Common Submission Errors and Resolutions

Encountering a submission error is not uncommon and can happen to any user at any time.

Whenever an error is encountered and resolved, the affected claim must be deleted and recreated in the Work Center > Insurance Billing > Create New Claims section to ensure the most recent version of the claim reflects any changes made. . 

User Permissions

Admin-level users do not require additional permissions to configure information or create and submit claims. User-level profiles cannot configure information but can create and submit claims with Edit-level permissions. For more information on configuring user permissions, click here. 

Claim Submission Errors

The list below details the most common errors users may encounter when submitting a claim. Let's review each message, its meaning, and how to resolve it. 

Error	Definition	Resolution
No Professional Services Lines are active for service [Service Name] from [Earliest DOS - Latest DOS]	This indicates a professional claim is being created, but no Professional Service Reference exists in the billing profile.	The professional service line must first be referenced in the billing profile. To learn more about this process, click here.
This Claim Requires a Paper Payer Address, but this address is not specified for the primary [Insurer Name] patient insurance profile	This indicates that a rule requires the payer's physical mailing address to be included in the claim.	Update the payer's mailing address. To learn more about this process, click here. If the rule is not meant to apply to this claim, include additional conditions to further instruct the system to which the rule should not apply.
Service [Service Name] Billing Profile does not allow multiple units per day on [Date]	This means the billing profile used to create the claim is not configured to allow multiple units recorded for the same date.	Update the configuration of the Service Billing Profile to allow for multiple units to be recorded for the same DOS. To learn more about the process, click here.
Upon Claim Submission Validation, the contents of the claim have changed. Please delete and recreate this claim.	This indicates something changed within the patient demographics, attendance calendar, or service configuration.	Delete the claim(s) and navigate back to the Create New Claims tab to recreate the claims with the updated information.
Service "[Service Name]" Billing Profile "[Profile Name]" is not active on [DOS]	This means the claim was created with a billing profile deactivated after submitting the treatment.	Reactivate the billing profile using the instructions here. Update the billing profile being used. For instructions on updating U/R Required Service Billing Profiles, click here. For instructions on updating Standalone Service Billing Profiles, click here.
No Professional Service Lines are active for service "[Service Name]" for [DOS-DOS]	This message occurs when a professional claim has been created, but no Professional Service Line has been referenced in the billing profile.	Click here for instructions on referencing a professional service line.  Click here for instructions on how to reference the professional service rate.
Service "[Service Name]" Professional Service Line "HCPCS/CPT-Modifier" is not active on [DOS]	This message occurs when a professional service line reference is marked inactive after creating the claim.	Click here for instructions on how to update and/or create a professional service line.
Service "[Service Name]" Billing Profile "[Service Billing Profile Name]" does not have a specified Claim Form Service Name on [DOS]	This means the claim was created with a billing profile that does not have a Claim Form Service Name.	Click here for instructions on updating the billing profile to include a Claim Form Service Name.
Service "[Service Name]" Billing Profile "[Service Billing Profile Name]" does not allow for multiple units per day on [DOS]	This means the claim records multiple units of the same service on the same day, but the billing profile is configured to allow one unit of service per day on a claim.	To use the existing billing profile, delete the claim and create a claim for each unit within the Create New Claims tab. Click here for instructions on updating the billing profile.  Click here for instructions on creating a service grouping rule to create the claim with a different, existing billing profile.
This claim requires an Accident Type, but this value is not specified for the treatment episode	This message occurs when a Claim Form Rule that requires an Accident Type is in place, but one has not been established for the patient.	To add accident information, navigate to Patient > Treatment Episode > Intake and add the accident information under the Admit/Discharge subsection.  Add more conditions to the rule to specify/omit the affected claim. Temporarily turn off the claim rule to recreate and submit the claim. Turn the rule back on and ignore any corrections that may be generated due to the rule being turned back on.
A Provider Taxonomy is required but is not specified for Rendering Provider "[Provider Name]"	This message occurs when a Claim Form Rule is in place that requires the Rendering Provider taxonomy, but one has not been established in the rendering provider profiles.	Add the taxonomy to the rendering providers profile under the Practice Admin > Rendering Providers section.  Temporarily turn off the claim rule to recreate and submit the claim. Turn the rule back on and ignore any corrections that may be generated due to the rule being turned back on.
Utilization Plan [DOS-DOS] has an Authorization Status of Pending	This message indicates the patient's utilization plan is still pending.	The status of the patient's U/R plan will need to be updated before the claims can be submitted.

Claim Splitting Errors

Occasionally, newly created claims will split when moved to the Submit Claims tab. These splits can occur for many reasons but can be resolved by identifying the root cause. Let's review some of the most common root causes and how to identify and fix them. 

• The Maximum Daily Charge (MDC) is managed under the Managing Organization Admin > Configuration > Account Settings and caps an individual claim's total charges.
  
  Example: If the MDC is $100,000 but the patient has $140,000 of charges, the system will create one claim with $100,000 in charges and a second claim to account for the remaining $40,000.
  

  
  Resolution: Adjust the MDC to account for all charges. This can later be adjusted back to its original amount after the claim has been submitted. 

• Scheduled Change Sets update configuration information as of a specific date.
  
  Example: If an IOP service is $1,000 a day in 2024 but will increase to $1,250 as of 2025, a Scheduled Change Set would be created to instruct the system to charge $1,250 for all DOS recorded in 2025.
  
  If a patient received treatment from 12/21/24-01/09/2025, the system would create two claims: one for the DOS that falls within 2024 and one for the DOS that falls within 2025.
  
  Resolution: Update the parameters of the Scheduled Change Set by adjusting the date or, in this example, updating the Facility Rate to be based on the Date of Admission (as opposed to the default Date of Service).  Note: If you struggle to locate where a change set might be occurring, use the User Audit Records
• The RCM will split claims when one or more Utilization Plans are in place for a patient, regardless of whether the information is the same.
  
  Example: The patient has two U/R plans for the same service and authorization numbers but spans different dates.
  
  Resolution: After deleting the claim, unsubmit the attendance from the second plan created and delete the second one. Next, update the end date of the first utilization plan to account for all authorized dates of service. After you re-record and submit the attendance, the claims should be combined when they are created. 
• When services are combined onto a claim form, their respective billing profiles must be compatible to ensure the system can combine them. The system will automatically split the claims if one or more settings are incompatible. 
  
  Example: The billing profile for IOP allows multiple services to be combined into one claim. However, the default billing profile for Group Therapy does not, resulting in split claims.
  
  Resolution: Update the billing profile for Group Therapy to allow for multiple services on one claim. A Service Grouping Rule is also available to update the default billing profile on standalone services if the correct conditions are met. 
• The system's maximum line item limit is 200. This means a single claim cannot include more than 200 lines of service.
  
  Example: An Admit-thru-Discharge claim includes over 250 lines of service, so one claim is created for 200 lines and a second claim for the remaining 50 lines. 
  
  Resolution: Unfortunately, no workaround allows for more than 200 line items in a single claim. Please contact [e-mail] for further assistance if you continue to run into this issue.
• Claim Rules are always applied last in the claim creation process. If a rule has specific conditions that apply to one service and not the other, the system will generate two claims to abide by the rules set.
  
  Example: A Service Grouping Rule was created to update a claim's billing profile. However, the new billing profile does not allow multiple services to be recorded on the same claim, so the claim is split upon creation.
  
  Resolution: Update the new billing profile to allow multiple services on one claim. Additionally, the rule's conditions can be added/removed to exclude the affected claim upon recreation.