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Paper Claim Rejection Reminders

We have recently been seeing a higher than normal volume of errors on paper claims. To help ensure that claims are processed quickly and correctly, please check the following before submitting the claim:

  • Avoid handwritten claims

  • All information must be submitted as clearly as possible, such as using uppercase characters

  • Validate the address, city, state and ZIP code against the United States Postal Service (USPS) database

    • URL:  https://tools.usps.com/go/ZipLookupAction_input

    • Both primary and secondary/alternative city names will be accepted
      Example of primary city (ex: Baldwinsville) and secondary city (ex: Lysander) name

    • Never use city names that are listed on the CITY NAMES TO AVOID list
      Examples of city names to avoid: Belgium NY, Radison NY, Radisson NY, Van Buren NY

    • If a city name has spaces, the claim submission needs to match the USPS format exactly
      Recommended city name: Le Roy. City name to avoid: LeRoy.

    • Abbreviations are only accepted if listed as a valid city name and must match USPS exactly
      Recommended city name: De Kalb Junction. Abbreviated name: De Kalb JCT.
      Recommended city name: East Rochester. Abbreviated city name: E Rochester.

If a rejection is received, please make the needed corrections and print a new claim.

  • Do not cross out or correct data on the original copy of the claim submitted for processing

  • Do not resubmit the correction with the return letter or the original claim as this will make it appear as if two claims are being submitted.

  • The field causing the rejection will have parentheses (xxx) around the incorrect data.

Examples:

  1. The ZIP code is invalid for the submitted city (13118) and state (NY)
    Billed as: 13118   NY   13071
    This is a provider billing error. You will need to submit a new claim with the correct city name.
     
  2. The ZIP code is invalid for the submitted city (EASL* SYRACUSE) and state (NY).
    Billed as: east syracuse,   ny   13057
    (East Syracuse, NY 13057 is correct)
    This is a payer error due to lower case letters looking similar. You will need to resubmit using all uppercase characters to ensure accuracy.
    *Correct spelling is East Syracuse

     

  3. The ZIP code is invalid for the submitted city (B’VILLE) and state (NY).
    Billed as: B'VILLE,   NY   13027
    (Baldwinsville, NY 13027 is correct)
    This is an invalid abbreviation for the city. You will need to resubmit spelling out the full city name.

 
 
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