Claim Rejections and Billing Errors

The claim reopening process may not be used when a claim is rejected on a provider’s electronic 277CA report, or when a claim is rejected and the provider is notified on a remittance advice. Providers must correct the missing, invalid or incomplete information and resubmit the claim as a new claim with the required information.

Billing errors are also known as "claim submission errors" or "rejections." Rejections are not the same as denials, although providers often use the terms interchangeably.

Rejections occur when a claim contains invalid information or is missing required information.

• Example of invalid information: the claim contains a CPT code that specifies "inpatient hospital," but the place of service on the claim indicates "office"
• Example of missing required information: the service submitted is an X-ray, but the NPI of the ordering or referring physician is missing

Important Facts About Billing Errors

• Every claim that is rejected as a "billing error" contains remittance advice remarks code MA130
• MA130 is accompanied by additional remark codes. Look for and review all remark codes to find the specific error.
• Many billing errors are identified automatically through the claims processing system
• In the vast majority of cases, the only way to resolve a billing error is to find and fix the specific error. It is also important to double-check the rest of the claim for accuracy.
• Once you have identified and corrected the billing error, the claim must be resubmitted as a new claim. Billing errors cannot be sent in for redeterminations (first level appeals).

Use web tools to help identify and correct billing errors, such as the Denial Finder, Modifier Lookup and specialty web articles.