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Education for Providers
Claim Submission Error Reports

The Upstate Medicare Division (UMD) would like to alert providers and their billing staff of the reasons and the volume of claim submission errors. For each quarter of the fiscal year (October through September), we will post charts depicting unprocessable claims information, which reflect claims that were submitted but not processed. Please keep this information in mind when submitting claims to Medicare.

For information on how to correct and avoid common claim submission errors, please refer to the chart titled How to Avoid Common Claim Submission Errors located at the bottom of this page.

2008
2007
2006
Unprocessable Claims Totals for the First Quarter of Fiscal Year 2008 - Revised 5-2-08

Reason for Return or Reject
(Click the reason for return or reject to view information on how to correct the error)		 October November December Total for Qtr. Avg. 4th Qtr 07 Avg. % Change
Missing/Incomplete/Invalid Referring/Ordering Provider # 7,460 5,737 4,209 17,406 5,802 4,399 32%
Missing/Incomplete/Invalid Group Practice Information 6,629 5,537 3,215 15,381 5,127 10,334 -50%
Missing/Incomplete/Invalid Procedure Code 1,998 1,550 1,569 5,117 1,706 1,491 14%
Missing/Incomplete/Invalid Place of Service Code 1,120 1,418 1,082 3,620 1,207 1,149 5%
Missing/Incomplete/Invalid Charges 629 839 872 2,340 780 558 40%
Missing/Invalid Modifier 814 798 613 2,225 742 663 12%
Missing/Incomplete/Invalid Entitlement Number or Name 662 505 487 1,654 551 532 4%
Diagnosis Code is Truncated/Incorrect/Missing 500 289 263 1,052 351 338 4%
Missing/Incomplete/Invalid Initial Treatment Date 277 392 180 849 283 362 -22%
Missing/Incomplete/Invalid Billing Provider/Supplier Secondary Identifier 193 197 170 560 187 NA NA

Unprocessable Claims

Unprocessable claims for the first quarter of fiscal year 2008.


Unprocessable Claims Totals for the Fourth Quarter of Fiscal Year 2007

Reason for Return or Reject
(Click the reason for return or reject to view information on how to correct the error)		 July August September Total for Qtr. Avg. 3rd Qtr 07 Avg. % Change
Missing/Incomplete/Invalid Group Practice Information 13,064 9,687 8,251 31,002 10,334 6,320 63.51%
Missing/Incomplete/Invalid Referring/Ordering Provider # 4,067 4,945 4,184 13,196 4,399 6,182 -28.85%
Missing/Incomplete/Invalid Procedure Code 1,630 1,603 1,239 4,472 1,491 1,570 -5.05%
Missing/Incomplete/Invalid Place of Service Code 937 1,561 949 3,447 1,149 1,074 6.98%
Missing/Invalid Modifier 568 838 582 1,988 663 527 25.74%
Missing/Incomplete/Invalid Charges 793 440 440 1,673 558 473 17.90%
Missing/Incomplete/Invalid Entitlement Number or Name 532 510 554 1,596 532 467 13.92%
Missing/Incomplete/Invalid Initial Treatment Date 488 258 339 1,085 362 281 28.71%
Diagnosis Code is Truncated 361 260 394 1,015 338 326 3.78%
Missing/Incomplete/Invalid Days or Units of Service 237 171 425 833 278 147 88.89

Unprocessable Claims

Unprocessable claims for the fourth quarter of fiscal year 2007.


Unprocessable Claims Totals for the Third Quarter of Fiscal Year 2007

Reason for Return or Reject
(Click the reason for return or reject to view information on how to correct the error)		 April May June Total for Qtr. Avg. 2nd Qtr 07 Avg. % Change
Missing/Incomplete/Invalid Group Practice Information 5,554 5,718 6,922 18,194 6,065 5,247 15.58%
Missing/Incomplete/Invalid Referring/Ordering Provider # 6,560 7,258 5,105 18,923 6,308 4,633 36.15%
Missing/Incomplete/Invalid Procedure Code 1,568 1,637 1,502 4,707 1,569 3,335 -52.95%
Missing/Incomplete/Invalid Place of Service Code 1,105 1,294 854 3,253 1,084 733 47.93%
Missing/Invalid Modifier 546 541 513 1,600 533 703 -24.13%
Missing/Incomplete/Invalid Charges 425 515 430 1,370 457 459 -0.51%
Missing/Incomplete/Invalid Entitlement Number or Name 515 495 438 1,448 483 677 -28.71%
Diagnosis Code is Truncated 313 343 309 965 322 492 -34.62%
Missing/Incomplete/Invalid Initial Treatment Date 586 318 244 1,148 383 274 39.66%
Missing/Incomplete/Invalid Days or Units of Service 206 189 104 499 166 NA NA

Unprocessable Claims

Unprocessable claims for the third quarter of fiscal year 2007.


Unprocessable Claims Totals for the Second Quarter of Fiscal Year 2007

Reason for Return or Reject
(Click the reason for return or reject to view information on how to correct the error)		 January February March Total for Qtr. Avg. 1st Qtr 07 Avg. % Change
Missing/Incomplete/Invalid Group Practice Information 5,349 5,172 5,219 15,740 5,247 6,515 -19.47%
Missing/Incomplete/Invalid Referring/Ordering Provider # 4,004 3,055 6,841 13,900 4,633 5,104 -9.22%
Missing/Incomplete/Invalid Procedure Code 4,653 3,126 2,226 10,005 3,335 1,723 93.56%
Missing/Incomplete/Invalid Place of Service Code 184 1,022 992 2,198 733 1,846 -60.31%
Missing/Invalid Modifier 772 722 614 2,108 703 1,219 -42.36%
Missing/Incomplete/Invalid Entitlement Number or Name 687 607 737 2,031 677 660 2.58%
Diagnosis Code is Truncated 645 398 433 1,476 492 478 2.93%
Missing/Incomplete/Invalid Charges 451 421 506 1,378 459 965 -52.40%
Missing/Incomplete/Invalid Initial Treatment Date 226 282 313 821 274 354 -22.69%
Diagnosis Code is Invalid 210 141 176 527 176 253 -30.57%

Unprocessable Claims

Unprocessable claims for the second quarter of fiscal year 2007.


Unprocessable Claims Totals for the First Quarter of Fiscal Year 2007

Reason for Return or Reject
(Click the reason for return or reject to view information on how to correct the error)		 October November December Total for Qtr. Avg. 4th Qtr 06 Avg. % Change
Missing/Incomplete/Invalid Group Practice Information 6,012 6,539 6,994 19,545 6,515 5,158 26.31%
Missing/Incomplete/Invalid Referring/Ordering Provider # 5,812 4,293 5,207 15,312 5,104 5,670 -9.98%
Missing/Incomplete/Invalid Place of Service Code 1,987 1,878 1,673 5,538 1,846 393 369.72%
Missing/Incomplete/Invalid Procedure Code 1,721 1,573 1,876 5,170 1,723 380 353.51%
Missing/Invalid Modifier 1,419 1,452 785 3,656 1,219 469 159.84%
Missing/Incomplete/Invalid Charges 1,923 546 426 2,895 965 1,689 -42.87%
Missing/Incomplete/Invalid Entitlement Number or Name 723 707 549 1,979 660 1,054 -37.41%
Diagnosis Code is Truncated 493 485 456 1,434 478 1,269 -62.33%
Missing/Incomplete/Invalid Initial Treatment Date 505 380 177 1,062 354 1,468 -75.89%
Diagnosis Code is Invalid 325 188 247 760 253 NA NA

Unprocessable Claims

Unprocessable claims for the first quarter of fiscal year 2007.


Unprocessable Claims Totals for the Fourth Quarter of Fiscal Year 2006

Reason for Return or Reject
(Click the reason for return or reject to view information on how to correct the error)		 July August September Total for Qtr. Avg. 3rd Qtr 06 Avg. % Change
Missing/Incomplete/Invalid Referring/Ordering Provider # 4,224 7,072 5,715 17,011 5,670 5,875 -3%
Missing/Incomplete/Invalid Group Practice Information 5,945 5,385 4,145 15,475 5,158 6,424 -20%
Missing/Incomplete/Invalid Charges 1,961 1,547 1,558 5,066 1,689 NA NA
Missing/Incomplete/Invalid Initial Treatment Date 1,467 1,493 1,444 4,404 1,468 411 257%
Diagnosis Code is Truncated 1,118 1,325 1,363 3,806 1,269 851 49%
Missing/Incomplete/Invalid Entitlement Number or Name 817 714 1,631 3,162 1,054 579 82%
Missing/Incomplete/Invalid Attending Provider Primary Identifier 629 730 592 1,951 650 272 139%
Missing/Invalid Modifier 587 531 290 1,408 469 1,645 -71%
Missing/Incomplete/Invalid Place of Service Code 324 370 485 1,179 393 1,407 -72%
Missing/Incomplete/Invalid Procedure Code 310 402 428 1,140 380 2,407 -84%

Unprocessable Claims

Unprocessable claims for the fourth quarter of fiscal year 2006.


Unprocessable Claims Totals for the Third Quarter of Fiscal Year 2006

Reason for Return or Reject
(Click the reason for return or reject to view information on how to correct the error)		 April May June Total for Qtr. Avg. 2nd Qtr 06 Avg. % Change
Missing/Incomplete/Invalid Group Practice Information 7,381 7,667 4,224 19,272 6,424 4,675 37.4%
Missing/Incomplete/Invalid Referring/Ordering Provider # 5,419 6,260 5,945 17,624 5,875 5,464 7.5%
Missing/Incomplete/Invalid Procedure Code 2,601 2,658 1,961 7,220 2,407 5,093 -52.7%
Missing/Incomplete/Invalid Date Patient Last Seen 2,163 1,316 384 3,863 1,288 2,278 -43.5%
Missing/Invalid Modifier 1,749 2,069 1,118 4,936 1,645 7,356 -77.6%
Missing/Incomplete/Invalid Place of Service Code 1,305 1,450 1,467 4,222 1,407 1,639 -14.1%
Diagnosis Code is Truncated 1,208 759 587 2,554 851 1,164 -26.9%
Missing/Incomplete/Invalid Entitlement Number or Name 496 611 629 1,736 579 578 0.1%
Missing/Incomplete/Invalid Initial Treatment Date NA 647 587 1,234 411 319 28.9%
Missing/Incomplete/Invalid Attending Provider Primary Identifier NA NA 817 817 272 NA NA

Unprocessable Claims

Unprocessable claims for the third quarter of fiscal year 2006.


Unprocessable Claims Totals for the Second Quarter of Fiscal Year 2006

Reason for Return or Reject
(Click the reason for return or reject to view information on how to correct the error)		 January February March Total for Qtr. Avg. 1st Qtr 06 Avg. % Change
Missing/Invalid Modifier 9,222 9,848 2,997 22,067 7,356 590 1146.7%
Missing/Incomplete/Invalid Referring/Ordering Provider # 4,526 4,813 7,053 16,392 5,464 4,803 13.8%
Missing/Incomplete/Invalid Procedure Code 6,784 4,843 3,653 15,280 5,093 2,272 124.2%
Missing/Incomplete/Invalid Group Practice Information 4,868 4,264 4,894 14,026 4,675 6,522 -28.3%
Missing/Incomplete/Invalid Date Patient Last Seen/Prov ID 1,799 1,793 3,241 6,833 2,278 3,236 -29.6%
Missing/Incomplete/Invalid Place of Service Code 1,441 1,567 1,908 4,916 1,639 1,452 12.9%
Diagnosis Code is Truncated 1,343 1,284 865 3,492 1,164 1,312 -11.3%
Missing/Incomplete/Invalid Entitlement Number or Name 548 513 672 1,733 578 559 3.3%
Diagnosis Code is Invalid 649 472 453 1,574 525 568 -7.6%
Missing/Incomplete/Invalid Initial Treatment Date 324 422 210 956 319 N/A N/A

Unprocessable Claims

Unprocessable claims for the second quarter of fiscal year 2006.


Unprocessable Claims Totals for the First Quarter of Fiscal Year 2006

Reason for Return or Reject
(Click the reason for return or reject to view information on how to correct the error)		 October November December Total for Qtr. Avg. 4th Qtr 05 Avg. % Change
Missing/Incomplete/Invalid Group Practice Information 7,629 5,668 6,269 19,566 6,522 5,417 20.4%
Missing/Incomplete/Invalid Referring/Ordering Provider # 4,629 4,645 5,136 14,410 4,803 5,070 -5.3%
Missing/Incomplete/Invalid Date Patient Last Seen/Prov ID 2,951 5,071 1,687 9,709 3,236 2,460 31.6%
Missing/Incomplete/Invalid Procedure Code 2,761 1,936 2,120 6,817 2,272 2,469 -8.0%
Missing/Incomplete/Invalid Place of Service Code 1,581 1,398 1,376 4,355 1,452 1,474 -1.5%
Diagnosis Code is Truncated 1,117 1,439 1,379 3,935 1,312 1,043 25.8%
Missing/Invalid Modifier 483 741 545 1,769 590 528 11.7%
Diagnosis Code is Invalid 458 506 741 1,705 568 549 3.5%
Missing/Incomplete/Invalid Entitlement Number or Name 574 538 564 1,676 559 N/A N/A
Missing/Incomplete/Invalid Charges 151 185 582 918 306 N/A N/A

Unprocessable Claims

Unprocessable claims for the first quarter of fiscal year 2006.


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 How to Avoid Common Claim Submission Errors

Submission Error Correction
Diagnosis Code is Truncated/Incorrect/Missing Item 21 - Enter the patient's diagnosis/condition. With the exception of claims submitted by ambulance suppliers (specialty type 59), all physician and non-physician specialties (i.e., PA, NP, CNS, CRNA) use an ICD-9-CM code number and code to the highest level of specificity for the date of service. Enter up to four diagnoses in priority order.
Missing/Incomplete/Invalid Attending Provider Primary Identifier

Missing/Incomplete/Invalid Date Last Seen

Missing/Incomplete/Invalid Date Patient Last Seen/Prov ID.		 Item 19 - Enter either a 6-digit (MM|DD|YY) or an 8-digit (MM|DD|CCYY) date patient was last seen and the UPIN (NPI when it becomes effective) of his/her attending physician when a physician providing routine foot care submits a claim.

For physical therapy, occupational therapy or speech-language pathology services, effective for claims with dates of service on or after June 6, 2005, the date last seen and the UPIN/NPI of an ordering/referring/attending/certifying physician or non-physician practitioner are not required. If this information is submitted voluntarily, it must be correct or it will cause rejection or denial of the claim. However, when the therapy service is provided incident to the services of a physician or non-physician practitioner, the incident to policies continue to apply.
Missing/Incomplete/Invalid Billing Provider/Supplier Secondary Identifier As of March 1, 2008, claims will be paid as long as there is an NPI/legacy match on the NPI crosswalk for primary provider fields. Claims will reject when there is not a match. You must correct any data which may be preventing an NPI/legacy match. See MLN Matters article SE0802.
Missing/Incomplete/Invalid Charges Verify that the billed amount, including cents, is entered correctly on the claim. Do not include special characters (i.e., dollar signs ($), decimal points(.), or dashes (-)).
Missing/Incomplete/Invalid Days or Units of Service Enter the number of days or units. This field is most commonly used for multiple visits, units of supplies, anesthesia minutes, or oxygen volume. If only one service is performed, the numeral 1 must be entered.

Some services require that the actual number or quantity billed be clearly indicated on the claim form (e.g., multiple ostomy or urinary supplies, medication dosages, or allergy testing procedures). When multiple services are provided, enter the actual number provided.

For anesthesia, show the elapsed time (minutes) in Item 24G. Convert hours into minutes and enter the total minutes required for this procedure.
Missing/Incomplete/Invalid Entitlement Number or Name Item 1a - Enter the patient's Medicare Health Insurance Claim Number (HICN) whether Medicare is the primary or secondary payer.

Item 2 - Enter the patient's last name, first name, and middle initial, if any, as shown on the patient's Medicare card.
Missing/Incomplete/Invalid Group Practice Information Item 33 - Enter the provider of service/supplier's billing name, address, zip code, and telephone number.

Item 33a - Effective March 1, 2008, and later, you MUST enter the NPI of the billing provider or group.

Item 33b - Enter the ID qualifier 1C followed by one blank space and then the PTAN of the billing provider or group. Effective May 23, 2008, and later, 33b is not to be reported.
Missing/Incomplete/Invalid Place of Service Code Item 24B - Enter the appropriate place of service code(s) from the list provided in Pub. 100-04, Medicare Claims Processing Manual, Chapter 26, §10.5.
Missing/Incomplete/Invalid Procedure Code Verify that a procedure code is present on the claim in item 24D. Verify the procedure code is valid for the date of service. Use the most current CPT and HCPCS coding manuals.
Missing/Incomplete/Invalid Referring/Ordering Provider # Item 17 - Enter the name of the referring or ordering physician if the service or item was ordered or referred by a physician.

Item 17a - Enter the ID qualifier 1G, followed by the CMS assigned UPIN of the referring/ordering physician listed in item 17.

Item 17b - Enter the NPI of the referring/ordering physician listed in item 17.

Note: Item 17a and/or 17b is required when a service was ordered or referred by a physician. Effective May 23, 2008, and later, 17a is not to be reported but 17b MUST be reported when a service was ordered or referred by a physician.
Missing/Incomplete/Invalid Initial Treatment Date Item 14 - For chiropractic services, enter a 6-digit (MM|DD|YY) or 8-digit (MM|DD|CCYY) date of the initiation of the course of treatment and enter a 6-digit (MM|DD|YY) or 8-digit (MM|DD|CCYY) date in item 19.
Missing/Invalid Modifier Verify the modifier is present and valid for the procedure code billed. Refer to the Modifier Reference Guide Adobe PDF Document - Click Here for Download Instructions.


Detailed descriptions of Remittance Advice Remark Codes (seen in the glossary section of the remittance) can be found on the Washington Publishing Company Web site at www.wpc-edi.com/codes.
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This page updated
May 2, 2008
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