Code

Description

Severity

Notes

1003

No valid client payers for service, remaining balance will be written off

WARNING

No client Payers valid on the date of Service are found. Any remaining balance for this Service will be written off. Navigate to Clients > Payers to review.

1005

Prior payment is missing a pccn

WARNING

A corrected claim, type 7 claim, is being submitted but the prior payment PCCN is missing. The value in the REF*F8 segment of the 837 or Box 22 Original Submission Code of the CMS1500 is missing.

1106

The charge strategy for this service is missing a default rate

WARNING

No default rate is set up for the Service. Navigate to Configuration > Services/Payers > Service Definitions > Rates to verify a default Rate exists. Then navigate to Payers > Rates to verify that the Service Definition is billable to the Payer, and if a Payer override exists, it is active for the date of the Service.

1203

Payer skipped due to invalid credentials

WARNING

There are no valid credentials for the skipped Payer. To view the credentials setup for the Payer navigate to Configuration > Services/Payers > Payers > Processing and view the settings for Only Bill for These Staff Credentials.

1301

Copay processed with no active Self Pay Payer

WARNING

There is a Payer setup with a Client Co-Pay, and no Self Pay Payer setup or valid on the date of Service. Navigate to Clients > Payers to review the Payers setup and effective dates. 

1302

Self Pay Payer has no active Guarantors

WARNING

The Client is missing a guarantor, or the Guarantor effective dates are outside the Service Date. To review and/or to add a guarantor, navigate to Clients > Payers and select the Self Pay Payer to view the current setup.

1304

Skipping payer due to negative charge balance

WARNING

The Payer setup, configuration, or other factors are causing a zero or negative charge balance. Navigate to the Claims menu to view the Service Status and Charge Status throughout the billing process. Use the search options to locate the service, click the service line to view claim detail. Additional information can be viewed by clicking the "Show Re-Processed Charges" option at the top right side of the screen.

1305

Payer skipped as payer does not accept this Direct Fee Service

WARNING

Navigate to Configuration > Services/Payers > Service Definitions or Payers to review the Rates configured for the Service Definition default and/or Payer rate.

1402

Payer skipped due to invalid diagnoses

WARNING

The Payer was skipped due to invalid diagnoses attached to the Service. To view Billable Payer Diagnoses, navigate to Configuration > Services/Payers > Payers > Processing and review the listed billable diagnoses or confirm that Bill for Any Diagnosis is listed. The Diagnosis Error Action may also be viewed or updated.

1403

All diagnoses for this service are invalid for this payer

WARNING

Invalid diagnosis is attached to this Service. To view Billable Payer Diagnoses, navigate to Configuration > Services/Payers > Payers > Processing and review the listed billable diagnoses or confirm that Bill for Any Diagnosis is listed. The Diagnosis Error Action may also be viewed or updated.

1404

Service Diagnosis not allowed for Payer

WARNING

The Diagnosis attached to the Service is not allowed for the Payer. To view Billable Payer Diagnoses, navigate to Configuration > Services/Payers > Payers > Processing and review the listed billable diagnoses or confirm that Bill for Any Diagnosis is listed. The Diagnosis Error Action may also be viewed or updated.

1600

Required Authorization Missing for Payer

WARNING

The Payer requires authorization to bill Services and an authorization is not found. A Charge creates, skips to the next Payer, or is put on hold based on the settings in the Clients > Payers When no authorizations are found section.  

1601

Required Authorization Missing for Payer and Service Date

WARNING

The Payer requires authorization to bill Services and an authorization effective as of the Service date is not found. A Charge creates, skips to the next Payer, or is put on hold based on the settings in the Clients > Payers When no authorizations are found section. This warning specifically references the Service Date, if an authorization does exist for the Client, check the authorization dates to ensure the Service Date is covered.     

1602

Insufficient Authorized Units available for Payer and Service Date

WARNING

The Payer requires authorization to bill Services and the Service entered has violated the authorization because the remaining Authorized units are insufficient. To review and update Client authorizations, navigate to the Clients > Payers and scroll to the Authorizations section. This warning specifically references the Service Date, if an authorization does exist for the Client, check the authorization dates to ensure the Service Date is covered.

1603

Authorized Units for Payer and Service Date have been overallocated

WARNING

The Payer requires authorization to bill services and the number of authorized units for this Payer and Service Date has been overallocated.  To review and update Client authorizations, navigate to Clients > Payers and scroll to the Authorizations section. This warning specifically references the Service Date, if an authorization does exist for the Client, check the authorization dates to ensure the Service Date is covered.

1604

Insufficient Authorized Visits available for Payer and Service Date

WARNING

The Payer requires authorization to bill Services and this Service exceeds the remaining number of authorized visits. To review and/or correct go to Client > Payers > Authorizations. This warning specifically references the Service Date, if an authorization does exist for the Client, check the authorization dates to ensure the Service Date is covered.   

1605

Authorized Visits for Payer and Service Date have been overallocated

WARNING

The Payer requires authorization to bill Services and the number of authorized visits for this Payer and Service Date has been overallocated. To review and update Client authorizations, navigate to Clients > Payers and scroll to the Authorizations section. This warning specifically references the Service Date, if an authorization does exist for the Client, check the authorization dates to ensure the Service Date is covered.

1606

Insufficient Authorized Dollars available for Payer and Service Date

WARNING

The Payer requires authorization to bill services and this Service exceeds the remaining dollar amount for authorized visits. To review and update Client authorizations, navigate to Clients > Payers and scroll to the Authorizations section. This warning specifically references the Service Date, if an authorization does exist for the Client, check the authorization dates to ensure the Service Date is covered.

1607

Authorized Dollars for Payer and Service Date have been overallocated

WARNING

The Payer requires authorization to bill Services and the remaining dollar amount for Services for this Payer and Service Date has been overallocated. To review and update Client authorizations, navigate to Clients > Payers and scroll to the Authorizations section. This warning specifically references the Service Date, if an authorization does exist for the Client, check the authorization dates to ensure the Service Date is covered.

1608

Service component codes did not match any authorization defined filters

WARNING

The Payer requires authorization to bill Services, but the Service component codes do not match any of the Defined Filters used by the authorizations. To review and update Client authorizations, navigate to Clients > Payers and scroll to the Authorizations section.

1610

Authorization Date Range does not match Service Date Range. Authorization not used.

WARNING

An authorization exists for the Service, but the Service Date does not fall within the authorization date range.

1800

Client missing Household Size or Gross Monthly Income. Client fee adjustment could not be created

WARNING

Review information in the Clients > Household tab.

1801

Sliding fee is not currently active. Client fee adjustment could not be created

WARNING

Review active date range for the Client Fee in Clients > Payers by selecting the Self Pay Payer. Also, review the active date range for the Sliding Fee table in Configuration > Services/Payers > Sliding Fees.

1802

Multiple sliding fees active, please end date all but one. Client fee adjustment could not be created

WARNING

Review the setup for the Sliding Fee in Configuration > Services/Payers > Sliding Fees.

3011

Missing staff NPI

WARNING

The Staff Member providing service is missing NPI (National Provider Identification Number) in Staff Files. To review and/or add the missing NPI navigate to Configuration > Staff/Users > Staff > Profile > Default NPI. 

3020

Referring Provider Missing

WARNING

This error is reported when the Client has no Enrollments or No Active Enrollments that match the Service when creating an 837P with the Report Referring Provider (Loop 2310A) checkbox selected in Configuration > Services/Payers > Payers > Billing Methods 837P config.