Rejection Codes

Code Description How to fix
RC193 This is generally for sending to secondary claims. It is where the insurance payment and adjustment codes are not equaling the total charge. This error is coming from no PR (Patient Responsibility) code added to the payment. Since this is not here, the clearinghouse is giving you an error. Check your payment and make sure that the Insurance Payment, Adjustments, and Patient Balance are equaling the Total Charge of the claims.
RC137 This rejection code is from an insurance (usually Medicare) where they are unable to process a claim with submission code 7 in box 22. This means they will not take a replacement claim in the Claim Frequency inside HENO. Change this to an Original claim and submit again.
RC80 Invalid Referring Physician NPI. An NPI was sent that did not fit the format of 10 digits in box 17b The number of digits may look correct on the claim image, so check the Patient -> Providers to verify the NPI that was entered into that providers information. Update information if needed and resubmit the claim.
RC07 Office Ally has a Duplicate filter in place, which does not allow for resubmission of claims. Contact Office Ally's Support and have them remove the filter on your account for 24 Hours, 48 Hours or Indefinitely. 
RC86 Invalid Rendering Physician NPI Format. An NPI was sent that did not fit the format of 10 digits or is an invalid NPI. The number of digits may look correct on the claim image, so check the Admin -> Practice to verify the NPI that was sent out. Update information if needed and resubmit the claim.
RC55 Payer Requires Pre-Enrollment for Electronic Claims Submission. Provider is not yet approved to submit claims electronically to this payer. Meaning pre-enrollment is not logged for this payer for the NPI in box 33a on Office Ally's end. Verify the claim was sent to the correct payer. Verify if word has been received from the payer that NPI is set up to send electronically. If Pre-enrollment has not been done, please go to the Payer EDI Enrollment Forms page HERE. If Pre-enrollment has been completed, please contact HENO Support.
RC66 Claim Contains Invalid Diagnosis Code References in Line Items Please check the diagnosis codes inside of the claim to ensure you have the most current diagnosis code and we recommend reaching out to the insurance to locate their billable diagnosis codes.
RC68 Printing Services were not requested from Office Ally due to rejection code RC55 Please see the information above for the RC55 rejection reason to fix this rejection reason.
RC62





RC120 		Printing Services Not Requested by User





Per Payer - Patient Relationship To Insured Must Be Self, Patient should be listed as both Patient and Insured.
  A. Print and Mail now by switching the submission method to "Print 1500" within the insurance company AND start/submit the enrollment form
OR
B. Hold the claims and start/submit the enrollment form. Submit claim again once enrollment is approved.
In the patients policy change the Relationship To Insured to SELF, then re-submit the claims.
    FE114 Invalid Facility Zip Verify the zip code information in Admin -> Practice. If it is correct, please contact HENO Support to assist you.
FE474 Invalid Claim Adjustment Reason Code in CAS Segment with Group Code PR (Patient Responsibility) You will need to enter an adjustment reason other than "0- Manual Adj." and resubmit the claim.
FE611 Incorrect filing indicator For Florida Medicare, change the filing indicator for Medicare (Billing -> Insurance -> Claims) to CI and re-send the claim to secondary.
FE120 Billing Provider Zip Code Invalid or Doesn't Match State Code Verify the zip code information in Admin -> Practice. If it is correct, please contact HENO Support to assist you.
FE357 Subscriber Zip Invalid For State Verify the zip code information in Patient Tab-> Edit Patient -> Case -> Policy -> Subscriber information. If it is correct, please contact HENO Support to assist you.
FE72 Patient Zip code required Verify the zip code information in Patient Tab-> Edit Patient -> Details. If it is correct, please contact HENO Support to assist you.
FE212



FE213 		Secondary Claim Information Missing or Invalid.



An electronic secondary claim was attempted to be sent to a payer that Office Ally cannot send secondary claims to yet
The amount in the primary payer payment amount plus the amounts in the reasons section do not add up to the amounts charged in the line items in box 24. Double check the info in each box to make sure the math adds up in the payment.

Change the submission method to Print 1500. Then print the claim & mail it to the secondary
FE67 Date of birth is missing inside the patient demographics. You will want to go into the Patient tab -> Edit the patient and add the date of birth. Once completed you can use the Rebill/Update and Send select in the Claims tab.
FE69 Patient Address is missing inside the patient demographics. You will want to go into the Patient tab -> Edit the patient and add the address. Once completed you can use the Rebill/Update and Send select in the Claims tab.
FE134 Accident Date Required on Accidents and Workers Comp Claims Check the patient's case. There are fields in the dates and conditions tabs that need to be filled out for the claims.

FE348 Patient/ Subscriber DOB Invalid - Future Dates Not Accepted You will want to go into the Patient tab -> Edit the patient and edit the patient date of birth. Once completed you can use the Rebill/Update and Send select in the Claims tab.
FE224



FV36 		Group Policy Number Cannot be the same as Insured ID


This rejection is due to the insured ID containing a dash.  		You will want to go into the Patient tab -> Edit the policy inside the case to have a number different from the Member ID/Policy Number inside the Group Number. If there is not one associated with this plan, we recommend using a generic 4 digit code across all insurances without a group number (i.e. 1111 or 0000). Once completed you can use the Rebill/Update and Send select in the Claims tab.
Remove the dash (-) from the patients member/policy ID and resubmit the claim. This will be box 1a on the claim submission.
LC1712 This rejection would be for Diagnosis code is no longer effective You will want to update the diagnosis code inside the patients chart (Patient -> Chart -> Edit pencil -> Scroll to diagnosis code). Once updated, you will want to resubmit the claims using the drop down Option 4 - Rebill/Update.
RC77 Pre-Enrollment is required for this payer in order to submit claims electronically You will need to go to Office Ally in order to fill out the pre-enrollment. Once it is complete, you will receive approval from the insurance. You can now submit claims electronically to that payer. *NOTE: If it is Medicare, please let HENO support staff know, they will need to contact Office Ally prior to you submitting claims*
LC1245 CPT/Procedure Code code invalid on Line 1 Check the claim CPT codes and be sure you are submitting correct codes. If the code is incorrect, you will want to Edit the Encounter and send the claim again.

LC1246 CPT/Procedure Code code invalid on Line 2 Check the claim CPT codes and be sure you are submitting correct codes. If the code is incorrect, you will want to Edit the Encounter and send the claim again.

LC1247 CPT/Procedure Code code invalid on Line 3 Check the claim CPT codes and be sure you are submitting correct codes. If the code is incorrect, you will want to Edit the Encounter and send the claim again.

LC1248 CPT/Procedure Code code invalid on Line 4 Check the claim CPT codes and be sure you are submitting correct codes. If the code is incorrect, you will want to Edit the Encounter and send the claim again.

LC1249 CPT/Procedure Code code invalid on Line 5 Check the claim CPT codes and be sure you are submitting correct codes. If the code is incorrect, you will want to Edit the Encounter and send the claim again.

LC1250
LC1253      		CPT/Procedure Code code invalid on Line 6
CPT/Procedure Code code invalid on Line 9
Check the claim CPT codes and be sure you are submitting correct codes. If the code is incorrect, you will want to Edit the Encounter and send the claim again.

LC1126, LC 1123 Modifier 1 on Line 1 is invalid Check the claim/encounter modifier. If the modifier is incorrect, you will want to Edit the Encounter and send the claim again.

LC1127 Modifier 1 on Line 2 is invalid Check the claim/encounter modifier. If the modifier is incorrect, you will want to Edit the Encounter and send the claim again.

LC1128 Modifier 1 on Line 3 is invalid Check the claim/encounter modifier. If the modifier is incorrect, you will want to Edit the Encounter and send the claim again.

LC1129 Modifier 1 on Line 4 is invalid Check the claim/encounter modifier. If the modifier is incorrect, you will want to Edit the Encounter and send the claim again.

LC1130 Modifier 1 on Line 5 is invalid Check the claim/encounter modifier. If the modifier is incorrect, you will want to Edit the Encounter and send the claim again.

LC1711 Diagnosis code 1 (D) not effective for this DOS Check the claim/Diagnosis codes. If the diagnosis codes need to be changed, you will want to Edit the Encounter and send the claim again.

LC1712 Diagnosis code 2 (D) not effective for this DOS Check the claim/Diagnosis codes. If the diagnosis codes need to be changed, you will want to Edit the Encounter and send the claim again.

LC1713 Diagnosis code 3 (D) not effective for this DOS Check the claim/Diagnosis codes. If the diagnosis codes need to be changed, you will want to Edit the Encounter and send the claim again.

LC1714 Diagnosis code 4 (D) not effective for this DOS Check the claim/Diagnosis codes. If the diagnosis codes need to be changed, you will want to Edit the Encounter and send the claim again.

LC1762 Claim Missing Diagnosis codes You will want to Edit the Encounter, add the diagnosis codes, and send the claim again. If you come across any codes that are not listed here, please let us know so we can add it here for all practice to reference.
LC1717



   

Duplicate Procedure Modifier
You will want to Edit the Encounter, check the modifiers added to the CPT lines, and ensure that there is not a similar modifier on the claim. Once corrected, resubmit the claim. 



RC206 Payer Agreement on File Required

 This payer requires an agreement to be on file so claims can pass through to the payer from our site. Here is a link with the form that you will be able to complete.
https://cms.officeally.com/OfficeAlly/Forms/UHIN-Pass-Through-Fee-User-Agreement.pdf
Once it has been added to the account then you will be able to resubmit the claims.