The AmeriVeri CR rejection report provides details on why a claim line is rejected. These details play a critical role in submitting non-payment to providers because each rejection is 100% objective.
This report also happens to be one of our methods for relaying non-payment recommendations to the payer when it is most convenient. But, as mentioned on the How It Works page, rejections can also be communicated via data feed to eliminate manual intervention and speed up the process.
The sample below shows the type of content contained in an AmeriVeri CR rejection report. Each batch of claims submitted to AmeriVeri CR will automatically generate a report similar to this. For each line contained in the report, AmeriVeri CR recommends non-payment until the particular claim line has been corrected by the provider and re-submitted for approval. Historically, only 1% of the claim lines recommended for non-payment have been re-submitted. Nearly all re-submitted claims are paid.
| Remark | Claim No. | Patient | DOS | Service | Modifier | Units | Diagnosis | Paid Amt. |
|---|---|---|---|---|---|---|---|---|
| 01 | 01010101O(3) | Patient A | 01/02/2010 | 80001 | 90 | 1 | 789.00 | $7.58 |
| 02 | 02020202R(4) | Patient B | 01/15/2010 | J2000 | 1 | 883.0 | $4.36 | |
| 03 | 03030303U(2) | Patient C | 01/30/2010 | 93000 | 1 | 250 | $18.29 | |
| 04 | 04040404F(2) | Patient D | 02/01/2010 | 559 | 1 | 296.30 | $112.00 | |
| 05 | 05050505F(4) | Patient E | 02/15/2010 | 262 | 3 | 276.51 | $161.54 | |
| 10 | 06060606T(2) | Patient F | 02/28/2010 | 69210 | 1 | 389.00 | $23.00 | |
| 465.9 | ||||||||
| 305.1 | ||||||||
| 20 | 07070707R(1) | Patient G | 03/01/2010 | 95115 | 7 | 477.9 | $68.23 | |
| 30 | 08080808R(1) | Patient H | 03/15/2010 | 99395 | 1 | V70.0 | $87.00 | |
| 40 | 09090909G(1) | Patient I | 03/30/2010 | 58100 | 1 | 626.8 | $126.57 | |
| 110(12002) | 10101010Y | Patient J | 04/01/2010 | 11200 | 1 | 701.9 | $36.41 | |
| 140(97001) | 11111111R | Patient K | 04/15/2010 | 97002 | 1 | 845.00 | $42.00 | |
| 150 | 12121212G | Patient L | 04/30/2010 | 99214 | 1 | 786.50 | $89.00 | |
| 160 | 13131313H | Patient M | 05/01/2010 | 99231 | 1 | $55.00 |
| Remark | Description |
|---|---|
| 01 | The CPT code reported is not valid for the date of service reported. |
| 02 | The HCPCS code reported is not valid for the date of service reported. |
| 03 | All Diagnosis codes are invalid for the date of service. The claim cannot be reviewed for payment without at least one valid diagnosis. |
| 04 | The Revenue code reported is not valid for the date of service reported. |
| 05 | The Revenue code reported requires a corresponding CPT/HCPCS code. |
| 10 | Procedure requires supporting documentation including identification of procedure/service and medical necessity. |
| 20 | The number of units reported has exceeded the maximum number typically reported. Documentation is required for processing. |
| 30 | The age reported for the patient is outside the acceptable age range for the service reported. |
| 40 | The gender reported for the patient is not acceptable for the service reported. |
| 110 | According to the National Correct Coding Initiative (NCCI), “Column B code” is an inclusive component of “Column A code”. These services are not paid separately. |
| 140 | According to the National Correct Coding Initiative (NCCI), “Column A code” and “Column B code” are mutually exclusive of each other. These services are not paid separately. A modifier is not allowed. |
| 150 | This claim is a duplicate claim of a claim already submitted for payment. |
| 160 | The claim is missing required information. |
