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Top 5 Reasons for Claims Rejections According to Cahaba Government Benefit Administrators®, LLC in Georgia during December 2007. 209 INVALID LAST NAME FOR HIC NUMBER (14,871 claims) The last name submitted for the beneficiary does not match the last name on record for the HIC number on the claim. The beneficiary's last name must include apostrophes, spaces, hyphens, etc., if they appear in the beneficiary's last name on his or her Medicare card. 383 INVALID NPI/LEGACY MEDICARE PROVIDER NUMBER COMBIN (14,165 claims) The legacy provider number submitted in the indicated loop is not associated on our crosswalk with the NPI submitted. Be sure the NPI submitted is the correct NPI for the legacy provider number submitted. If it is then verify the provider's information with enumerator; be sure all of the information entered is correct and complete, including tax ID numbers, addresses, phone numbers, etc. If this information is correct then contact the provider enrollment department at 877.567.7271 210 INVALID FIRST NAME/INIT FRO HIC (12,802 claims) The first name submitted for the beneficiary does not match the last name we have on record for the HIC number on the claim. The beneficiary's first name must include apostrophes, spaces, hyphens, etc., if they appear in the beneficiary's last name on his or her Medicare card. 421 DIAG CODE (XXXXX) INVALID FOR DATE SVC (9,298 claims) The invalid diagnosis code will appear inside the parenthesis. Be sure that you are using the latest ICD-9 diagnosis codes, and that the code you are using is the most specific one. Also be sure that you are not using a date of service that is before the effective date of the diagnosis code. 333 INVALID PROVIDER NUMBER IN LOOP XXXXXX (9,128 claims) The provider number is the indicated loop is not valid. The invalid provider number used will appear in the text for the edit.
Are you getting NPI rejections? If your claims are rejecting, here are steps in resolving your NPI issues. First go into the NPPES website located at https://nppes.cms.hhs.gov/ and validate that your information is correct and that you reported your provider legacy provider numbers in the appropriate sections of the ‘Other Provider Identification Numbers’ field. Your legacy provider number is the identifier assigned to you by the insurance plan upon enrollment and used prior to NPI assignment. Sometimes multiple legacy identifiers are assigned to a single provider, usually because the provider had multiple locations or, if the provider is an individual and worked in multiple locations. If the information in your NPPES record is correct and contains your valid legacy identifiers, print the screen, call your insurance plan and ask that they confirm your NPI information is in their crosswalk. Remember, getting an NPI is free. Not having an NPI or not registering your NPI can be costly!