Common Claim Rejection Reason – Invalid MBR

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Common Claim Rejection Reason Invalid MBR
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Common Claim Rejection Reason Invalid MBR
Claims are most often rejected due to incorrect
or invalid information that doesnt match whats
on file with the payer. Rejections can come from
either the clearinghouse or the insurance payer.
A rejection status does not necessarily indicate
that the payer has determined that the claim is
not payable. Possible Reasons Possible reason
could be mismatched insurance information that
you have entered in CMS-1500. Or it could be
incorrect patient information i.e. incorrect
patient demographics. Insurance Coverage
Expired There are some cases in which patient is
no longer covered under that insurance plan. If
this is the case, you will either need to get new
insurance information from your patient or bill
the session to your patient i.e., patient
responsibility. You should always verify patient
benefits or patient eligibility before submitting
any claim. Wrong Payer In such rejected claims
double check payer ID on CMS-1500. You might be
submitting claim to wrong payer (insurance
company). You can call the phone number on the
copy of the patients insurance card and ask them
for their EDI Payer ID. Resubmit the claims with
correct payer ID.
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Common Claim Rejection Reason Invalid MBR
Wrong Insured ID Number Recheck insurance ID
number (1a) on CMS-1500 claim and patients
insurance card. This is the unique ID that
identifies the patient. Make sure that is
entered correctly. Make sure you dont have any
invalid characters in the primary ID. Some of
insurance companies will have trailing numbers at
the end of their primary ID separated by a dash
or a space. You may want to ask the payer if they
want the trailing numbers in Box 1a of the
CMS-1500. Wrong Insureds Information Cross-check
insurance information with an insurance card. It
is always best to make sure you enter it
correctly on CMS-1500. Sometimes you could have
misspelled a name or entered the wrong
birthdate. How can you resolve Invalid MBR
issue? Resubmit the claim You can edit the claim
with correct details, from the error page, you
can then click the resubmit claim electronically
button from your practice management software to
send the claim out with the new information.
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Common Claim Rejection Reason Invalid MBR
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