Claim Error Needs Correction Reference

When you process your claims, your PCC system reviews them for accuracy before submitting them electronically. This “claim scrubbing” results in cleaner claims, fewer claim rejections due to errors, and faster payment. Claims that need corrections will appear in the Needs Correction tab in the Claims tool.

What Claim Information Does PCC “Scrub” for Errors?

What kinds of pre-submission errors can your PCC system check for? What does it review before the claim is submitted? Here’s a partial list shared by PCC’s EDI specialists:

  • Patient first and last name
  • Patient date of birth
  • Patient Care Center assignment
  • Account (guarantor and custodial) names
  • Account address line, city, state, and ZIP
  • Account phone number
  • Patient / account relationship
  • Referring provider
  • Service date (relative to current date, patient date of birth)
  • CPT / HCPCS code (the claim processor checks your practice’s procedure code table to see that the codes on the claim are valid for the service date)
  • ICD-10-CM code (valid for service date; primary non-External Cause code)
  • Place of service address line, city, state, ZIP, phone number, and code
  • CARC values and charge / payment / adjustment balancing
  • NPI, tax identifier, and taxonomy code
  • Inpatient admission date
  • Practice address line, city, state, and ZIP
  • Pay-To Provider address line, city, state, and ZIP
  • Payor address line, city, state, ZIP, and [clearinghouse] identifier
  • Subscriber first and last name
  • Subscriber identifier
  • Subscriber group identifier
  • Subscriber date of birth
  • Subscriber address line, city, state, and ZIP
  • Original claim reference number
  • Accident state

PCC’s claim processing reviews all of the above and more.

When I See an Error, What Does It Mean? How Do I Fix a Claim Error?

The table below displays all the claim errors that can appear in the Needs Correction tab, in logs, or in other PCC reports that show claims that could not be submitted.

Claim Rejections and Denials: This list only includes the errors created when you process your claims. Remember to also review claim rejections and denials, found in responses from claim clearinghouses and payors. See Work on Claim Errors and Rejections.

Error Code Reason Claim Can Not Be Submitted Suggestions to Fix Previous Description (found in logs prior to PCC 9.6)
100 The patient’s first or last name is missing. Edit the patient’s first or last name. The patient’s name is invalid
102 The patient’s date of birth is either missing or invalid. Review and update the patient’s date of birth. The patient’s date of birth is invalid
103 The patient’s relationship code ([CODE]) for the relationship “[RELATIONSHIP]” is invalid. Review the patient’s policies and update the patient’s relationship to the subscriber. If the relationship is already correct, review the codes for that relationship in your Relationships table. Invalid relationship code found
104 The patient’s relationship to the subscriber is missing. Review the patient’s policies and update the patient’s relationship to the subscriber. Patient’s relationship to the insured is invalid
105 The patient’s PCP is not assigned. Add a PCP to the patient’s demographics. Patient does not have a provider entered in (the patient record)
106 Some part of the policy’s subscriber address is missing or incomplete. Review the patient’s policies and update the subscriber address. Subscriber address is bad
200 The billing account ([PCC#]) is missing a first or last name. Edit the first or last name of the patient’s billing account. The guarantor’s name is invalid
202 Some part of the billing account’s ([PCC#]) address is missing or incomplete. Edit the address of the billing account. The guarantor’s address is bad
204 The home account ([PCC#]) is missing a first or last name. Edit the first or last name of the patient’s home account. The custodian’s name is invalid
205 Some part of the home account’s ([PCC#]) address is missing or incomplete. Edit the home account and update the address. The custodian’s address is bad
207 The subscriber’s date of birth is either missing or invalid. Edit the patient’s policy and enter a valid subscriber date of birth. The insured’s date of birth is invalid
208 The policy’s certificate number has fewer than 2 characters. Edit the patient’s policy and enter a valid certificate number. The insurance certificate number is invalid
209 The policy’s group number is missing. Edit the patient’s policy and enter a valid group number. The insurance group number is invalid
210 The policy “[INSURANCE PLAN]” is not active for the date(s) of service. Review the patient’s policies, and verify policy effective dates are correct. Review the charges for this encounter and ensure they are pending the correct policy. If you change the responsible party for the charges, generate a new claim and delete this claim. Claim is for an insurance company no longer on the patient
300 Some part of the insurance plan address is missing or incomplete. If you want to file a claim with this plan, update the address of the plan in the Insurance Companies table. The insurance company address is bad
302 The payor ID for the insurance plan is missing. If you want to file a claim with this plan, add the plan’s payor ID in the Insurance Companies table. The ins company does not have a payor ID number in ted
303 The place of service “[POSNAME]” has an invalid address. Edit the place of service and update the address. The Place of Service Address is invalid
305 The place of service “[POSNAME]” is missing an NPI. Edit the place of service and update the NPI. The place of service NPI is invalid
306 The referring provider’s name is missing. Edit the referring provider and update their name. The referring provider’s name is invalid
307 The [CHOICE] for the referring provider “[NAME]” is missing. Edit the referring provider and update any missing information. The referring provider’s %s is invalid
308 The provider “[COMMON.PROV.NAME]” is missing their tax ID. Edit the provider and update their Tax ID. The provider Tax ID is invalid
309 The provider “[COMMON.PROV.NAME]” is missing their taxonomy code. Edit the provider and update their taxonomy code. The provider taxonomy code is invalid
310 The provider “[COMMON.PROV.NAME]” is missing an NPI. If you want to file this claim with this provider, update the provider’s NPI in the Providers table. If the provider is not correct, either update the charges with the correct billing provider or delete and repost the encounter. The provider NPI is invalid
311 Some part of the practice’s address is missing or incomplete. Edit Practice Configuration and update the practice’s address, including a ZIP+4 code. The Practice Address is invalid. The Practice Address requires at least one address line, city, state, and ZIP+4.
312 Some part of the batch-specific practice address is missing or incomplete. Contact PCC. The Alternate Practice Address, from the insurance batch configuration, is invalid. The Alternate Practice Address requires at least one address line, city, state, and ZIP+4.
313 Some part of the batch-specific pay-to practice address is missing or incomplete. Contact PCC. The Pay-To Practice Address, from the insurance batch configuration, is invalid. The Pay-To Address requires at least one address line, city, state, and ZIP+4.
314 The billing account’s zip code ([ZIP CODE]) is less than nine digits. Edit the billing account to include a ZIP+4 code. POS: Home: Guarantor needs ZIP+4
314 The home account’s zip code ([ZIP CODE]) is less than nine digits. Edit the home account to include a ZIP+4 code. POS: Home: Custodian needs ZIP+4
700 The procedure “[COMMON.PROC.NAME]” has a code ([PROC.CODE]) with less than 5 characters. If you want to file this procedure on the claim, edit the procedure’s code in the Procedures table. Otherwise, change the responsible party of the charge so it is personal. Then the procedure will not be filed on this claim. Procedure code contains less than 5 characters
701 The procedure “[COMMON.PROC.NAME]” has a code ([PROC.CODE]) that is invalid for the date of service. Delete and repost the charges for the encounter. The procedure code “XXXXX” is obsolete for the date of service.
702 The procedure code modifier ([MODIFIER]) for the procedure code ([CODE]) is invalid. Modifiers can only have 2, 4, 6, or 8 characters. Edit the procedure and update the billing code. The procedure modifier “XXX” has an invalid number of characters.
703, 704, 705, or 706 The diagnosis code ([CODE]) is invalid for the date of service. Edit the encounter’s charges and change the diagnoses. If the encounter was posted for the wrong date of service, delete the charges and repost them with the correct date. Diagnosis code is not valid for the date of service
708 The place of service “[POSNAME]” is missing a POS code (schedule [A-F]). Edit the place of service and update the POS code. Place Of Service(POS) code is invalid
710 The date of service ([DOS]) is invalid. Date(s) of service must be after 1980. Delete and repost the charges for the encounter. Charge posting date is invalid
711 The date of service ([DOS]) is invalid. Date(s) of service must be today or in the past. Delete and repost the charges for the encounter. Charge posting date is in the future
721 The primary diagnosis code on the claim must not be an External Cause code (beginning with V, W, X, Y). The current primary diagnosis is “[DIAG NAME]” ([DIAG CODE]). Edit the encounter’s charges and change the order of the diagnoses. The primary diagnosis cannot be an External Cause diagnosis code
722 The total of CARC adjustment(s) and insurance payment amounts from the primary insurance can not exceed the charge amount. Procedure: [PROCEDURE NAME] Charge Amount: $[######] Primary Payment: $[######] CARC Total: $[######] Delete the payments and adjustments, repend the charges towards the appropriate responsible party, and then repost the payments and adjustments so they include the correct CARC amounts. The total posted CARC adjustment(s) and insurance payment cannot exceed the the charge amount.
800 The date first seen ([DATE]) must be within the dates of service. Edit the date first seen for the encounter’s charges. Date first seen is after the first date of service
801 This claim is missing the accident state. Enter the accident state for the encounter’s charges. Accident was posted without entering the accident state
803 This inpatient hospital claim is missing the admit date. Enter the admit date for the encounter’s charges. Inpatient hospital service was posted without an admission date
804 This claim, with a claim delay code of 09, is missing a payer claim control number. Enter the payer claim control number into the Reference Number field for the encounter’s charges. A Reference Number is required when the Claim Delay Code is “09”
996 This claim has no insurance policy. Review the patient’s policies, and verify policy effective dates are correct. Review the charges for this encounter and ensure they are pending the correct policy. Generate a new claim and delete this claim. Claim batched w/o insurance. Check insurance effective dates
997 The charge ID ([CHARGE HANDLE]) can not be processed. Contact PCC. No configuration match found for this charge
998 The charges for this claim are no longer associated with this patient ([PCC#]). Identify the correct patient account and review their account history. Generate a new claim and delete this claim. Charges for a sibling were found rebatched with this claim
1001 The billing account ([PCC#]) can not be accessed. Contact PCC. Error getting account data pcc=%ld
1002 The patient ([PCC#]) can not be accessed. Contact PCC. Error getting patient data pcc=%ld
  • Last modified: June 11, 2024