Review the various errors below to understand how to correct and resubmit. When viewing your 277CA, all TRICARE Prime® Demo by CareSource Military & Veterans™ rejections will have a Claim Status Category Code of A7. The second code is the Claim Status Code. This is the Error Number from the list below. You can find this after the A7 in the STC segment of your 277CA.
21
Invalid birth weightHow to fix: Enter a numeric birth weight.
21
Newborn Delivery Claims without gestation ageHow to fix: On professional claims, the CPT procedure codes must be tied to the appropriate ICD-10 diagnosis codes. Diagnosis code validation edits on professional claims are based on detail-level diagnosis pointers, and the 5010 X12 837P standard only allows up to four diagnoses to be pointed per detail. If the weeks of gestation code is missing or not pointed to on one of the four diagnosis pointer fields in the delivery detail of the claim, the delivery detail will be denied.
30
Beneficiary mismatchHow to fix: Either the beneficiary had the wrong sex identified on the claim submission, or the beneficiary’s address on the claim does not match the beneficiary’s address in our system. Correct the data and send a new claim.
33
Beneficiary not found for submitted beneficiary ID, beneficiary mismatch, or claim received for group not valid to process claimsHow to fix: The system will check the beneficiary ID, DOD ID (if supplied), sex, DOB, and first 4 characters of the last name to attempt to identify the correct beneficiary. Contact Provider Services at 1-833-230-2170 to resolve this issue.
128
Submitted Provider Tax ID not in FacetsHow to fix: The provider is not set up with CareSource to send electronic claims. The provider needs to submit a W-9 form to CareSource prior to sending electronic claims. Please contact Provider Services at 1-833-230-2170 or visit the Claims page for instructions.
132
Missing/Invalid Medicaid ID for Atypical ProviderHow to fix: Ensure correct Medicaid ID is provided.
187
Date of Service (DOS) after received dateHow to fix: DOS must be prior to Received Date.
255
Rejection for Newborn Delivery Claims without gestation ageHow to fix: Include Newborn Gestation age.
453
Procedure code/mod combo not validHow to fix: Resubmit with a valid Procedure Code and/or Modifier.
488
Invalid Diagnosis codeHow to fix: Enter valid Diagnosis Code(s) for services rendered.
508
ICD-09 Code Found After ICD-10 Implementation DateHow to fix: Remit current ICD-10 code.
538
Corrected claim, with no original claim IDHow to fix: If you are sending a corrected claim with frequency of 7, you must include the last adjudicated Claim ID in the REF*F8 segment. If the last adjudicated claim ID is unknown, contact Provider Services at 1-833-230-2170.
677
Rendering National Provider Identifier (NPI) not affiliated to the billing agenciesHow to fix: Rendering provider on the claim was not actively affiliated with the billing group on the Provider Maintenance Form (PMF) during the DOS. The provider’s affiliation status will need to be reviewed, and once updated on the PMF, the claim can be resubmitted.
700
Claim is being rejected because it had an ICD-10 CPT code before ICD-10 was implemented in 2015. Majority of the time, the date is a typo or the code is not a valid ICD-10 code.How to fix: Correct DOS with date after ICD-10 was available.
773
Claim is rejected for service line date spans more than a calendar yearHow to fix: Make sure all service lines are in the same calendar year.
Note: CareSource’s source page lists a legacy Ohio Medicaid phone number (1-800-488-0134) and ODM/MITS references for errors 33, 128, 538 and 677. These have been replaced with the TRICARE Prime Demo Provider Services line pending CareSource confirmation.