FLASH: Rejected Electronic Claims
February 23, 2021As a follow-up to our May 2020 INFORMED newsletter, please be reminded that electronic claims must be filed with the patient’s full member number and date of birth in order for claims to be processed.
Historically, if a member was not found in our system based on this data, the claim was disallowed and disclosed on your remittance advice with a member ID of 999981111-01 and a name of MEMBER ID NOT FOUND. Due to a change in policy, we are no longer able to place these claims on your remittance advice.
Effective with claims processed after February 28, 2021, claims where the member is not found will be rejected back to the provider’s clearinghouse. Providers will need to work with their clearinghouse or billing service to make sure those claims are captured, corrected and resubmitted electronically.
Please contact Provider Relations if you have questions or concerns.