Claims submitted may be rejected for a variety of error conditions. Each file submission
processed by the ministry will generate an Error Report (if applicable), therefore, several
error reports may be received throughout the month based on the frequency of claims submissions. Claims rejected to an Error Report are automatically deleted from the
payment stream. Rejected claims must be corrected and resubmitted to be processed
for payment.
A Claims Error Report provides a list of rejected claims and the appropriate error codes
or error report message for each claim. Error codes may be reported at the header level
of a claim and/or at the item level. Rejected claims may have more than one error code
or error report message assigned.
The Error Code is a three-character alpha/numeric code. The first character is an alpha
and denotes the type of reject as follows:
- V Validity Error (applies to HCP/WCB/RMB payment programs)
- A Assessment Error (applies to HCP/WCB/RMB payment programs)
- E Eligibility Error (applies to HCP/WCB/RMB payment programs)
- R Reciprocal Medical Billing (RMB) Specific Errors
A rejected claims item may be internally re-routed to the Error Report by the ministry
and will include an error report message. The error report message is generated to
provide more detailed information as to why the claim is being returned. Error report
messages appear directly below the related claim item (refer to section – Error Report
Messages).
Rejected claims shown on the Error Reports are returned during the processing month.
The corrected information should be resubmitted immediately. If the resubmitted
information is received prior to the 18th of the same month, the claim can be processed
for payment in the same billing cycle. Claims must be resubmitted within six months of
the date of service to avoid being rejected as a stale dated claim.
Claims Error Reports should be retained on file in your office to assist in monthly
payment reconciliations. If claims are not approved for payment on your monthly
Remittance Advice Report (RA), then check your Error Report for that month to
determine if the claim was rejected and needs to be submitted again.
A Claims Error Report is usually sent within 48 hours of claims file submission. If claims
are uploaded on a weekend, holiday or at month end, the Error Report is delivered on
the next claims processing day.
This article offers general information only and is not intended as legal, financial or other professional advice. A professional advisor should be consulted regarding your specific situation. While information presented is believed to be factual and current, its accuracy is not guaranteed and it should not be regarded as a complete analysis of the subjects discussed. All expressions of opinion reflect the judgment of the author(s) as of the date of publication and are subject to change. No endorsement of any third parties or their advice, opinions, information, products or services is expressly given or implied by RBC Ventures Inc. or its affiliates.
