Payer Specific Transaction
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Availity® Health Information Network Batch Electronic Data Interchange (EDI) Companion Guides Payer Specific Transaction Edits Version 11.08 - Updated 08/20/2011 Availity, L.L.C. P.O. Box 550857 Jacksonville, FL 32255-0857 August 2011 Payer Specific Updates Error Codes Error Messages Error Descriptions Updates Loop Element Trans Types 3938afb Service Line Date is required on outpatient claims. Segment DTP (Service Line Date) is missing. It is required on outpatient claims when revenue, procedure, HIEC or drug codes are reported in the SV2 segment. New Edit 68050, 68053 68057, 68058 SHP11 2400 DTP03 837I 3938b51 Last Menstrual Period may be used only for female patient. Segment DTP (Date - Last Menstrual Period) is used. It is not expected to be used when patient is not female (element DMG03 in loop 2010BA is not 'F'). Payers Added 68050, 68053 68057, 68058 SHP11 2300 DTP03 837P prof.SFB The patient (2010CA) or subscriber (2010BA) first and last name fields can contain letters and Special characters are not allowed in the spaces only. Special characters are not allowed. subscriber/patient name fields. Edit Relaxed 68050, 68053 68057, 68058 SHP11 2010BA NM103 NM104 837P The date of the last menstrual period (loop 2300, DTP*484) cannot be the same as the onset of similar symptoms or illness (loop 2300, DTP*438). New Edit 68050, 68053 68057, 68058 SHP11 2300 DTP03 837P S206P The date of the last menstrual period (loop 2300, DTP*484) cannot be the same as the onset of similar symptoms or illness (loop 2300, DTP*438). Visit our website: www.availity.com Availity® Health Information Network EDI Payer Specific Transaction List Error Codes Error Messages Error Descriptions Loop Element Trans Types 837P 837I Payers 810021 Element has a data type of ‘Numeric’ R. Leading zeros are not allowed. Leading zeros are not allowed. 2320 AMT*B6 CAS03 CAS04 810021 Element has a data type of ‘Numeric’ R. Leading zeros are not allowed. Leading zeros are not allowed. 2430 CAS03 SVD02 SVD05 837P 837I 38520, 57106 61125, 00720 00220 810021 Element has a data type of ‘Numeric’ R. Leading zeros are not allowed. Leading zeros are not allowed. 2410 CTP03 CTP04 837P 837I 38520, 57106 61125, 00720 00220 810021 Element has a data type of ‘Numeric’ R. Leading zeros are not allowed. Leading zeros are not allowed. 2000B 2000C PAT08 837P 837I 38520, 57106 61125, 00720 00220 810021 Element has a data type of ‘Numeric’ R. Leading zeros are not allowed. Leading zeros are not allowed. 2400 SV104 837P 38520, 57106 61125, 00720 00220, 59274 75137 810021 Element has a data type of ‘Numeric’ R. Leading zeros are not allowed. Leading zeros are not allowed. 2400 SV205 837I 38520, 57106 61125, 00720 00220, 59274 810021 Sub-Element HI01-05 has a data type of 'Numeric' R. Leading zeros are not allowed. Leading zeroes not allowed 2300 HI 837I 00611, 00851 00932, 93221 810024 Element CLM12 is a coded list element. Code '02' is not allowed. Element CLM12 is a coded list element. Code '02' is not allowed. 2300 CLM12 837P 00720 810024 Element SV103 is a coded list element. Code 'F2' is not allowed. Element SV103 is a coded list element. Code 'F2' is not allowed. 2400 SV103 837P 00720 810024 Element SV204 is a coded list element. Code 'F2' is not allowed. Element SV204 is a coded list element. Code 'F2' is not allowed. 2400 SV204 837I 00220 810062 An invalid code value was encountered. An invalid code value was encountered. 2300 CLM11 837P 00720 3939321 Value of element CAS02 is incorrect. Expected value is from external code list - Adjustment Reason Code 139 Claim Adjustment Reason Code must be valid based upon the code list. 2430 CAS02 837P 837I 94036, 00934 93093, 26374 26375, 26378 3939331 Value of element PRV03 is incorrect. Expected value is from external code list - Health Care Provider Taxonomy Code (682). Segment PRV is defined in the guideline at position 003. When present, the taxonomy code in PRV03 must be valid. 2000A, 2310A 2310B, 2420F PRV03 837P 837I 01260, NIA11 SHP11, 68050 68053, 05130 WA001, OR001 00835, 00831 03102, AK001 00836, 26374 26375, 26378 39393fa Value of element CAS has been already used. Claim Adjustment Reason Codes are expected to have unique values within segment CAS. Claim Adjustment Reason Codes cannot be duplicated within the same CAS category. 2320 CAS 837I 837P 14163 Visit our website: www.availity.com 38520, 57106 61125, 00720 00220 August 2011 Availity® Health Information Network EDI Payer Specific Transaction List Error Codes Error Messages Error Descriptions Loop Element 2010AA, 2010AB 2010BA, 2010BB 2010BC, 2010CA 2310D, 2330A 2420C, 2420E 2400 N403 Trans Types 837P REF02 837P 2300 REF02=X4 837P Payers 3939342 Value of element N403 is incorrect. Expected value is from external code list - ZIP Code (51) when country is US. Segment N4 is defined in the guideline at position 030. Must be a valid US Postal Service Zip Code. 3939345 Value of element REF02 (Universal Product Number (UPN)) is incorrect. Expected value is Universal Product Code (format is 12-14 digits where the last one is a check digit) when REF01='OZ'. Value of element REF02 (CLIA Identification) is incorrect. CLIA number format is 10 characters where the third character is the letter ‘D’. When the Universal Product Number (UPN) (REF02) is incorrect; the expected value is Universal Product Code (format is 12-14 digits where the last one is a check digit) CLIA ID is invalid. 3939382 Value of element REF02 (Universal Product Number (UPN)) is incorrect. Expected value is Universal Product Code (format is 12-14 digits where the last one is a check digit) When the Universal Product Number (UPN) (REF02) is incorrect; the expected value is Universal Product Code (format is 12-14 digits where the last one is a check digit) 2400 REF02 837P 68050, 68053 68057, 68058 SHP11 3939384 Value of element AMT02 (Patient Estimated Amount Due) is incorrect. It may not be more than When the Patient Estimated Amount Due (AMT02) is incorrect; it value of element CLM02. cannot be more than the total claim charge (CLM02). 2300 AMT02 837I 68050, 68053 68057, 68058 SHP11 3939386 3939388 Statement Dates is invalid. Date Last Seen is invalid: it is after Transaction Creation Date. Statement Dates is invalid. Edit relaxed to allow future DOS 2300 2300 DTP03 DTP03 837I 837P 00220 04102, 04202 04302, 04402 00904, 04301 00882 3939389 Statement thru date is after transaction create date Statement thru date must not be after the file submission date 2400 DTP*472 837I 3939391 Value of element REF02 (Rendering Provider Secondary ID) is incorrect. Expected value is Social Security Number (format is '9 digits or '000-00-0000'') when REF01='SY'. Value of element REF02 (Rendering Provider Secondary ID) is incorrect. Expected value is Social Security Number (format is '9 digits or '000-00-0000'') when REF01='SY'. 2010AA 2310B REF02 837P 14163, 14164 SHP11, 68057 68053, 68050 68058 11345 3939392 Value of element REF02 (Referring Provider Secondary ID) is incorrect. Expected value is UPIN (format is '1 alpha and 5 digits; or one of the values RES000, VAD000, PHS000, RET000, INT000, SLF000, OTH000') when REF01='1G' Value of element NM109 does not look like a valid Social Security Number according SSA requirements. The UPIN is invalid 2310A REF02 837P AIDID, AIDWA 2010AA, 2010AB 2010BA, 2010CA 2310A, 2310B 2310C, 2310E 2330A, 2330C 2420A, 2420B 2420D, 2420E 2420F NM109 837P 837I 14163, 14164 3939396 Value of element NM102 is incorrect. Expected value is ‘1’ when Subscriber is the same person as patient. SBR02=18 (2000B) is present, then NM102 (2010BA) should be a ‘1’ 2000B 2010BA SBR02 837P 837I 3939396 Value of element NM102 is incorrect. Expected value is ‘1’ when the subscriber is the same person as patient Subscriber must be listed as an entity code ‘1’. 2010BA NM102 837P 837I 26374, 26375 26378, 77027 SHP11, 68057 68053, 68050 68058 14163, 14164 77027 3939381 3939393 If Social Security number (REF02=SY) is indicated, the number should meet Social Security Administration enumeration requirements. Visit our website: www.availity.com 05130, WA001 OR001, 00835 00831, 03102 AK001, 00836 38520, 57106 61125, 00934 93093, AIDWA 14163, 14164 01260, NIA11 CNTNM, 80705 63665, 66893 95379, 95388 95412, 95569 AIDWA, 91121 91051 August 2011 Availity® Health Information Network EDI Payer Specific Transaction List Error Codes Error Messages Error Descriptions Loop Element Trans Types 837P Payers Service date must be earlier than the primary payment paid date. 2330B DTP 2000B 2320 SBR01 837P 837I 2000B/2320 SBR01 837P 837I BHT BHT04 837P 837I 2010BA DMG02 837P 837I 80705, 63665 95379, 95388 95412, 95569 66893 PRINT, 68057 68053, 68050 68058, SHP11 HPN11, GTPA1 MCA11, VFP11 INET1. KLSY1 SCOK1. WITH1 TX1ST, NWDC1 PPMO1, FMCHP SSC11, CIPA1 KMG11, GHEDI AIDWA 2300 DTP03 837P 10207, PRINT 2300 DTP03 PRINT, AIDWA 2400 DTP03 2300 HI 837P 837I 837P 837I 837P 837I 3939453 The value of element DTP03 (Service Date) is incorrect. Expected value for date or start period date should be a date earlier than the Claim Adjustment date specificed in loop 2330B. 3939460 Value of element SBR01 is incorrect. Primary payer is not specified (elements SBR01 in loops There must be a primary payer specified on claim. 2000B/2320 do not have 'P' value). It's expected to be used when other payers are known to be involved. 3939461 Value of element SBR01 is incorrect. Secondary payer is not specified (elements SBR01 in loops 2000B/2320 do not have 'S' value). It is expected to be used when tertiary payers are known to be involved. SBR01 is incorrect. Secondary payer is not specified. 3939472 Value of element BHT04 (Transaction Set Creation Date) is incorrect. Expected value is Date in format '19, 20 or 21 century'. When the transaction creation date is prior to 1800, the claim will be rejected. 3939472 Value of element DMG02 (Subscriber Birth Date) is incorrect. Expected value is Date in format When the subscriber date of birth is prior to 1800, the claim will be '19, 20 or 21 century'. Segment DMG is defined in the guideline at position 032. rejected. 3939472 Value of element DTP03 (Date - Initial Treatment) is incorrect. Expected value is Date in format '19, 20 or 21 century'. Value of element DTP03 (Date - Onset of Current Illness/Symptom) is incorrect. Expected value is Date in format '19, 20 or 21 century'. Value of element DTP03 (Service Line Date) is incorrect. Expected value is Date in format '19, 20 or 21 century'. Segment DTP is defined in the guideline at position 455. Value of sub-element is incorrect. E-code can not be used as Primary/Admitting/’Reason for Visit’ diagnosis code. When the date of initial treatment is prior to 1800, the claim will be rejected. When the onset of current illness/symptom date is prior to 1800, the claim will be rejected When the service line date is prior to 1800, the claim will be rejected Diagnosis codes beginning with ‘E’ are not allowed as the primary diagnosis code. 3939612 HCPCS Procedure Code is invalid in Principal Procedure Information. 2300 HI 837I 3939615 Value of sub-element SV202-2 is incorrect. Expected value is from external code list - HIPPS Code when SV202-01=ZZ HCPCS Procedure Code is invalid in Principal Procedure Information. Product Service ID must be valid based upon the code list 2400 SV202-2 837I 3939642 Composite HI02 is used. It's not expected to be used when composite HI01 is missing. Diagnosis codes must be in consecutive order. 2300 HI 837I 8220001 If CLM20 = '11' (Other) then additional documentation is required using the NTE or PWK segments. If the PWK segment is used, PWK02 must not be 'AA'. If Delay Reason Code is Other (CLM20 = '11') then additional documentation is required. 2300 CLM20 837P 00720 8220001 If CLM20 = '11' (Other) then additional documentation is required using the NTE or PWK segments. If the PWK segment is used, PWK02 must not be 'AA'. If Delay Reason Code is Other (CLM20 = '11') then additional documentation is required. 2300 PWK 837I 00220 8220001 If CLM20 = '11' (Other), then PWK02 must not be 'AA'. If Delay Reason Code is Other (CLM20 = '11') then report transmission code can not be 'Available on Request at Provider Site'. 2300 CLM20 PWK02 837P 837I 00720, 00220 3939472 3939472 3939600 Visit our website: www.availity.com CNTNM, 68050 68053, 68057 68058, SHP11 80705, 63665 66893, 95379 95388, 95412 95569, 68057 68053, 68050 68058, SHP11 PRINT, AIDWA 14163, 14164 SHP11, 68057 68053, 68050 68058 00220 94036, 80705 63665, 66893 95379, 95388 95412, 95569 00932, 00851 00611, 93221 SHP11, 68057 68053, 68050 68058, 26374 26375, 26378 August 2011 Availity® Health Information Network EDI Payer Specific Transaction List Error Codes Error Messages Error Descriptions Loop Element Not Covered/Denied Amount cannot exceed the Service Line Charge Amount. Only 'BR' should be used for Principal Procedure Qualifier. Principal Procedure Date must be within the Statement Dates or equal to/greater than the Admission Date. 2400 Service Date DTP03 must be greater than or equal to Patient's Date of Birth. SV104 Quantity, zero '0' is not a valid value. Zero '0' is not a valid value for quantity (SV104). The Patient Paid Amount (AMT02) must not exceed the Claim Charge Amount (CLM02). The Patient Paid Amount (AMT02) must not exceed the Claim Charge Amount (CLM02). The billing provider tax ID (2010AA, REF02) and the rendering provider tax ID (2310B, REF02) The billing provider tax ID and the rendering provider tax ID must must be identical. be identical. 8220001 Not Covered/Denied Amount cannot exceed the Service Line Charge Amount. 8220001 8220001 Only 'BR' should be used for Principal Procedure Qualifier. Principal Procedure Date must be within the Statement Dates or equal to/greater than the Admission Date. 8220001 Service Date DTP03 must be greater than or equal to Patient's Date of Birth. 8220001 8220001 C113P Payers SV207 Trans Types 837I 2300 2300 HI HI 837I 837I 00220 00220 2400 DTP03 837P 00720 2400 2300 SV104 AMT 837P 837I 00720 00220 2010AB REF02 837P 53589 00220 D102I Claim should not have a negative submitted charge amount (SV203) at the service line (loop 2400). All values should be zero or a positive number Claim charge cannot have a negative amount. 2400 SV203 837I 07003 D102P Claim should not have a negative submitted charge amount (SV102) at the service line (loop 2400). All values should be zero or a positive number Element PER07 is used. It is expected to be used only when element PER05 is used. Claim charge cannot have a negative amount. 2400 SV102 837P 07003 Contact Information fields must not be skipped. 2010AA PER07 837P 837I 837I 837P 77027 0x39392ec 3938aef Segment DTP is missing. It is required when claim was adjudicated and loop 2430 is not used Segment DTP is missing. It is required when claim was adjudicated and loop 2430 is not used 2330B DTP 3938aef Segment DTP is missing. It is required when claim was adjudicated and loop 2430 is not used. Claim Adjudication date is required when payer identified has previously adjudicated the claim. The claim adjudication date is also known as the EOB date or Check date. 2330B DTP 837P 14163, 14164 77027 3938aef Segment DTP is missing. It is required when claim was adjudicated and loop 2430 is not used Claim Adjudication date is required when line level adjudication segment is not used. Claim Adjudication date at claim level is required. Segment AMT (COB Payer Paid Amount) is missing. It's expected to be used when segment Segment AMT (COB Payer Paid Amount) is missing. It's CAS is used (claim has been adjudicated). expected to be used when segment CAS is used (claim has been adjudicated). 2320 DTP 837I 837P CNTNM 2320 AMT02 837P 3938b00 Segment CRC (EPSDT Referral) is missing. Segment CRC for EPSDT Referral is required when CLM12 is ‘01’ 2300 CRC 837P 3938b00 Segment CRC (EPSDT Referral) is missing. It is required when element CLM12 is '01'. CRC Segment is missing 2300 CLM12 837P 3938b00 Segment CRC (EPSDT Referral) is missing. It is required when element CLM12 is '01'. CLM12 = ‘01’ (EPSDT), but 2300 CRC segment for EPSDT Referral (CRC01 = ‘ZZ’) is missing. 2300 CRC 837P 3938b00 Segment DTP (Date - Last X-ray) is missing. It is required when element CR212 is 'Y' 2300 DTP 837P 3938b02 Segment CRC (DMERC Condition Indicator) is missing. It is required when segment CR3 is used. X-ray date (DTP01 = 455) is required when spinal manipulation is indicated. If DME certification (2400,CR3) is present on the claim, then the DMERC Condition Indicator (2400,CRC) is required. 63665, 66893 80705, 95379 95388, 95412 95569 38520, 57106 61125, 95827 HCDPBC 35174, 95827 HCDPBC SHP11, 68053 68050, 95827 HCDPBC, 61160 77027 2400 CRC 837P 3938af0 Visit our website: www.availity.com 68050, 68053 68057, 68058 SHP11 68050, 68053 68057, 68058 SHP11 August 2011 Availity® Health Information Network EDI Payer Specific Transaction List Error Codes Error Messages Error Descriptions Loop Element Trans Types 837P 837I Payers 3938b0f Segment DMG is missing. It is required when Other Subscriber is a person (NM102 in loop 2330A is '1') Other subscriber demographic information is required when Other Subscriber is a person (2330A, NM102 is 1). 2320 DMG 3938b10 Subscriber Demographic Information is required when Subscriber is a Patient. 2000B DMG 837P 95827, HCDPBC 3938b13 Segment REF is missing. It is required when elements NM108/09 are not used in this loop. When subscriber is the patient, date of birth and gender is required. Referring provider tax id is required when NM108/09 are missing. 2310A REF02 837P 14163, 14164 3938b4d Segment REF (Original Reference Number (ICN/DCN)) is used. It is not expected to be used when CLM05-03 is not '7','8','X' or 'Y' Original Reference Number (ICN/DCN)' should only be used when the 'Claim Submission Reason Code' (CLM05-3) is 7, or 8 2300 REF = F8 837P 80705, 63665 66893, 95379 95388, 95412 95569, 14163 14164, SHP11 68053, 68057 68058 3938b4d Segment REF (Original Reference Number (ICN/DCN)) is used. It is not expected to be used when CLM05-03 is not '7','8','X' or 'Y'. Segment REF (Original Reference Number (ICN/DCN)) is used. It is not expected to be used when CLM05-03 is not '7','8','X' or 'Y'. 2300 REF 837P 68050, 68053 68057, 68058 SHP11 3938b51 Segment DTP (Date - Last Menstrual Period) is used. It is not expected to be used when patient is not female (element DMG03 in loop 2010BA is not 'F'). Last Menstrual Period date can only be present when Subscriber Gender code is Female. 2010BA DMG03 837P 3938b60 Segment PAT is used. It is expected to be used only when Subscriber is the same person as Patient (loop 2000B, SBR02 = '18'). Segment PAT is used. It is expected to be used only when Subscriber is the same person as Patient (loop 2000B, SBR02 = '18'). Segment AMT (Coordination of Benefits (COB) Patient Responsibility Amount) is missing. It is Segment AMT (COB Patient Responsibility Amount) is missing. required if patient is responsible for payment according to another payer's adjudication (CAS01 It's required if patient is responsible for payment according to with 'PR' is used in loop 2320). another payer's adjudication (CAS01 with 'PR' is used in loop 2320). 2000C PAT 837P 2320 AMT 837P 837I 80705,63665 66893,95379 95388,95412 95569, 95827 HCDPBC SHP11, 68057 68053, 68050 68058 80705, 63665 66893, 95379 95388, 95412 95569, NANPR NAELM, NAHOI NAHIN, NAHLX NAING, NANWC NAOAK, NASCR NASWD, 14163 16164, CNTNM Segment REF (Billing Provider Secondary Identification) is missing. Either EIN or SSN of Provider must be carried in this REF segment when NM108 is 'XX'. Segment REF (Pay-To Provider Secondary Identification) is missing. Either EIN or SSN of Provider must be carried in this REF segment when NM108 is 'XX'. 2010AA REF01 837P 2010AB REF01 837P 3938bb4 3938bc5 3938bc5 Segment REF (Billing Provider Secondary Identification) is missing. Segment REF (Pay-To Provider Secondary Identification) is missing Visit our website: www.availity.com 38520, 57106 61125, WA001 00835, 00836 HPN11, GTPA1 MCA11, VFP11 INET1. KLSY1 SCOK1. WITH1 TX1ST, NWDC1 PPMO1, FMCHP SSC11, CIPA1 KMG11, GHEDI 71063, TOPA1 AZ001, 03102 00831, 05130 OR001, 04120 04202, 04302 04402, 00952 00953, 13350 09102, 94036 48145, 95827 HCDPBC 48145, 95827 HCDPBC August 2011 Availity® Health Information Network EDI Payer Specific Transaction List Error Codes Error Messages Error Descriptions Loop Element 2320 SBR01 Trans Types 837P 837I Payers 3938c4c Loop 2320 is missing. It's expected to be used when other payers are known to be involved in Other payer information was received on the claim, but paying claim (SBR01 is 'S' or 'T'). information about the subscriber in the 2320 Loop was missing. 3938c57 Loop 2310C is missing. It is required when segment AMT (Total Purchased Service Amount) is The Purchased Service Provider Name is required when the Total used Purchased Service Amount (2300 AMT*NE) is present. 2310C AMT01 837P 38520, 57106 61125, 35174 68050, 68053 68057, 68058 SHP11, 38338 HPN11, GTPA1 MCA11, VFP11 INET1. KLSY1 SCOK1. WITH1 TX1ST, NWDC1 PPMO1, FMCHP SSC11, CIPA1 KMG11, GHEDI 71063, TOPA1 3938c58 Loop 2310B (Rendering Provider Name) is missing. It is expected to be used when loop 2420A is used with the same value in every loop 2400. 2310B NM1 837P 3938c5f Loop 2420D (Supervising Provider Name) is used. It is not expected to be used when loop 2310E is not used. Loop 2310B (Rendering Provider Name) is missing. It is expected to be used when loop 2420A is used with the same value in every loop 2400. Loop 2420D (Supervising Provider Name) is used. It is not expected to be used when loop 2310E is not used. 2420D NM1 837P 3938c6b Loop 2430 (Line Adjudication Information) is used. It is not expected to be used when loop 2320 is not used. Loop 2430 (Line Adjudication Information) is used. It is not expected to be used when loop 2320 is not used. 2430 CAS SVD 837P SHP11, 68057 68053, 68050 68058 SHP11, 68057 68053, 68050 68058 00720 3938c7e Loop 2310E is missing. It is required when Billing/Pay-To Provider address is PO Box 2310E N3 837I LS328 3938ed5 Loop 2310E is missing. It is required when Billing/Pay-To Provider address is PO Box Claim balancing is failed: total charge amount (CLM02) does not equal sum of line charge amounts (SV102). COB service line balancing Claim balancing is failed: total charge amount (CLM02) does not equal sum of line charge amounts (SV102). COB service line balancing is failed : charge amount (SV102) does not equal sum of paid amount (SVD02) and all line adjustment amounts (CAS) COB claim balancing has failed (NM109 in loop 2330B): total charge amount (CLM02) does COB claim balancing has failed (NM109 in loop 2330B): total not equal sum of paid amount (AMT02 in loop 2320) and all adjustment amounts (CAS in 2320 charge amount (CLM02) does not equal sum of paid amount and 2430) (AMT02 in loop 2320) and all adjustment amounts (CAS in 2320 and 2430) 2400 SV102 837P CLM02 SV102 837P 00720, 10775 11345 10775 2320 AMT02 837I 837P 2320 AMT02 837P 837I 3938ed5 3938edc 3938edc COB claim balancing is failed for payer (NM109 in loop 2330B): total charge amount (CLM02) COB Service Line Balancing Failed for payer - Total Charge does not equal sum of paid amount (AMT02 in loop 2320) and all adjustment amounts (CAS in amount (CLM02) does not equal sum of paid amount (AMT02 in 2320 and 2430). Loop 2320) and all adjustment amounts (CAS in 2320 and 2430) Visit our website: www.availity.com 01260, NIA11 77027, 00934 93093, SHP11 68057, 68053 68050, 68058 94036 68050, 68053 68057, 68058 SHP11, D0328 00220, 00720 07003 94036, 77027 00934, 93093 August 2011 Availity® Health Information Network EDI Payer Specific Transaction List Error Codes Error Messages Error Descriptions Loop Element Trans Types 837P Payers 3938edd COB service line balancing is failed : charge amount (SV102) does not equal sum of paid amount (SVD02) and all line adjustment amounts (CAS). Segment SVD is defined in the guideline at position 540. COB Service Line Balancing Failed Charge amount (SV102) does not equal sum of paid amount (SVD02) and all lines adjustment amounts (CAS). 2300 2430 2430 SV102 SVD02 CAS 3938edd COB service line balancing is failed : charge amount (SV102) does not equal sum of paid amount (SVD02) and all line adjustment amounts (CAS). Segment SVD is defined in the guideline at position 540. COB Service Line Balancing Failed for payer - Charge amount (SV102) does not equal sum of paid amount (SVD02) and all lines adjustment amounts (CAS). 2430 SVD02 837P 837I 94036, 38520 57106, 61125 95112, 35174 35174, 37330, 54160 39392cb Element NM104 is missing. It is required when Other Subscriber is a person (NM102=1) Other subscriber name and policy number are required. 2330A NM1 14163, 14164 39392cb Element NM104 is missing. It is required when Referring Provider is a person. 2310B NM104 39392cb Element NM104 is missing. It is required when Referring Provider is a person. 2310A NM104 837P 39392d1 Element CLM10 is missing. It is required when CLM09 is not 'N'. NM104 is present, must contain at least 1 alpha/numeric character. When name is present, must contain at least 1 alpha/numeric character. Patient signature source code (CLM10) is required when the release of information (CLM09) is not N - No. 837P 837I 837P 2300 CLM10 837P 39392ec 39392ef Element PER07 is used. It is expected to be used only when element PER05 is used. Element NM104 is used. It is not expected to be used when Billing Provider is not a person (NM102 is not '1'). PER data elements must not be skipped. First Name (Element NM104) is used. It is not expected to be used when Billing Provider is not a person (NM102 is not '1'). 2010AA 2010AA 2010AB PER07 NM104 837P 837P 39392ef Element NM105 is used. It is not expected to be used when Billing Provider is not a person (NM102 is not ‘1’). Element PAT09 is used. It is not expected to be used when patient is not female (DMG03 in loop 2010CA is not 'F'). Element NM105 is used. It is not expected to be used when Billing Provider is not a person (NM102 is not ‘1’). If the Pregnancy Indicator equals 'Y', then Patient Gender Code must equal 'F' 2010AA 2010AB 2000C NM105 837P PAT09 837P Element CR109 is used. It should not be used when CR103 is not 'X'. CR109 (Ambulance Round Trip Purpose Description) should not be present unless CR103 (Ambulance Transport Code) equals ‘X’ (Round Trip). 2300 CR109 837P Value of CL102 is incorrect. Expected value is from external code list - Admission Source Code. Admission source code must be valid as listed on the code source. 2300 CL101 837I 39392f1 39392f8 393931d Visit our website: www.availity.com 00611, 00851 00932, 01260 93221, 68053 NIA11, 26374 26375, 26378 SHP11, 68050 14163, 14164 NANPR, NAELM NAHOI, NAHIN NAHLX, NAING NANWC, NAOAK NASCR, NASWD 00934, 93093 HPN11, GTPA1 MCA11, VFP11 INET1. KLSY1 SCOK1. WITH1 TX1ST, NWDC1 PPMO1, FMCHP SSC11, CIPA1 KMG11, GHEDI 71063, TOPA1 26374, 26375 26378 26374, 26375 26378 AIDWA, LABOR 95827, HCDPBC 53120, 00720 91121, 91051 14163, 14164 94036, 00934 93093, 91051 AIDWA, 68058 SHP11, 68057 68053, 68050 94036, 00934 93093 80705, 63665 66893, 95388 95412, 95569 95379 04102, 04202 04302, 04402 68050, 68053 IL621, SHP11 09102 26375, 26374 26378 August 2011 Availity® Health Information Network EDI Payer Specific Transaction List Error Codes Error Messages Error Descriptions 393931e Admission Source Code is invalid 393933b National Drug Code must be 11 numeric 393933e Value of element SV105 is incorrect. Expected value is from external code list - Place of Service Code (237). Value of element REF02 (CLIA Number) is incorrect. Expected value is CLIA number (format is '10 characters where the third character is 'D''). 393938b Loop Element Payers CL1 Trans Types 837I When Point of Origin Admission Code is 7 and the transaction create date is on or after July 1, 2010. LIN03 should contain 11 numeric 2300 2410 LIN 837P Based upon Code Source 237, Place of Service code is invalid. 2400 SV105 837P 00932, 93221 00851, 00611 95827, HCDPBC When the CLIA ID present, it has to be 10 characters and the third byte is a D. 2300 REF 837P 2010AB NM108 NM109 837I 68050, 68053 68057, 68058 SHP11 38338 2010AA, 2010AB 2310A , 2310B 2310C, 2310D 2310E, 2420A 2420B, 2420C 2420D NM108 837P 48145, 38338 2010AA PER 837P 837I 68050, 68053 68057, 68058 SHP11 00611, 00851 00932, 68050 68053, 68057 68058, SHP11 00934, 93093 95827, HCDPBC 38520, 57106 61125, 35174 95827, HCDPBC 94036 95827, HCDPBC 00220 393939e The identification code qualifier (loop 2010AB, segment NM108) must equal XX and the pay-to The identification code qualifier (loop 2010AB, segment NM108) provider identifier (loop 2010AB, segment NM109) must be a valid NPI. The payer does not must equal XX and the pay-to provider identifier (loop 2010AB, accept a tax ID as the pay-to provider identifier. segment NM109) must be a valid NPI. The payer does not accept a tax ID as the pay-to provider identifier. 393939e The National Provider ID (NPI) is required for this payer. Expected value for NM108 is 'XX.' Please add the Provider's NPI to this transaction and resubmit for processing. Providers can apply for an NPI online at https://nppes.cms.hhs.gov. The National Provider ID (NPI) is required for this payer. 39393AD Value of element PER06 is incorrect. Expected value is E-mail address when PER05='EM'. When the contact information (2010AA, PER) is 'EM' the email address has to be in a valid email format. 39393b0 Value of element PER06 is incorrect. Expected value is Facsimile number (format is '10 digits') When present or indicated, fax number must be 10 numeric. when PER05='FX'. 2010AA PER05 837P 39393b8 Value of element PER04 is incorrect. Expected value is Telephone number (format is ’10 digits’) when PER03 = ‘TE’ Value of element PER04 is incorrect. Expected value is Telephone number (format is ’10 digits’) when PER03 = ‘TE’. When present, telephone numbers must be 10 digits. 2010AA PER04 837P Communication telephone numbers must be 10 digits. 1000A, 2010AA 2330B, 2420E PER04 837P 837I 39393cb Value of element CRC03 is incorrect. Expected value is 'NU' when CRC02 is 'N'. 2300 CRC03 837P 39393cd Value of element SVD01 is incorrect. It must match corresponding Other Payer Identifier in NM109 in 2330B loop. When Certification Condition Indicator equals N-No, a condition indicator is not required. Line adjudication payer id must match secondary payer id. 2430 SVD01 837P 837I 14163, 14164 77027, 95379 80705, 63665 66893, 95388 95412, 95569 61160 39393cf Value of element CRC03 is incorrect. Value ‘NU’ is not expected to be used when CRC02 is not ‘N’ Value NU is not allowed when an EPSDT referral was given to the patient. 2300 CRC03 837P 39393d0 Value of element NM109 is incorrect. It should be different from value of element SBR03 (group number) Member id must not be the same as the member’s group number. 2010BA NM109 837P 837I 39393d0 Value of element NM109 is incorrect. It should be different from value of element SBR03 (Group or Plan Number). When present, the group/plan number must be different from the subscriber id. 2010BA SBR03 837P 837I 14163, 14164 77027, 95827 HCDPBC, 68050 68053, 68057 68058, SHP11 CNTNM 14163 14164, 77027 68050, 68053 68057, 68058 SHP11 SHP11, 68057 68053, 68050 68058 39393b8 Visit our website: www.availity.com August 2011 Availity® Health Information Network EDI Payer Specific Transaction List Error Codes Error Messages Error Descriptions Loop Element 2010AA, 2010AB 2010BA, 2010BB 2010BC, 2010CA 2310D, 2330A 2420C, 2420E 2010AA, 2010AB 2010BA, 2010BB 2010BC, 2010CA 2310E, 2330A 2330B N403 Trans Types 837P Payers N403 837I 80705, 63665 66893, 95379 95388, 95412 95569 2300 REF 00611, 00851 00932 68050, 68053 68057, 68058 SHP11 00934, 93093 38520, 57103 61125, 77027 53589, 00720 AIDWA 00934, 93093 38520, 57106 61125, 77027 AIDWA 39393d1 Value of element N403 is incorrect. It should be formatted as 'XXXXXX' or 'XXX XXX' for Canadian Zip Code. If Country code (N404) is equal to CA, then the Postal code (N403) must be in the correct format. 39393d1 Value of element N403 is incorrect. It should be formatted as 'XXXXXX' or 'XXX XXX' for Canadian Zip Code. If Country code (N404) is equal to CA, then the Postal code (N403) must be in the correct format. 39393ed Value of element REF01 has been already used in loop 2300. Elements REF01 are expected to have unique values within loop 2300. Value of element REF01 is incorrect. Value ‘EI’ should not be used when the referring provider (2310A, NM108/09) is not used. Duplicate REFs not allowed in Loop 2300. If Referring Provider Tax ID is present, then the NPI must be present. 2310A REF01 837P 837I 837P 39393f5 Rendering Provider Secondary Identification is a duplicate of Primary ID When the Rendering Provider Primary Identifier (2310B – NM109) contains a qualifier of ‘24’ (Employer’s Identification Number), the Rendering Provider Secondary Identification (2310B – REF01) should not contain ‘EI’ (Employer’s Identification Number). 2310B REF02 837P 39393f5 Rendering Provider Secondary Identification is a duplicate of Primary ID. When the Rendering Provider Primary Identifier (2310B – NM109) contains a qualifier of ‘34’ (Social Security Number)., the Rendering Provider Secondary Identification (2310B – REF01) should not contain ‘SY’ (Social Security Number) 2310B REF02 837P 39393f5 Subscriber Secondary Identification is a duplicate of Primary ID. When the Subscriber Identifier contains a qualifier of ‘MI’ (Member ID), the secondary identifier (REF01) should not contain ‘1W’ (Member ID). REF01 837I 53589, 00220 39393f5 Subscriber Secondary Identification is a duplicate of Primary ID. When the Subscriber Identifier contains a qualifier of ‘MI’ (Member ID), the secondary identifier (REF01) should not contain ‘1W’ (Member ID). REF01 837P 53589, AIDWA 39393f5 Value of element REF01 is incorrect. Value '2U' should not be used when element NM108 is 'PI'. Segment REF is defined in the guideline at position 355. The Other Payer Secondary Qualifier (2330B – REF01) should not contain a ‘2U’ (Payer Identification Number) when 2330B – NM109 contains a qualifier of ‘PI’ (Payer Identification Number). 2010BA 2010CA 2330A 2330C 2010BA 2010CA 2330A 2330C 2330B REF01 837P 837I 39393f8 Value of element REF01 has been already used in loop 2010AA. Elements REF01 are expected to have unique values within loop 2010AA. Segment REF is defined in the guideline at position 035. Element REF01 must be unique within Loop 2010AA, 2010AB 2010BA, 2010BB 2010BD, 2010CA 2310A, 2310B 2310C, 2310D 2310E, 2330A 2330B, 2330C 2330D, 2330E 2330G, 2330H 2420A, 2420B 2420C, 2420D 2420E, 2420F REF01 837P 837I 00611, 00851 00932, 93221 38520, 57106 61125, IL621 77027, AIDWA 00611, 00851 00932, 01260 93221, LS328 75137, 00932 01260, NIA11 77027, 68050 68053, 68057 68058, SHP11 TCHD1, SHMAP EPNSH, SHPCH WCMAP, UHSCH CMSEB, UT3F HLTHQ, SHCAR SHEBP 39393fb Value of element CRC03 has been already used. Condition Indicator should be unique for every CRC segment. Multiple condition indicator values cannot be duplicated within the same segment. 2300 CRC03 837P 837I 39393f0 Visit our website: www.availity.com 80705, 63665 66893, 95379 95388, 95412 95569 SHP11, 68057 68053, 68050 68058 August 2011 Availity® Health Information Network EDI Payer Specific Transaction List Error Codes Error Messages Error Descriptions Loop Element Trans Types 837P 837I Payers 393945f Value of element SBR01 has been already used in loops 2000B/2300. Elements SBR01 are Payer responsibility sequence number code can not be expected to be different from SBR01 specified in loop 2000B and to have unique values within duplicated. loop 2300 excluding 'T' value. 2000B SBR01 393945f Value of element SBR01 has been already used in loops 2000B/2300. Elements SBR01 are Payer responsibility sequence number code can not be expected to be different from SBR01 specified in loop 2000B and to have unique values within duplicated. loop 2300 excluding 'T' value. 2320 SBR01 837I 837P 393946e Value of element DTP03 (Service Line Date) is incorrect. Expected value for date should be Service Line Date should be with in dates of Service within a Statement Dates range. Sub-element SV101- 05 is used. It is not expected to be used when sub-element SV101-04 is First available modifier field should be used. not used. 2300 DPT03 837I LS328 2400 SV101 837P 14163, 14164 95827, HCDPBC 77027, AIDWA 39395df Sub-element SV201- 05 is used. It is not expected to be used when sub-element SV202-04 is First available procedure modifier field should be used not used. 2400 SV202 837I 14163, 14164 63665, 66893 80705, 95379 95388, 95412 95569, 00851 00611, 00932 93221 39395df Sub-element SV202-04 is used. It is not expected to be used when sub-element SV202- is not SV101-05 is not expected when SV101-04 is not used used. Segment SV2 is defined in the guideline at position 375. When a procedure modifier SV202-04 is used. It is not expected to be used when procedure When a procedure modifier SV202-04 is used. It is not expected modifier SV202-03 is not used. to be used when procedure modifier SV202-03 is not used. 2400 SV101-05 837P 2400 SV202 837I 26374, 26375 26378, 77027 68050, 68053 68057, 68058 SHP11 2400 SV101 837P 68050, 68053 68057, 68058 SHP11 39395df 39395df When procedure modifier SV101-05 is used. It is not expected to be used when procedure modifier SV101-04 is not used. 80705,63665 66893,95379 95388,95412 95569, CNTNM 09102 68050, 68053 68057, 68058 SHP11, CNTNM 39395df When procedure modifier SV101-05 is used. It is not expected to be used when procedure modifier SV101-04 is not used. 39395df Sub-element SV101- 05 is used. It is not expected to be used when sub-element SV101-04 is Modifier fields must not be skipped. not used. 2400 SV101 837P 38520, 57106 61125, 35174 37330, 54160 39395ec Value of sub-element HI03-02 has been already used. Diagnosis Codes (primary and secondary) are expected to be unique within claim. Duplicate Diagnosis Codes are not allowed. 2300 HI 837P 39395ec Value of sub-element HI03-02 has been already used. Diagnosis Codes (primary and secondary) are expected to be unique within claim. Value of sub-element HI03-02 has been already used. Diagnosis Codes (primary and secondary) are expected to be unique within claim. 2300 HI 837I 14163, 14164 CNTNM, 68050 68053, 68057 68058, SHP11 68050, 68053 68057, 68058 SHP11 39395ee Duplicate procedure modifier. Procedure modifiers can not be duplicated. 2400 SV202 837I 39395ee Duplicate procedure modifier. Duplicate Procedure Modifier Code found. Value of sub-element CLM11-03 has been already used. Related-Causes Codes are expected Value of sub-element CLM11-02 has been already used. Relatedto be unique within composite CLM11. Causes Code should be unique within composite CLM11. SV101 SVD03 CLM11 837P 39395ef 2400 2430 2300 Visit our website: www.availity.com 837P 14163, 14164 95827, HCDPBC 14163, 14164 95827, HCDPBC 80705, 63665 66893, 95379 95388, 95412 95569, 77027 August 2011 Availity® Health Information Network EDI Payer Specific Transaction List Error Codes Error Messages Error Descriptions Element 2400 SV107 Trans Types 837P Payers 39395f6 Value of sub-element SV107-01 is incorrect. Expected value is 1 through 8, inclusive. Segment SV1 is defined in the guideline at position 370. 393961a Value of sub-element HI01-02 is incorrect. Expected value is from external code list - ICD-9Value of sub-element HI01-02 is incorrect CM Diagnosis code (131) and a decimal point should not be used. Segment HI is defined in the guideline at position 231. Value of sub-element HI01-02 is incorrect. It looks like a local code from external code list 132 - AmeriChoice allows occurrence code 54. NUBC, Occurrence Codes. It is not allowed to use local codes after compliance date under the HIPAA rules. 2300 HI 837P ALL 2300 HI01-02 837I 95378 393963c Composite HI02 is missing. Admitting Diagnosis is required on all inpatient admission claims and encounters. Admitting Diagnosis is required on all inpatient admission claims and encounters. 2300 HI 837I 393963d Composite CLM11 is missing. It is required when segment DTP (Date - Accident) is used. 2300 CLM11 837P 81002a Sub-Element SV101-04 length is '1'. The minimum allowed length is '2'. Segment SV1 is defined in the guideline at position 370 The length of Element SV105 is '3'. The maximum allowed length is '2'. Segment SV1 is defined in the guideline at position 370. When there is an accident date present, related cause information is required. Modifier fields must be two bytes in length 26374, 26375 26378, 00851 00932, 93221 00611 95827, HCDPBC 2400 SV101 837P All Facility codes/Place of Service must be two bytes in length 2400 SV105 837P All 393962f 81002b If present, the SV107 (Diagnosis Code Pointer) must contain a value of 1 – 8 and reference an existing diagnosis code. Loop IL621, 26374 AIDWA, 13350 94036, SHP11 68050, 68053 95112, 14163 00611, 00851 00932, 93221 05130, WA001 OR001, 00835 00831, 03102 AK001, 00836 CHPWA, 77027 LABOR, 91051 91121, M3IL1 M3IL2, M3FL2 M3FL3, M3FL4 M3FL5, M3FL6 M3FL7, M3FL8 M3CA1, 14164 26375, 26378 AIDOR, 95827 HCDPBC, 10775 01260, 38520 57106, 61125 53120 HPN11, GTPA1 MCA11, VFP11 INET1. KLSY1 SCOK1. WITH1 TX1ST, NWDC1 PPMO1, FMCHP SSC11, CIPA1 KMG11, GHEDI 71063, TOPA1 C100P LMP Date Missing. When the pregnancy indicator is Y-Yes, a last menstrual period (LMP) date is required. 2000B 2000C PAT09 837P 00720 C101I The attending physician name (loop 2310A, NM103, NM104) is required for Home Health services. Attending physician name is required for Home Health services. 2310A NM103 NM104 837I 00220, 07003 Visit our website: www.availity.com August 2011 Availity® Health Information Network EDI Payer Specific Transaction List Error Codes C103I Qualifier code BR or BQ (loop 2300, HI01-1) is not allowed unless the type of bill (loop 2300, CLM05-1) is an inpatient admission (11, 12, 18, 21, 28, 41, 65, 66, or 84). ICD9-CM surgery procedure codes are not allowed on outpatient claims. The surgery procedure code must be a CPT-4 procedure code listed on the detail line charge. 2300 HI01-1 Trans Types 837I C104I Qualifier code BP or BO (loop 2300, HI01-1) is not allowed. Institutional claims with surgery must be coded with the ICD9-CM Procedure Code rather than the CPT-4 procedure code. 2300 HI01-1 837I 00220, 07003 C105I A claim code segment (loop 2300, CL1) including admission type code, admission source code, and patient status code is required for hospital inpatient admissions. 2300 CL1 837I Edit Relaxed 00220, 07003 C106I The admission type code (loop 2300, CL101) is required for hospital inpatient admissions. Claims for hospital inpatient admissions must include information for admission type code, admission source code, and patient status code. The inpatient admission type code is missing. 2300 CL101 837I 00220, 07003 C107I The admission source code (loop 2300, CL102) is required for hospital inpatient admissions. The inpatient admission source code is missing. 2300 CL102 837I 00220, 07003 C108I C109I The patient status (loop 2300, CL103) is required for hospital inpatient admissions. The inpatient admission patient status is missing. The admitting diagnosis code (loop 2300, HI02-1) is required for hospital inpatient admissions. An admitting diagnosis code is required for inpatient admissions. 2300 2300 CL103 HI02-1 837I 837I 00220, 07003 00220, 07003 C110I When the condition code qualifier BG is used (loop 2300, HI01-1), the condition code in HI01-2 Condition Codes 12 through 16 or 62 through 65 are not valid. must be a value other than 12 through 16 or 62 through 65. Please correct and resubmit the claim. Invalid Character [^] received in Other Payer Name (loop 2330B, NM103). Invalid Character [^] received in Other Payer Name (loop 2330B, NM103). 2300 HI 837I 38520, 57106 61125 2330B NM103 837P Invalid Character [^] Received in Other Subscriber Address (loop 2330A, N301). Other Payer Name must not contain special characters. 2330A N301 837P 2330B NM1 837I Other Payer Name must not contain special characters. 2330B NM1 837P SHP11, 68057 68053, 68050 68058 00835, 00836 03102, 00831 38520, 57106 61125 38520, 57106 61125 Other Payer Primary ID (loop 2330B, NM109) is invalid. Must contain at least two characters. 2330B NM1 837P 00836 C111P Error Messages C112P Invalid Character [^] Received in Other Subscriber Address (loop 2330A, N301). C114I Invalid character (^) received in Other Payer Name (loop 2330B, NM103). Please correct and resubmit. Invalid character (^) received in Other Payer Name (loop 2330B, NM103). Please correct and resubmit. C114P Error Descriptions Loop Element Payers 00220, 07003 C117P Other Payer Primary ID (loop 2330B, NM109) is invalid. Must contain at least two characters. C118P Characters are not allowed for Other Insured Group Name Invalid Character [^] Received in Other Insured Group Name (loop 2320, SBR04). Please correctInvalid and resubmit| (loop 2320, SBR04) A prescription date (loop 2300, DTP*471) is required when billing for replacement lenses or Prescription date is required when billing for replacement lenses frames (loop 2300, CRC*E1, E2, or E3). or frames. If the quantity for oxygen therapy certification (loop 2400, CR511) is greater than 88, then an Oxygen therapy certification cannot be greater than 88. oxygen test find code must be present in either CR513, CR514, or CR515 Total Purchased Service Amount (loop 2300, AMT-01=NE) is required when Total Purchased Service Amount (loop 2300, AMT-01=NE) is Purchase Service Information (loop 2400, PS1) is present. required when Purchase Service Information (loop 2400, PS1) is present. The ending date of service at the line level (loop 2400, DTP*472*RD8) must not be in the The detail thru service date of service can not be in the future. future compared to the date Availity processed the claim. 2320 SBR 837P 2300 DTP 837P 2400 CR511 837I 00611, 00851 00932, 93221 3852, 57106 61125 IL621 2300 AMT01 837P 65055 2400 DTP 837I 00720 The approved amount' (2400-AMT*AAE) should be greater than or equal to the service line paid amount (2430-SVD02). The approved amount should be greater than or equal to the service line paid amount. 2400 AMT 837P 00882, 04102 04202, 04302 04402, 00904 Secondary Claims Not Accepted Electronically For This Payer|2320 If the 2320 Loop (Other Subscriber Information) has Medicare listed as the other coverage, reject the claim. 2320 SBR 837I CNTNM C120P D100P D101P D104I D105P inst.3AM Visit our website: www.availity.com August 2011 Availity® Health Information Network EDI Payer Specific Transaction List Error Codes Length of element CLM01 cannot exceed 20 characters. Patient control number cannot be greater than 20 characters in length. 2300 CLM01 Trans Types 837I inst.H1B inst.HIE National Drug Code must be an 11 digit numeric value Value Code 80 not valid in this ANSI version. Continue to use QTY segment. 2410 2300 LIN03 HI02 837I 837I inst.K301 Invalid POA indicator. 4th Character must be Y, N, U, W or 1 and last character must be Z. 2300 K301 837I 52629, 01260 38520, 57106 61125 53589 inst.SED NDC code must be 11 numeric. Rejects institutional claims when Value Code of 80 is used on ANSI format. When the fourth position in the POA does not equal Y, N, U, W or 1. Print to paper service is not available for providers in the state of Minnesota. In compliance with Minnesota statutes, Availity cannot submit paper claims to health plans on behalf of Minnesota providers. As a result, Availity's Print-to-Paper service is no longer available to Minnesota providers. Availity cannot submit paper claims to health plans in the State of South Carolina. As a result, Print to paper service is not available for payers in the state of Availity's print to paper service is no longer available for payers with South Carolina addresses. South Carolina. 2010AA N402 837I PRINT 2010BC N402 837I PRINT 2000B 2000C SBR03 837I 37330 2010BA NM109 837I MRCHP 2010BA NM109 837I MRIPA 2010CA NM109 837I MRCHP 2010CA NM109 837I MRCHP 2010CA NM109 837I MRIPA 2330A REF02 837I 68050, 68053 68057, 68058 SHP11 inst.CLM01 MaxLength inst.SEF inst.SEH inst.SEI inst.SEJ inst.SEK inst.SEK inst.SEL inst.SEP Error Messages Error Descriptions The group/plan PHYSICIANS HEALTH PLAN OF SOUTH MICHIGAN (PHPSM) is no longer a For payer code 37330, claims submitted on or after 11/1/2009 valid group/plan under payer ID 37330. If you have any questions, please call 1-800-394-7569. (BHT04) will be rejected when the group/plan number begins with "J" (2000B SBR03). The patient or subscriber ID in segment NM109 in loop 2010BA and/or loop 2010CA must Applies to 2010BA loop only contain three numeric characters followed by three alpha characters The patient or subscriber ID in segment NM109 in loop 2010BA and/or loop 2010CA must Applies to 2010BA loop only contain eight alphanumeric characters The patient or subscriber ID in segment NM109 in loop 2010BA and/or loop 2010CA must Applies to 2010CA loop only contain three numeric characters followed by three alpha characters The patient or subscriber ID in segment NM109 in loop 2010BA and/or loop 2010CA must Applies to 2010CA loop only contain three numeric characters followed by three alpha characters The patient or subscriber ID in segment NM109 in loop 2010BA and/or loop 2010CA must Applies to 2010CA loop only contain eight alphanumeric characters The patient or subscriber social security number (SSN) must contain nine numeric digits. The patient or subscriber social security number (SSN) must These nine digits cannot be identical and the first digit cannot be a '8' or '9'. contain nine numeric digits. These nine digits cannot be identical and the first digit cannot be a '8' or '9'. Loop Element Payers HPN11, GTPA1 MCA11, VFP11 INET1. KLSY1 SCOK1. WITH1 TX1ST, NWDC1 PPMO1, FMCHP SSC11, CIPA1 KMG11, GHEDI AHS01, 71063 TOPA1, 68050 68053, 68057 68058, SHP11 52629, WIMCE 00220 inst.SFA A date (loop 2300, HI) is required only when an ICD-9-CM code is received (element HI01-1 equal to BR). For all other values, do not provide a date. Only send a date when an ICD-9-CM code is received and a value of 'BR' is received. 2300 HI 837I 68050, 68053 68057, 68058 SHP11 inst.SFL Secondary Claims Not Accepted Electronically For This payer Secondary Claims are not accepted electronically for this payer. 2320 SBR 837I 39151 inst.SFM The date of service is required for all service lines (loop 2400, segment DTP03) on institutional When a facility claim type of bill is 13 (outpatient), the date outpatient claims. of service is required on all service lines. 2400 DTP03 837I inst.SFP Claim should not have a negative submitted charge amount (SV102) at the service line (loop 2400). All values should be zero or a positive number 2400 SV102 837I inst.U2A Payer requires admission type code. 2300 CL101 837I 68057, 68053 68050, 68058 SHP11, D0328 68057, 68053 68050, 68058 SHP11 CNTNM Claim should not have a negative submitted charge amount (SV102) at the service line (loop 2400). All values should be zero or a positive number Regardless of value in CLM05-01, admission type code is required when CL101 is present. Visit our website: www.availity.com August 2011 Availity® Health Information Network EDI Payer Specific Transaction List Error Codes Error Descriptions Loop Element Your encounter was received with an incorrect payer ID. If this is an encounter, resubmit with payer ID 59354. If this is not an encounter, use CH in Claim or Encounter Indicator field. Encounters for Wellcare must be submitted using payer id 59354. BHT BHT06 Trans Types 837I P100I The value submitted for patient ID (loop 2010CA, NM109) is invalid. The patient id is invalid. 2010CA NM109 837I HPN11, GTPA1 MCA11, VFP11 KLSY1, SCOK1 WITH1, TX1ST NWDC1, PPMO1 FMCHP, SSC11 CIPA1, KMG11 GHEDI, TOPA1 P100P The value submitted for patient ID (loop 2010CA, NM109) is invalid. The patient id is invalid. 2010CA NM109 837P HPN11, GTPA1 MCA11, VFP11 KLSY1, SCOK1 WITH1, TX1ST NWDC1, PPMO1 FMCHP, SSC11 CIPA1, KMG11 GHEDI, TOPA1 prof.2GE01 The Information in Address 2 should not match the information in Address 1 2010AA N302 837P 00934, 93093 prof.2GE02 The Information in Address 2 should not match the information in Address 1 2010BA N302 837P 00934, 93093 prof.2GE03 The Information in Address 2 should not match the information in Address 1 2010BC N302 837P 00934, 93093 prof.2GE04 The Information in Address 2 should not match the information in Address 1 The billing provider’s address in Address 2 should be different than the one given in Address 1. The subscriber’s address in Address 2 should be different than the one given in Address 1. The responsible party’s address in Address 2 should be different than the one given in Address 1. The ordering provider’s address in Address 2 should be different than the one given in Address 1. If the 2320 Loop (Other Subscriber Information) is received, reject the claim If the 2320 Loop (Other Subscriber Information) has Medicare listed as the other coverage, reject the claim Referring provider last name in 2310A NM103 cannot be all numbers Rendering Provider NPI Missing Rendering Provider Name is not required when 2000A PRV is used 2420E N302 837P 00934, 93093 2320 SBR 837P AIDOR, 39151 2320 SBR 837P CNTNM 2310A NM103 837P 53120 2310B 2310B NM109 PRV 837P 837P GCVCP M3IL1, M3IL2 M3FL2, M3FL3 M3FL4, M3FL5 M3FL6, M3FL7 M3FL8, M3CA1 61160, NASWD NASCR, NANPR NAOAK, NANWC NAING, NAHLX NAHIN, NAHOI NAELM, 10775 65055, SC359 2420A 2310B REF REF01 837P 837P CNTNM CNTNM 2010AA, 2010AB 2310B, 2310A 2310C, 2310D 2310E, 2420A 2420C, 2420D 2420E, 2420F REF = G2 837P 48145 inst.WCE Error Messages prof.3AD Secondary Claims Not Accepted Electronically For This Payer prof.3AM Secondary Claims Not Accepted Electronically For This Payer|2320 prof.5CH Referring Provider Org or Last Name Invalid prof.BA5 prof.BAH Rendering Provider NPI Missing Rendering Provider Name (Loop 2310B) is used. It's not required when segment PRV (loop 2000A) is used prof.BCM prof.BCN Payer Requires Rendering Provider Tax ID Payer requires rendering provider tax ID prof.BCT10 Provider Secondary ID (Provider Commercial Number) Contains Non Numeric Characters. Line level rendering provider requires tax id. If 2310B loop is present, reject claim if rendering provider tax is missing. Provider number must not have alpha characters Visit our website: www.availity.com Payers 14163, 14164 August 2011 Availity® Health Information Network EDI Payer Specific Transaction List Error Codes prof.BDE Invalid Character [^] Received in Referring Provider Organization/Last Name Unprintable character ‘^’ not acceptable in Referring Provider Organization and/or last name 2310A NM103 Trans Types 837P prof.BDF Invalid Character [^] Received in Referring Provider First Name Unprintable character ‘^’ not acceptable in Referring Provider first name 2310A NM104 837P prof.BDG Invalid Character [^] Received in Subscriber's Address. Unprintable character ‘^’ not acceptable in Subscriber's Address. 2010BA N301 837P prof.BMK Facility Prov Name Cannot Be the Same as Billing Prov Name Facility Provider Name 2310D cannot be the same as Billing Provider Name 2010AA Patient control number cannot be greater than 20 characters in length. 2010AA 2310D 2300 NM103 837P CLM01 837P HPN11, GTPA1 MCA11, VFP11 INET1. KLSY1 SCOK1. WITH1 TX1ST, NWDC1 PPMO1, FMCHP SSC11, CIPA1 KMG11, GHEDI AHS01, 71063 TOPA1, 68050 68053, 68057 68058, SHP11 52629, WIMCE 00720 When total claim before tax amount is present, payer paid amount is required. Rendering Provider Medicaid ID must be 9 numeric characters when present 2320 AMT01 837 94036 2310B REF02 837P CCHP9 2010AA REF02 837P CCHP9 Original Reference Number (ICN/DCN) Required. 2300 REF01 837P CHPWA, LABOR 00934, 93093 AIDOR 38520, 57106 61125, 35174 HPN11, GTPA1 MCA11, VFP11 INET1, KLSY1 SCOK1. WITH1 TX1ST, NWDC1 PPMO1, FMCHP SSC11, CIPA1 KMG11, GHEDI 71063, TOPA1 prof.CLM01 MaxLength Error Messages Error Descriptions Length of element CLM01 cannot exceed 20 characters. Coordination of Benefits (COB) Total Claim Before Taxes Amount was not expected because the Payor Paid Amount (2320/AMT) is not present. prof.COOKCHILDR Rendering Provider Medicaid Number Must Be 9 Numeric ENSSTAR BBSBR prof.COOKCHILDR Rendering Provider Medicaid Number Must Be 9 Numeric ENSSTAR BBSBR prof.GBA Original Reference Number (ICN/DCN) Required prof.COC The Billing Provider Medicaid TPI number must be present and 9 numerics. Loop Element prof.GC4 Total Purchase Service Amount Missing AMT*NE - Required when Purchased Service Provider loop 2310C is present. 2300 AMT 837P prof.GFA The sum of service lines OTAF (2400 CN102) should equal claim OTAF amount (2300 CN102) The sum of the service lines for OTAF must = the claim level OTAF 2300 CN102 837P prof.GHB Invalid Character [^] Received in Claim Note Text Unprintable character ‘^’ not acceptable in narrative and/or note at the claim level. 2300 NTE02 837P Visit our website: www.availity.com Payers 00836, 00835 00831, 03102 WA001, OR001 AZ001 00836, 00835 00831, 03102 WA001, OR001 AZ001 00836, 00835 00831, 03102 WA001, OR001 AZ001 AIDOR 04102, 04202 04302, 04402 00952, 00953 09102 00836, 00835 00831, 03102 WA001, OR001 AZ001 August 2011 Availity® Health Information Network EDI Payer Specific Transaction List Error Codes Error Messages prof.GHC prof.GHE Value of element SV104 is incorrect, its value should be to a maximum of 999 REF segment exists but NM109 primary ID is missing prof.GHI Invalid Character [^] Received in Claim Note Text prof.H1B prof.H1BSBR prof.HR2 prof.HRP Error Descriptions Loop Element Payers SV104 NM109 Trans Types 837P 837P & 837I Anesthia minutes must be 3 bytes or less. Service Facility Primary ID is required when Service Facility Secondary ID is present. Unprintable character ‘^’ not acceptable in narrative and/or note at the service line. 2400 2310D 2400 NTE02 837P 00836, 00835 00831, 03102 WA001, OR001 AZ001 53120 52629 COMMF, 26374 26375, 26378 00720 35174, 38520 57106, 61125 00932, 93221 00851, 00611 13350, 61101 61102, 61105 65018, 72127 95348, 95885 HUMAR, Z0005 38333, OCH01 38334, CIMSA NM505, 20149 20554, UNMSC 38336, 51062 MHHNP, 95092 95093, 00590 53589, 84980 00790, 00621 00840, 53120 14163, 14164 01260 National Drug Code Must Be 11 Numerics National Drug Code must be an 11 digit numeric value Diagnosis Pointer Missing or Out of Sequence National Drug Code Must Be 11 Numerics. NDC code must be 11 numeric. Diagnosis code pointer fields must not be skipped. 2410 2400 2400 LIN03 LIN02 SV107 837P 837P 837P Diagnosis Code Missing For Pointer Diagnosis code missing 2400 SV107 837P prof.NDC1 Invalid NDC code format. Must be 11 numeric. Spaces and / or hyphens not accepted. Please NDC code must be 11 numeric. correct and resubmit. 2400 LIN02 837P prof.NDC2 Invalid NDC code according to Availity NDC code set. Please correct and resubmit. 2400 LIN02 837P NDC code must be valid as listed on the current code set. Visit our website: www.availity.com 91051 35174 13350, 61101 61102, 61105 65018, 72127 95348, 95885 HUMAR, Z0005 38333, OCH01 38334, CIMSA NM505, 20149 20554, UNMSC 38336, 51062 MHHNP, 95092 95093, 53589 84980, 00790 00621, 00840 53120, 14163 14164 August 2011 Availity® Health Information Network EDI Payer Specific Transaction List Error Codes prof.NDC3 The NDC is not active for this date of service. Please correct and resubmit. Based upon the current code set, the NDC is not active for this date of service. 2400 LIN02 Trans Types 837P prof.POB Payer requires physical address for where services were rendered Rejection occurs when Billing provider address is a PO Box and the facility address is not present or also has a PO Box listed. 2010AA 2310D N301 837I 38520, 57106 61125 prof.QBB Billing Provider Secondary Id Missing or Invalid 2010AA REF01 837P GCVCP prof.QGA Billing Provider NPI Missing 2010AA NM108 837P GCVCP prof.QGA Billing Provider NPI missing and is required The billing provider REF segment must be present and the REF01 must contain a qualifier of ‘LU’. Also, the REF02 must contain an 8 digit alpha/numeric value. The billing provider NPI must be present within Loop 2010AA (NM108/NM109). The billing provider identification qualifier (NM108) must be ‘XX’ and the billing provider NPI must be present in NM109 The QGA message requires the 'XX' qualifier in LOOP ID 2010AA (Billing Provider Name) segment ID, NM108 and the National Provider Identifier in segment ID NM109. 2310B Rendering Provider Name is not required when 2000A PRV is used. 2310B Rendering Provider Name is not required when 2000A PRV is used. 2010AA NM109 837P 83490, 00079 00621 2310B 837P PRIME 2310B NM103 PRV03 NM1 837P 35174, 37330 48055, 54160 TOPTN, LS328 01260, NIA11 CHPWA, 94036 63665 2000B SBR02 837P CNTNM, 77072 2010BA 2010BA NM109 NM109 HCDPBC 95827 2010BA NM109 837P 837P 837P 2010BA 2010AA NM109 N402 837P 837P 94999 PRINT 2010BB N402 837P PRINT 2000B 2000C SBR03 837P 37330 2010BA NM109 837P MRCHP 2010BA NM109 837P MRIPA prof.RENREQ SBR prof.RENREQ SBR Error Messages Error Descriptions Rendering Provider Name (Loop 2310B) is used. It's not required when segment PRV (loop 2000A) is used Rendering Provider Name (Loop 2310B) is used. It's not required when segment PRV (loop 2000A) is used. prof.SA0 Patient relationship must be self prof.SCE prof.SCF prof.SCO Member ID must be a minimum of 9 characters. Member ID must be a minimum of 6 characters. Subscriber ID invalid. Must be 9, 10 or 14 numeric prof.SCQ Subscriber ID Must Be 9, 10, or 11 Digit Alpha-Numeric. In compliance with Minnesota statutes, Availity cannot submit paper claims to health plans on behalf of Minnesota providers. As a result, Availity's Print-to-Paper service is no longer available to Minnesota providers. Provider Secondary ID (Provider Commercial Number) Contains Non Numeric Characters. prof.SED prof.SEF prof.SEH prof.SEI prof.SEJ If 2000B loop (Subscriber Information) does not list the patient relationship as self, reject the claim. Member ID must be a minimum of 9 characters. Member ID must be a minimum of 6 characters. If member id is not numeric and not 9, 10 or 14 digits, reject the claim Subscriber ID Must be 9,10,or11 Digit Alph-Numeric Print to paper service is not available for providers in the state of Minnesota. Print to paper service is not available for payers in the state of South Carolina. The group/plan PHYSICIANS HEALTH PLAN OF SOUTH MICHIGAN (PHPSM) is no longer a For payer code 37330, claims submitted on or after 11/1/2009 valid group/plan under payer ID 37330. If you have any questions, please call 1-800-394-7569. (BHT04) will be rejected when the group/plan number begins with "J" (2000B SBR03). The patient or subscriber ID in segment NM109 in loop 2010BA and/or loop 2010CA must Applies to 2010BA loop only contain three numeric characters followed by three alpha characters The patient or subscriber ID in segment NM109 in loop 2010BA and/or loop 2010CA must Applies to 2010BA loop only contain eight alphanumeric characters Visit our website: www.availity.com Loop Element Payers 13350, 61101 61102, 61105 65018, 72127 95348, 95885 HUMAR,Z0005 38333, OCH01 38334, CIMSA NM505, 20149 20554, UNMSC 38336, 51062 MHHNP, 95092 95093, 53589 84980, 00790 00621, 00840 53120, 14163 14164 CNTNM August 2011 Availity® Health Information Network EDI Payer Specific Transaction List Error Codes The patient or subscriber ID in segment NM109 in loop 2010BA and/or loop 2010CA must contain three numeric characters followed by three alpha characters The patient or subscriber ID in segment NM109 in loop 2010BA and/or loop 2010CA must contain eight alphanumeric characters The patient or subscriber social security number (SSN) must contain nine numeric digits. These nine digits cannot be identical and the first digit cannot be a '8' or '9' Applies to 2010CA loop only 2010CA NM109 Trans Types 837P Applies to 2010CA loop only 2010CA NM109 837P MRIPA The secondary ID has to be nine characters and cannot be the same digit. 2010BA REF 837P 837I prof.SEP The patient or subscriber social security number (SSN) must contain nine numeric digits. These nine digits cannot be identical and the first digit cannot be a '8' or '9 The patient or subscriber social security number (SSN) must contain nine numeric digits. These nine digits cannot be identical and the first digit cannot be a '8' or '9 2330A REF02 837P 68050, 68053 68057, 68058 SHP11 68050, 68053 68057, 68058 SHP11 prof.SFB The patient (2010CA) or subscriber (2010BA) first and last name fields can contain letters and Special characters are not allowed in the subscriber/patient name spaces only. Special characters are not allowed. fields. 2010BA NM103 NM104 837P prof.SFF The patient and subscriber ID number in segment NM109 in loop 2010BA and/or 2010CA must contain at least two alpha number characters. The patient signature source code (loop 2300, segment CLM10) is not required when the release of information code is 'N' (loop 2300, segment CLM09) 2010BA NM109 837P 68050, 68053 68057, 68058 SHP11 IL621 2300 CLM10 837P 53120 2010AB NM108 NM109 837P 38338 2010AA NM108 NM109 837P 38338 prof.SEK prof.SEL prof.SEM prof.SFH prof.SFI Error Messages Error Descriptions Applies to 2010BA loop only The patient signature source code (loop 2300, segment CLM10) is not required when the release of information code is 'N' (loop 2300, segment CLM09)| The identification code qualifier (loop 2010AB, segment NM108) must equal XX and the pay-to The identification code qualifier (loop 2010AB, segment NM108) provider identifier (loop 2010AB, segment NM109) must be a valid NPI. The payer does not must equal XX and the pay-to provider identifier (loop 2010AB, accept a tax ID as the pay-to provider identifier. segment NM109) must be a valid NPI. The payer does not accept a tax ID as the pay-to provider identifier. Loop Element Payers MRCHP prof.SFJ The identification code qualifier (loop 2010AA, segment NM108) must equal XX and the billing provider identifier (loop 2010AA, segment NM109) must be a valid NPI. The payer does not accept a Tax ID as the billing provider identifier. The identification code qualifier (loop 2010AA, segment NM108) must equal XX and the billing provider identifier (loop 2010AA, segment NM109) must be a valid NPI. The payer does not accept a tax ID as the billing provider identifier. prof.SFK When an internal control number (ICN/DCN) is included on the claim, it must contain 12 alphanumeric characters When an internal control number (ICN/DCN) is included on the claim, it must contain 12 alphanumeric characters 2300 REF02 837P prof.SFO Claim should not have a negative submitted charge amount (SV102) at the service line (loop 2400). All values should be zero or a positive number 2400 SV102 837P prof.SS2 Subscriber First Name is Invalid 2010BA NM104 837P prof.WCE Your encounter was received with an incorrect payer ID. If this is an encounter, resubmit with payer ID 59354. If this is not an encounter, use CH in Claim or Encounter Indicator field. Claim should not have a negative submitted charge amount (SV102) at the service line (loop 2400). All values should be zero or a positive number The first position of the Subscriber’s first name cannot be a space. The first position must be alpha or numeric Encounters for Wellcare must be submitted using payer id 59354. 68057, 68053 68050, 68058 SHP11 68057, 68053 68050, 68058 SHP11 53120 BHT BHT06 837P 14163, 14164 2310B 2000B 2000C 2010BA 2010BA 2010BA PRV03 PAT09 837P 837P EPF03, EPF02 00934, 93093 NM109 NM109 REF HCDPBC 95827 39151 2010BA NM1 837P 837P 837P 837I 837P 837I 2010BA N3 837P 837I CCIH 2000B SBR04 837P 00851, 00611 00932, 93221 prof.Y7DSBR prof.YED Rendering Provider Taxonomy Code Missing or Invalid LMP Date Missing S101P S102P S103P The member ID (Loop 2010BA, Segment NM109) must be nine numeric digits. The member ID (Loop 2010BA, Segment NM109) must be eight numeric digits. The payer does not accept a subscriber secondary ID (REF segment) in loop 2010BA S104P The subscriber ID (loop 2010BA, MN109) must be six characters in the following format: the first character must be a letter, the second character must be a letter or number, and the remaining four characters must be numbers S105P The patient address is invalid (loop 2010BA, segment N3). Select an abbreviation from the Institutional Abbreviation List located at http://www.correctcare.com/portal S108P Invalid character (^) received in Insured Group Name (loop 2000B, SBR04). Please correct and resubmit. Rendering Provider Taxonomy Code Missing or Invalid When the pregnancy indicator is Y-Yes, a last menstrual period (LMP) date is required. Member ID must be nine numeric Member ID must be eight numeric The payer does not accept a subscriber secondary ID (REF segment) in loop 2010BA The inmate CDCR number must be six characters in the following format: the first character must be a letter; the second character must be a letter or number; and the remaining four characters must be numbers The patient address should be the institutional abbreviation from the Institutional Abbreviation List located at http://www.correctcare.com/portal. Invalid character (^) received in Insured Group Name (loop 2000B, SBR04). Please correct and resubmit. Visit our website: www.availity.com CCIH August 2011 Availity® Health Information Network EDI Payer Specific Transaction List Error Codes Loop Element 2010BA S113I Insured City (loop 2010BA, N401) invalid. Must contain two alpha characters. Please correct Insured city must be two consecutive alpha characters. and resubmit. Payer City (loop 2010BB, N401) invalid. Must contain two alpha characters. Please correct and Payer city must be two consecutive alpha characters. resubmit. Invalid Character [^] Received in Subscriber Middle Name (Loop 2010BA, NM105) Invalid Character [^] Received in Subscriber Middle Name (Loop 2010BA, NM105) The value submitted for member ID (loop 2010BA, NM109) is invalid. The subscriber id is invalid. S113P The value submitted for member ID (loop 2010BA, NM109) is invalid. S114I The value submitted for the member Id (loop 2010BA, NM109) is invalid. S109P S110P S111P Error Messages Error Descriptions N401 Trans Types 837P 91121, 91051 2010BB N401 837P 91121, 91051 2010BA NM1 837P AIDWA 2010BA NM109 837I HPN11, GTPA1 MCA11, VFP11 KLSY1, SCOK1 WITH1, TX1ST NWDC1, PPMO1 FMCHP, SSC11 CIPA1, KMG11 GHEDI, TOPA1 The subscriber id is invalid. 2010BA NM109 837P HPN11, GTPA1 MCA11, VFP11 KLSY1, SCOK1 WITH1, TX1ST NWDC1, PPMO1 FMCHP, SSC11 CIPA1, KMG11 GHEDI, TOPA1 The member id must be 9, 10, or 14 digits and must not be equal to all one's, two's, three's, etc. 2010BA NM1 837I CNTNM Visit our website: www.availity.com Payers August 2011
