Payor Billing Errors

All of these billing warnings can be viewed in Enterprise Edition by proceeding to Master Files | Payors / Plans | Payor Billing Errors.

Error ID

Field Name

Error Message

Remedy

Hidden

Editable

01AGFEDTAX

Agency Fed Tax ID

Required element missing

Enter an agency tax ID in 'Master Files'

1

0

01AGNAME

Agency Name

Required element missing

Enter an agency name in 'Master Files'

1

0

01AGADDR

Agency Address

Required element(s) missing

Enter an agency address in 'Master Files'

1

0

01AGPHONE

Agency Telephone Number

Required element missing

Enter an agency telephone number in 'Master Files'

0

1

10MCRPRV

Medicare and/or National Provider

Required element missing

Enter a Medicare and/or National Provider Number in 'Agency Master'

1

0

20PRHOLD

Prior Hold

Cannot bill this patient due to prior holds

Remove holds in prior batches & bill those items first.

1

0

20LNAME

Last Name

Required element missing

Enter last name in 'Patient/Referral'

1

0

20LNAME

First Name

Required element missing

Enter first name in 'Patient/Referral'

1

0

20INSSEX

Insured's Sex

Invalid gender

Enter valid sex code in 'Demographics'.

1

0

20DOBGR

Patient Date of Birth

WARNING: %1 is greater than the admit date of %2

Verify birthdate in 'Demographics'.

1

0

20DOBFTR

Patient Date of Birth

WARNING: Future date

Modify birthdate in 'Demographics'.

1

0

20DOBINV

Patient Date of Birth

WARNING: Is %1 correct?

Verify birthdate in 'Demographics'.

1

0

20DOBMIS

Patient Date of Birth

Required element missing

Enter birthdate in 'Demographics'.

1

0

20PTADDR

Patient Address

Required element missing

Enter address in 'Address/Phones'.

0

1

20PTCITY

Patient City

Required element missing

Enter address in 'Address/Phones'.

0

1

20PTST

Patient State

Required element missing

Enter address in 'Address/Phones'.

0

1

20PTZIP

Patient Zipcode

Required element missing

Enter address in 'Address/Phones'.

0

1

20ADMDATE

Admission Date

Required element missing

Enter admission date in 'Admission'.

1

0

20ADMPEND

Admission Pending

Admission is still marked as Pending.

Change admission pending status.

0

1

20CBSA

CBSA

Required CBSA missing for timeframe

Enter an address for the specified timeframe with a valid CBSA in 'Addresses'.

0

1

20PTSTNUM

Patient Status

Non-numeric entry.  Must be a valid numeric value.

Non-numeric entry.  Must be a valid numeric value.

1

0

20PTSTINV

Patient Status

Invalid code value.

Update code values in 'Admit/Dschg'.

0

1

20PTSTMIS

Patient Status

Required element missing.

Update code values in 'Admit/Dschg'.

1

0

20PTSTLAMD

Patient Status

Invalid code value for Louisiana MCDR&B.

Update code values in 'Admit/Dschg' using secondary LAMCDRB status dropcombo.

0

1

20ADMSRC

Source of Admission

WARNING: Patient Referral Category not available. Setting Source Of Admission to 'UNKNOWN'.

Enter referral category in 'Patient/Referral'.

1

0

20RAPAMT

CBSA / HIPPS / Plan

Cannot compute RAP amount.

Erroneous information to compute prospective payment.

0

1

20PAYOR

Payor Plan

Can't find Payor Plan for Charge.

Verify the payor plan on the charge if overridden.

0

1

20PAYORMIS

Payor Plan

Payor Plan associated with Charge doesn't exist.

Verify the payor plan on patient's insurance or charge

1

1

30INSPAYOR

Payor Identification Number

Required element missing

Add a payor for patient in 'Insurance'.

0

1

30MCDNUM

Medicaid#

Required element missing

Update Medicaid Billing # in 'Patient Insurance'.

0

1

30HICNUM

HIC#

Required element missing

Update HIC# in 'Patient Insurance'.

1

0

30PATSSN

Patient SSN

Required element missing

Update SSN in 'Demographics'.

0

1

30INSCVST

Patient Insurance Coverage

Ins. coverage start date greater than batch start date

Update coverage start date in 'Patient Insurance'.

0

1

30INSCVEND

Patient Insurance Coverage

Ins. coverage end date less than batch end date

Update coverage end date in 'Patient Insurance'.

0

1

30PYRNM

Payor Name

Required element missing

Update Name in 'Payors'.

0

1

30PROVNUM

Provider Number

Required element missing

Enter an agency NPI in 'Master Files'

0

1

701PRIMDIA

Primary Diagnosis

Required element missing

Designate a diagnosis as primary in 'Patient Prognosis/Diagnosis.'

1

0

80PHYS

Attending Physician

Required element missing

Enter an attending physician in 'Patient/Referral'

1

0

80PHYSNPIB

Attending Physician NPI

Required element invalid

Correct attending physician NPI # in 'Master Files'.  Must be 10 digits.

0

1

80PHYSID

Attending Physician Identifier

Required element missing

Record attending physician UPIN, License, or Registration # in 'Master Files'

0

1

80PHYSNM

Attending Physician Name

Required element(s) missing

Record attending physician first & last name in 'Master Files'

0

1

EPSMSCHGS

Missing Charges

Missing Charges for Episode %1 thru %2 with AdmitDate %3

Add Charges in Charge Entry

1

0

485UNSGN

Unsigned 485's

There are 485's not signed by a physician for this episode. %1 created %2

Use Document Tracking/485s or firstCPO Portal to log your 485s as received/signed.

0

1

MPOUNSGN

Unsigned Med Orders

There are Medication Physician Orders not signed by a physician for this episode. Order Ids: (%1)

Use Document Tracking/Orders or firstCPO to log your orders as received/signed.

0

1

OASISMS

Oasis not extracted

Oasis Assessments have not been extracted for this episode. (%1 created %2)

Use Tools/Oasis Extract to submit your Oasis assessments.

0

1

PHYSORDERS

Physician Orders

There are physician orders not signed by a physician and/or medical director.  Order Ids: (%1)

Use Document Tracking/Orders or firstCPO to log your orders as received/signed.

0

1

F2FNOTSIGN

Physician Signature Date

The F2F document has not been signed by physician.

The F2F document has not been signed by physician.

0

1

F2FENCMHOM

Certify Date

The F2F encounter date is missing for this billing period.

Ensure an appropriate F2F encounter exists for the billing period.

0

1

61NOHIPPS

HIPPS / HHRG

Missing HIPPS/HHRG for Episode

Enter HIPPS/HHRG in Patient Episodes

0

1

61NONCVD

NonCovered

NonCovered Charge on %1

Ensure therapy reassessments are properly scheduled

0

1

OUTLIER

Episode Amount

Episode amount changed from %1 to %2.

Verify all visit charges have been entered.

0

1

NOSUPPLIES

HIPPS / HHRG

No supply revenue code reported on final claim.

Claim will be sent with updated HIPPS code.

0

1

NORAP

No RAP

No posted RAP found for this final claim.

A posted RAP must exist prior to creating a final claim.

0

1

EPSAMTCHG

HIPPS / HHRG

HHRG changed from %1 to %2.  Episode amount changed from %3 to %4.  Therapy anticipated: %5, therapy delivered: %6.

Verify all therapy charges have been entered.

0

1

40NOOCC55

Occurrence Code

Occurrence code 55 must be present when patient discharge code is that of expired (20, 40, 41 or 42).

Update occurrence code values on discharge codes in Reference Files, screen Admit / Dischg Status codes.

0

1

NOFORMAT

Billing Format

No billing format is specified for Payor: %1, Plan: %2

Save a billing format for the plan

1

0

NOPLAN

Billing Format

No billing options are saved for Payor: %1

Save billing options for the plan

1

0

80PECOS

Attending Physician PECOS Enrolled

Physician %1 is not PECOS Enrolled.

Verify the physician is enrolled in PECOS and update the Physician record accordingly.

0

1

BADSVCLOCA

HCPCS

Invalid HCPCS on location of service.

Update HCPCS on location code in hospice mode.

0

1

F2FNODOCHM

Face to Face Document

The F2F document is missing.

Create a F2F Document.

0

1

F2FRAPNDOC

Face to Face Document

The F2F document is missing.

Create a F2F Document.

0

1

F2FEPDTEHM

F2FDate

The F2F episode date is missing.

Insert a F2F date.

0

1

F2FRAPEPDT

F2FDate

The F2F episode date is missing.

Insert a F2F date.

0

1

F2FEPOORHM

F2FDate

The F2F date %1 is outside the accepted range. Acceptable range is %2 - %3.

Verify the date entered is the correct date.

0

1

PHYSOORHOM

Physician Signature Date

The physician signature date %1 is outside the accepted range. Acceptable range is %2 - %3

Verify the date entered is the correct date.

0

1

F2FRAPENCM

Certify Date

The F2F encounter date is missing for this billing period.

Ensure an appropriate F2F encounter exists for the billing period.

0

1

F2FENCIHOM

Certify Date

The F2F date %1 is outside the accepted range. Acceptable range is %2 - %3.

Verify the date entered is the correct date.

0

1

NOFFSHIPPS

Fee for Service HIPPS

Unable to locate HIPPS code for this billing period.

Create an OASIS document or a manual assessment.

0

1

VSTNOTREL

Visit Status

Visit(s) exist within the billing date range that need to be cancelled and/or released: %1

Cancel or release the visits.

0

1

CHGNOTVER

Charge Status

Visits exist within the episode date range that need to be verified.

Verify the visit charges.

0

1

EOEEXISTS

EOE Exists

A final claim (EOE) already exists for this episode.

Reverse the final claim and rebill.

0

1

EOERAPFBV

First Billable Visit

EOE First billable visit date of %1 does not match RAP first billable visit date of %2.

Ensure charges and documentation for the first billable visit are the same on the final as the RAP.

0

0

FBVADMITDT

First Billable Visit

First billable visit date does not match admit date of %1.

Ensure charges and documentation for the first billable visit are matching the admit date of the patient.

0

1

VISIT0HOM

Time Value

A visit on this patient has a zero or negative duration.

Ensure visit hours are appropriate for the visit.

0

1

NOICD10

Diagnosis Codes

Claim requires ICD-10 codes, but the admission has diagnosis codes with no corresponding ICD-10 code selected.

Resubmit the rejected admission with ICD-10 codes included.

0

1

SERVICE50

Service Details

Claim Level - There are more than 50 service lines on this claim.

Select a revenue code grouping option in 'Billing Formats'.

0

1

NOUMPI

UMPI Not Assigned

UMPI number not assigned to personnel chart

Delete the claim, enter the UMPI number for the corresponding employee, and then regenerate the claim.

0

1

NOUTN

UTN/Pre-Claim Review #

Missing UTN/Pre-Claim Review #

Enter the correct UTN for applicable episodes that are missing a UTN in PPS Episodic Periods.

0

1

NOUTNLDT

Pre Claim Review/UTN Go Live Date

Missing Pre Claim Review/UTN Go Live Date or it is not effective for the statement from date.

Enter the correct begin date to indicate when the software will begin utilizing UTN numbers for the corresponding payor/plan.

0

1

NOHHSCCDX

Secondary Diagnosis

Secondary DX code Z76.89 is required if HH status condition codes are excluded.

Please update the patient's chart with secondary DX of Z76.89.

0

1

O1MCRSUB

Medicare Submitter ID

Medicare Submitter ID is missing from Agency.

Add Medicare Submitter ID to Agency Master File for office being billed.

1

0

80PHYSECID

Medicaid Provider IDs

The attending physician (%1) is missing their Medicaid Provider ID in Master Files. State=%2.

In Physician Master Files add the attending's state Medicaid number to the Physician record.

0

1

30MCDSTATE

Plan Medicaid State Form

The plan (%1 / %2) does not have a Medicaid State Form state specified.

In the Billing Formats tab of the Payors/Plans master file editor, select a Medicaid State Form state. This is necessary when Use Medicare Provider Number is checked.

0

1

01AGCITY

Agency Office Address, City, State and Zip Code

The office Address, City, State and/or 9-digit Zip Code is blank.

Please enter agency office address, city, state, and full 9-digit zip code.

1

0

30PROVNPI

National Provider ID

The office NPI number is blank.

Please enter the National Provider Identifier for the office being billed.

1

0

2010AAN301

Agency Pay-To Physical Address

Agency physical address must be complete when the agency address is a PO Box.

Enter a complete Physical Address Line1, City, State and Zip in the agency master files Pay-To Address tab.

1

0

61HOMSVCDT

Service Date

Service line From date (%1) is outside the statement span (%2-%3).

Correct service date.

0

1

01RECEIVER

Receiver ID

Payor does not have a receiver selected.

Assign a receiver to the payor.

1

0

01MCRSUBID

AgencyReceiver

Receiver %1 is not associated with the office %2.

In the Agency | Electronic Submitters screen, associate receiver %1 with office %2.

1

0

01AGENCYCT

Office Phone or Fax or Email

Agency contact information is missing or invalid.

Please enter an agency contact office phone number, fax number or email address.

1

0

61UNITBLNK

Units

Service line units are missing.

Correct service line units.

0

1

20PAYSRCNM

Payment Source

Payment Source does not match receiver ID.

Update the payor's payment source to be Medicare A or update the payor's receiver ID to not be a Medicare receiver ID.

0

1

20PAYSRCM

Payment Source

Payment Source does not match receiver ID.

Update the payor's payment source to not be Medicare A or update the payor's receiver ID to be a Medicare receiver ID.

0

1

20PTADRRNG

Patient Effective Address Dates

Patient does not have effective address dates that span this billing date range.

Updated the Effective Thru date for the address to span the entire billing period.

0

1

DOCLOCNV

Document Status

Document(s) exist within the billing date range that are locked but Visit Details not completed: %1

Enter the appropriate Visit Details (P-Page) information and save the document.

0

1

DOCNLOC

Document Status

Document(s) exist within the billing date range that are not locked and Visit Details not completed: %1

Users can either check the Time Not Recorded box within the document (to indicate visit details are not required) or enter the Visit Details (P-Page) information and lock the document. Additionally, users have the option to delete the entire document.

0

1

DOCNLOCV

Document Status

Visit(s) exist within the billing date range that are attached to Visit Details and document is not locked: %1

Lock the document.

0

1