Claim Rejection - Subscriber ID does not match

Rejection Message

• Member Not Found 
• SUBSCRIBER/PATIENT not eligible for Medical Benefits for Payer on Submitted Dates of Service. Verify the subscriber and/or patient information on the claim matches the ID card exactly. 
• Rejected by Payer, Subscriber and/or Subscriber Member ID not found. Verify that the information on the claim matches the member ID Card Exactly and that the claim was sent to the correct Payer ID, Member Pick Rejected 
• Rejected by Payer, Patient/Subscriber policy has been canceled  
• Subscriber and/or patient id does not match the payers records 

Definition

Generally this type of error is due to the Member ID in the patient's Insurance Set not matching the data that the Payer has on file. 

Resolution

In order to resolve this rejection, the Insurance Set will need to be edited in AveaOffice. Here are some steps to do so: 

1. Navigate to the Patient's intake profile for the relevant Treatment Episode (Patients > Patient Name > Intake) 
2. Select Insurance 
3. Select the Insurance Set 
4. Select Policy Holder 
5. Select Edit 
6. Verify that the Insurance ID and Policy Holder are correct 
7. Once any corrections have been, select "Save"
   
   Once this is completed a corrected claim will need to be submitted. Please follow these steps to submit the claim:  
   1. Navigate to the patient's profile (Patients > Patient Name)  
   2. Select "Treatment Episodes"  
   3. Select the Treatment Episode related to the claim  
   4. Select Insurance Billing  
   5. Select Review Corrections  
   6. Select Resolve next to the claim in question  
   7. Enter the Corrected Claim information as necessary and select "Resolve and Go to Submit Claims"  
   8. Click Submit Claims at the top of the screen.