Medical Billing Forum

Billing => Billing => : minhtm2902 May 21, 2009, 12:51:05 AM

: CLAIMS REJECTED BY HMSA
: minhtm2902 May 21, 2009, 12:51:05 AM

Dear Michell,

I met a reason from HMSA that makes cl rejected as :"missing mandatory PS101( D.E. 127) at col.5, conditional element relation violated: If either NM108 or NM109 is present,then the other is required". call the information about the pt and insurance is correct, but cl was rejected so many times. Pls verify for me :(

Thanks so much.

: Re: CLAIMS REJECTED BY HMSA
: Michele May 21, 2009, 10:02:28 AM

The rejection you have described sounds like an electronic claim rejection.  If that is the case I would contact your electronic vendor because it sounds like you have a mapping issue.  If you give them the exact reason below they should be able to help you.

Michele

: Re: CLAIMS REJECTED BY HMSA
: PMRNC May 21, 2009, 10:33:55 AM

Yes, that's an EDI rejection but it also sounds like you have either EIN, SSN or NPI issue or all of the above. You'll have to get clarification from your clearinghouse..but the NM rejection codes are related to NPI issues.

: Re: CLAIMS REJECTED BY HMSA
: minhtm2902 May 21, 2009, 10:16:59 PM

Ok, Thanks so much for your help :)