Common Rejection Messages (Apex)

Below are the most common rejections billers receive from the insurance companies, along with instructions on how to correct these claims. If you do not see the rejection you're looking for listed below, please contact Apex Support at 800-840-9152 or [e-mail]

Rejection code	What this rejection means	How to correct it
The claim/encounter has invalid information as specified in the status details and has been reject., Status: HCPCS, Entity:	The claim is being rejected for having an invalid procedure code.	Revisit the claim and ensure all procedure codes are properly formatted and consistent with the diagnosis codes used and resubmit the claim.
Claim Frequency Code	The payer does not accept corrected claims or the claim was sent as a corrected claim erroneously (claim frequency code "7" indicated it as a corrected claim). IMPORTANT: Medicare DOES NOT accept any claim with a frequency code that isn't 1	Resubmit the claim as an original claim, but still include any information that was updated. (Use claim frequency code "1" instead of code "7").
Payer Assigned Claim Control Number	Box 22 has an invalid ICN or its missing	If you are sending an ICN/Payer Control Number, you will need to make sure to follow the corrected claim guidelines here
Information submitted inconsistent with billing guidelines. Usage: At least one other status code is required to identify the inconsistent information	Resubmission, or Claim Frequency, code is incorrect. (Found in boxes 19 and 22 on the Apex Claims)	Resubmit the claim following the corrected claim guidelines here
Subscriber and subscriber ID not found	The claim was submitted with a subscriber/insured ID that is not recognized by the payer's system	Verify that the information being sent in the claim matches the insurance card. If it does, then contact the payer to verify the subscriber ID.
Prefix for entity's contract/member number	Subscribers ID has a missing or invalid Alpha Prefix. This rejection is specific to BCBS	Verify that the information being sent in the claim matches the insurance card. If it does, then contact the payer to verify the subscriber ID.
Patient eligibility not found with entity	The claim could have been sent to the wrong payer, or the subscriber or patient info may be incorrect.	Verify that you are sending the claim to the correct payer here.
Total Charge Amount: [155], Status Message: MISSING OR INVALID INFORMATION. MISSING OR INVALID INFORMATION. [D2391]	The service line containing procedure code [D2391] totaling [$155] was billed incorrectly. The procedure code and amount can be any code or amount.	Check with the payer's billing guidelines to ensure that the services being charged are input on the claim correctly
This code requires the use of an Entity Code., Entity: Service Location (77)	The information in box 32 matches the information in box 33.	To correct, just remove the information in box 32 and resubmit the claim.
SmartEdit (INFO)	The payer has made an update to their claim processing system that will need to be applied to any future claim sent to this insurance	Read the entire message first to understand what the claim update needs to be. Then you can either change and resubmit the claim OR you can wait 5 business days and it will automatically go back to being accepted.  Important: If you receive this message from Medicare, you will have to resubmit the claim with the updates.