME MISSING PAYER ID MISSING PAYER ID NOT VALID PAT CTRL NUM MISSING BEN ASSIGN IND MISSING BEN ASSIGN IND INVALID MED ASSIGN CD MISSING MED ASSIGN CD INVALID

Error Description

Total Charges not equal to Line Charges Provider ID for Coverage Type is not present Provider ID for Coverage Type is not valid Billing Provider Tax ID is missing Billing Provider Tax ID is not 9 numeric Billing Provider Tax ID and NPI combination is not on the LRSP database Unable to find a valid Provider Location Code when member has Blue Chip Coverage Provider not authorized to submit Blue Shield professional claims Provider not authorized to submit Blue Cross Institutional claims Provider not authorized to submit Dental Claims Billing Provider Last Name or Organization Name is not present Billing Provider Entity Type is 1 (person) and Billing Provider First Name is missing Billing Provider Street Address is missing Billing Provider City is missing Billing Provider State is missing Billing Provider Zip Code is missing Payer Responsibility Code is not present Payer Responsibility Code is not equal to `P', `S', or `T' Payer Name is missing Payer ID is missing Payer ID is not equal to 00870 or 00370 Patient Control Number is missing Patient Benefit Assignment Indicator is missing Patient Benefit Assignment Indicator is not `Y' or `N' Medicare Assignment Code is missing Medicare Assignment Code is not valid

Applies To Claim Type

A I,P I,P A A

A

P

P I D A

P, D

A A A A A A A A P, D A A A P P

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Blue Cross & Blue Shield of Rhode Island Provider Control Report Error Message Code Guide

Error Number

C427 C428 C429 C430 C431 C432

C433

C434

C435

C436 C437 C438 C439 C440 C441 C442

C443

C444

C445 C446 C447 C448 C449 C450 C451 C452 C453

Version: 2.0

Error Message

Error Description

PROV SIGN IND MISSING

Provider Signature Indicator is not present

PROV SIGN IND INVALID

Provider Signature Indicator is not valid

REL INFO CD MISSING

Release of Information Code is missing

REL INFO CD INVALID

Release of Information Code is not valid

CLM FREQUENCY CD MISSING Claim Frequency Code Missing

CLM FREQUENCY CD INVALID Claim Frequency Code Invalid

Claim Frequency Code indicates

ADJ CLM-NO ORIG CLM NUM

an adjustment claim and original BCBSRI claim number is not

present

Claim Frequency Code indicates

ADJ CLM-ORIG CLM NUM INV an adjustment claim and original

BCBSRI claim number invalid

INVALID PWK ATTACH CD

Invalid Attachment Paperwork Code

Attachment Control Type equals

ATTACH CNTRL NUM MISSING `BM', `EL', `EM, OR `FX' and no

Attachment Control number given

POS MISSING

Place of Service is missing

POS INVALID

Place of Service is not valid

Place of Service is Inpatient

HSP ADMIT DATE MISSING

hospital and Admission Date is not

present

ADMIT DATE INVALID

Admission Date is not a valid Date

ADMIT DT > RECEIPT DATE

Admission Date is greater than receipt Date

ONSET DATE INVALID

Onset Date is present but is not a valid date

Onset Date is present but is

ONSET > 1ST SVC DATE

greater than the first Date of

Service

Onset and Admission Dates are

ONSET DATE > ADMIT DATE present and Onset Date is greater

than Admission Date

Either Employment, Auto or Other

ACCIDENT DATE MISSING

Accident Indicator is yes but no

Accident Date given

ACCIDENT DATE INVALID

Accident Date not a valid date

PRIN DX MISSING

Principal Diagnosis is missing

PRIN DX NOT DEFINITIVE

Principal Diagnosis is not a Definitive Diagnosis

PRIN DX INVALID PAT SEX

Principal Diagnosis is invalid for Patient's Sex

PRIN DX INVALID PAT AGE

Principal Diagnosis is invalid for Patient's Age

OTH DIAG NOT DEFINITIVE

Other Diagnosis is not a Definitive Diagnosis

OTH DIAG INVALID PAT SEX

Other Diagnosis is invalid for Patient's Sex

OTH DIAG INVALID PAT AGE

Other Diagnosis is invalid for Patient's Age

February 24, 2014

Applies To Claim Type

A A A A A A

A

A

A

A P, D P, D P, D P, D P, D

P

P

P

P, D P, D P, I P, I P, I P, I P, I P, I P, I

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Blue Cross & Blue Shield of Rhode Island Provider Control Report Error Message Code Guide

Error Number

Error Message

C454 REF PROV ID INV FORMAT

C455 REF PROVID INV COVERAGE

C456 REF PROV ID NOT ON FILE

C457 NO OTH PAY SUB LAST NAME

C458 C459 C460

OTH PAY SUB ID MISSING OTH PAYER NAME MISSING OTH PAYER ID MISSING

C461 2ND CLM-NO OTHPAYER INFO

C462 NO PRIM PAY SUB LNAME

C463 PRIM PAY SUB ID MISSING

C464 C465

PRIM PAYER NAME MISSING PRIM PAYER ID MISSING

C466 NO PRIM PAYER INS TYPE

C467 NO PRIM PAYER PAY AMT

C468 NO PRIM PAYER PAID DT

C469 NO PRIM PAYER0 ADJ REASN

C470 NO 2NDARY PAY SUB LNAME

C471 C472 C473

NO 2NDARY PAY SUB ID NO 2NDARY PAYER NAME 2NDARY PAYER ID MISSING

C474 NO 2NDARY PAYER INS TYPE

Error Description

Referring Provider ID submitted is invalid format Referring Provider ID submitted is invalid for Coverage Type Referring Provider ID submitted is not on file Other Payer indicated but Other Payer Subscriber Last Name is missing Other Payer indicated but Other Payer Subscriber ID is missing Other Payer indicated but Other Payer Name is missing Other Payer indicated but Other Payer Payer ID is missing Claim submitted indicates BCBSRI is not primary, but no Other Payer Information is given BCBSRI Secondary or Tertiary and Primary Payer Subscriber Last Name is missing BCBSRI Secondary or Tertiary and Primary Payer Subscriber ID is missing BCBSRI Secondary or Tertiary and Primary Payer Name is missing BCBSRI Secondary or Tertiary and Primary Payer, Payer ID is missing BCBSRI Secondary or Tertiary and Primary Payer Insurance Type Code is missing BCBSRI Secondary or Tertiary and Primary Payer Paid Amount is missing BCBSRI Secondary or Tertiary and Primary Payer Paid Date is missing BCBSRI Secondary and Primary Payer Paid Amount is zero, but no Adjustment Reason Code given or Patient Responsibility amount given BCBSRI Tertiary and Secondary Payer Subscriber Last Name is missing BCBSRI Tertiary and Secondary Payer Subscriber ID is missing BCBSRI Tertiary and Secondary Payer Name is missing BCBSRI Tertiary and Secondary Payer ID is missing BCBSRI Tertiary and Secondary Payer Insurance Type Code is missing

Applies To Claim Type

P P P A A A A A

A

A A A P

A

A

A

A A A A P

Version: 2.0

February 24, 2014

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