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Availity® Health Information Network
Batch Electronic Data Interchange (EDI)
Companion Guides
Payer Specific Transaction Edits
Version 11.08 - Updated 08/20/2011
Availity, L.L.C.
P.O. Box 550857
Jacksonville, FL 32255-0857
August 2011
Payer Specific Updates
Error Codes Error Messages Error Descriptions Updates Loop Element Trans
Types
3938afb Service Line Date is required on outpatient claims. Segment DTP (Service Line Date) is missing. It is
required on outpatient claims when revenue, procedure,
HIEC or drug codes are reported in the SV2 segment.
New Edit
68050, 68053
68057, 68058
SHP11
2400 DTP03 837I
3938b51 Last Menstrual Period may be used only for female patient. Segment DTP (Date - Last Menstrual Period) is used. It is
not expected to be used when patient is not female
(element DMG03 in loop 2010BA is not 'F').
Payers Added
68050, 68053
68057, 68058
SHP11
2300 DTP03 837P
prof.SFB The patient (2010CA) or subscriber (2010BA) first and last name fields can contain letters and
spaces only. Special characters are not allowed.
Special characters are not allowed in the
subscriber/patient name fields.
Edit Relaxed
68050, 68053
68057, 68058
SHP11
2010BA NM103
NM104
837P
S206P The date of the last menstrual period (loop 2300, DTP*484) cannot be the same as the onset
of similar symptoms or illness (loop 2300, DTP*438).
The date of the last menstrual period (loop 2300,
DTP*484) cannot be the same as the onset of similar
symptoms or illness (loop 2300, DTP*438).
New Edit
68050, 68053
68057, 68058
SHP11
2300 DTP03 837P
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Error Codes Error Messages Error Descriptions Loop Element Trans
Types
Payers
810021 Element has a data type of ‘Numeric’ R. Leading zeros are not allowed. Leading zeros are not allowed. 2320 AMT*B6
CAS03
CAS04
837P
837I
38520, 57106
61125, 00720
00220
810021 Element has a data type of ‘Numeric’ R. Leading zeros are not allowed. Leading zeros are not allowed. 2430 CAS03
SVD02
SVD05
837P
837I
38520, 57106
61125, 00720
00220
810021 Element has a data type of ‘Numeric’ R. Leading zeros are not allowed. Leading zeros are not allowed. 2410 CTP03
CTP04
837P
837I
38520, 57106
61125, 00720
00220
810021 Element has a data type of ‘Numeric’ R. Leading zeros are not allowed. Leading zeros are not allowed. 2000B
2000C
PAT08 837P
837I
38520, 57106
61125, 00720
00220
810021 Element has a data type of ‘Numeric’ R. Leading zeros are not allowed. Leading zeros are not allowed. 2400 SV104 837P 38520, 57106
61125, 00720
00220, 59274
75137
810021 Element has a data type of ‘Numeric’ R. Leading zeros are not allowed. Leading zeros are not allowed. 2400 SV205 837I 38520, 57106
61125, 00720
00220, 59274
810021 Sub-Element HI01-05 has a data type of 'Numeric' R. Leading zeros are not allowed. Leading zeroes not allowed 2300 HI 837I 00611, 00851
00932, 93221
810024 Element CLM12 is a coded list element. Code '02' is not allowed. Element CLM12 is a coded list element. Code '02' is not allowed. 2300 CLM12 837P 00720
810024 Element SV103 is a coded list element. Code 'F2' is not allowed. Element SV103 is a coded list element. Code 'F2' is not allowed. 2400 SV103 837P 00720
810024 Element SV204 is a coded list element. Code 'F2' is not allowed. Element SV204 is a coded list element. Code 'F2' is not allowed. 2400 SV204 837I 00220
810062 An invalid code value was encountered. An invalid code value was encountered. 2300 CLM11 837P 00720
3939321 Value of element CAS02 is incorrect. Expected value is from external code list - Adjustment
Reason Code 139
Claim Adjustment Reason Code must be valid based upon the
code list.
2430 CAS02 837P
837I
94036, 00934
93093, 26374
26375, 26378
3939331 Value of element PRV03 is incorrect. Expected value is from external code list - Health Care
Provider Taxonomy Code (682). Segment PRV is defined in the guideline at position 003.
When present, the taxonomy code in PRV03 must be valid. 2000A, 2310A
2310B, 2420F
PRV03 837P
837I
01260, NIA11
SHP11, 68050
68053, 05130
WA001, OR001
00835, 00831
03102, AK001
00836, 26374
26375, 26378
39393fa Value of element CAS has been already used. Claim Adjustment Reason Codes are
expected to have unique values within segment CAS.
Claim Adjustment Reason Codes cannot be duplicated within the
same CAS category.
2320 CAS 837I
837P
14163
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Error Codes Error Messages Error Descriptions Loop Element Trans
Types
Payers
3939342 Value of element N403 is incorrect. Expected value is from external code list - ZIP Code (51)
when country is US. Segment N4 is defined in the guideline at position 030.
Must be a valid US Postal Service Zip Code. 2010AA, 2010AB
2010BA, 2010BB
2010BC, 2010CA
2310D, 2330A
2420C, 2420E
N403 837P 05130, WA001
OR001, 00835
00831, 03102
AK001, 00836
3939345 Value of element REF02 (Universal Product Number (UPN)) is incorrect. Expected value is
Universal Product Code (format is 12-14 digits where the last one is a check digit) when
REF01='OZ'.
When the Universal Product Number (UPN) (REF02) is incorrect;
the expected value is Universal Product Code (format is 12-14
digits where the last one is a check digit)
2400 REF02 837P 38520, 57106
61125, 00934
93093, AIDWA
3939381 Value of element REF02 (CLIA Identification) is incorrect. CLIA number format is 10
characters where the third character is the letter ‘D’.
CLIA ID is invalid. 2300 REF02=X4 837P 14163, 14164
01260, NIA11
CNTNM, 80705
63665, 66893
95379, 95388
95412, 95569
AIDWA, 91121
91051
3939382 Value of element REF02 (Universal Product Number (UPN)) is incorrect. Expected value is
Universal Product Code (format is 12-14 digits where the last one is a check digit)
When the Universal Product Number (UPN) (REF02) is incorrect;
the expected value is Universal Product Code (format is 12-14
digits where the last one is a check digit)
2400 REF02 837P 68050, 68053
68057, 68058
SHP11
3939384 Value of element AMT02 (Patient Estimated Amount Due) is incorrect. It may not be more than
value of element CLM02.
When the Patient Estimated Amount Due (AMT02) is incorrect; it
cannot be more than the total claim charge (CLM02).
2300 AMT02 837I 68050, 68053
68057, 68058
SHP11
3939386 Statement Dates is invalid. Statement Dates is invalid. 2300 DTP03 837I 00220
3939388 Date Last Seen is invalid: it is after Transaction Creation Date. Edit relaxed to allow future DOS 2300 DTP03 837P 04102, 04202
04302, 04402
00904, 04301
00882
3939389 Statement thru date is after transaction create date Statement thru date must not be after the file submission date 2400 DTP*472 837I 14163, 14164
SHP11, 68057
68053, 68050
68058
3939391 Value of element REF02 (Rendering Provider Secondary ID) is incorrect. Expected value is
Social Security Number (format is '9 digits or '000-00-0000'') when REF01='SY'.
Value of element REF02 (Rendering Provider Secondary ID) is
incorrect. Expected value is Social Security Number (format is '9
digits or '000-00-0000'') when REF01='SY'.
2010AA
2310B
REF02 837P 11345
3939392 Value of element REF02 (Referring Provider Secondary ID) is incorrect. Expected value is
UPIN (format is '1 alpha and 5 digits; or one of the values RES000, VAD000, PHS000,
RET000, INT000, SLF000, OTH000') when REF01='1G'
The UPIN is invalid 2310A REF02 837P AIDID, AIDWA
3939393 Value of element NM109 does not look like a valid Social Security Number according SSA
requirements.
If Social Security number (REF02=SY) is indicated, the number
should meet Social Security Administration enumeration
requirements.
2010AA, 2010AB
2010BA, 2010CA
2310A, 2310B
2310C, 2310E
2330A, 2330C
2420A, 2420B
2420D, 2420E
2420F
NM109 837P
837I
14163, 14164
3939396 Value of element NM102 is incorrect. Expected value is ‘1’ when Subscriber is the same
person as patient.
SBR02=18 (2000B) is present, then NM102 (2010BA) should be
a ‘1’
2000B
2010BA
SBR02 837P
837I
26374, 26375
26378, 77027
SHP11, 68057
68053, 68050
680583939396 Value of element NM102 is incorrect. Expected value is ‘1’ when the subscriber is the same
person as patient
Subscriber must be listed as an entity code ‘1’. 2010BA NM102 837P
837I
14163, 14164
77027
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Error Codes Error Messages Error Descriptions Loop Element Trans
Types
Payers
3939453 The value of element DTP03 (Service Date) is incorrect. Expected value for date or start
period date should be a date earlier than the Claim Adjustment date specificed in loop 2330B.
Service date must be earlier than the primary payment paid date. 2330B DTP 837P CNTNM, 68050
68053, 68057
68058, SHP11
3939460 Value of element SBR01 is incorrect. Primary payer is not specified (elements SBR01 in loops
2000B/2320 do not have 'P' value). It's expected to be used when other payers are known to
be involved.
There must be a primary payer specified on claim. 2000B
2320
SBR01 837P
837I
80705, 63665
66893, 95379
95388, 95412
95569, 68057
68053, 68050
68058, SHP11
3939461 Value of element SBR01 is incorrect. Secondary payer is not
specified (elements SBR01 in loops 2000B/2320 do not have 'S' value).
It is expected to be used when tertiary payers are known to be involved.
SBR01 is incorrect. Secondary payer is not specified. 2000B/2320 SBR01 837P
837I
80705, 63665
95379, 95388
95412, 95569
66893
3939472 Value of element BHT04 (Transaction Set Creation Date) is incorrect. Expected value is Date
in format '19, 20 or 21 century'.
When the transaction creation date is prior to 1800, the claim will
be rejected.
BHT BHT04 837P
837I
PRINT, 68057
68053, 68050
68058, SHP11
3939472 Value of element DMG02 (Subscriber Birth Date) is incorrect. Expected value is Date in format
'19, 20 or 21 century'. Segment DMG is defined in the guideline at position 032.
When the subscriber date of birth is prior to 1800, the claim will be
rejected.
2010BA DMG02 837P
837I
HPN11, GTPA1
MCA11, VFP11
INET1. KLSY1
SCOK1. WITH1
TX1ST, NWDC1
PPMO1, FMCHP
SSC11, CIPA1
KMG11, GHEDI
AIDWA
3939472 Value of element DTP03 (Date - Initial Treatment) is incorrect. Expected value is Date in format
'19, 20 or 21 century'.
When the date of initial treatment is prior to 1800, the claim will be
rejected.
2300 DTP03 837P 10207, PRINT
3939472 Value of element DTP03 (Date - Onset of Current Illness/Symptom) is incorrect. Expected
value is Date in format '19, 20 or 21 century'.
When the onset of current illness/symptom date is prior to 1800,
the claim will be rejected
2300 DTP03 837P
837I
PRINT, AIDWA
3939472 Value of element DTP03 (Service Line Date) is incorrect. Expected value is Date in format '19,
20 or 21 century'. Segment DTP is defined in the guideline at position 455.
When the service line date is prior to 1800, the claim will be
rejected
2400 DTP03 837P
837I
PRINT, AIDWA
3939600 Value of sub-element is incorrect. E-code can not be used as Primary/Admitting/’Reason for
Visit’ diagnosis code.
Diagnosis codes beginning with ‘E’ are not allowed as the primary
diagnosis code.
2300 HI 837P
837I
14163, 14164
SHP11, 68057
68053, 68050
68058
3939612 HCPCS Procedure Code is invalid in Principal Procedure Information. HCPCS Procedure Code is invalid in Principal Procedure
Information.
2300 HI 837I 00220
3939615 Value of sub-element SV202-2 is incorrect. Expected value is from external code list - HIPPS
Code when SV202-01=ZZ
Product Service ID must be valid based upon the code list 2400 SV202-2 837I 94036, 80705
63665, 66893
95379, 95388
95412, 95569
3939642 Composite HI02 is used. It's not expected to be used when composite HI01 is missing. Diagnosis codes must be in consecutive order. 2300 HI 837I 00932, 00851
00611, 93221
SHP11, 68057
68053, 68050
68058, 26374
26375, 26378
8220001 If CLM20 = '11' (Other) then additional documentation is required using the NTE or PWK
segments. If the PWK segment is used, PWK02 must not be 'AA'.
If Delay Reason Code is Other (CLM20 = '11') then additional
documentation is required.
2300 CLM20 837P 00720
8220001 If CLM20 = '11' (Other) then additional documentation is required using the NTE or PWK
segments. If the PWK segment is used, PWK02 must not be 'AA'.
If Delay Reason Code is Other (CLM20 = '11') then additional
documentation is required.
2300 PWK 837I 00220
8220001 If CLM20 = '11' (Other), then PWK02 must not be 'AA'. If Delay Reason Code is Other (CLM20 = '11') then report
transmission code can not be 'Available on Request at Provider
Site'.
2300 CLM20
PWK02
837P
837I
00720, 00220
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Error Codes Error Messages Error Descriptions Loop Element Trans
Types
Payers
8220001 Not Covered/Denied Amount cannot exceed the Service Line Charge Amount. Not Covered/Denied Amount cannot exceed the Service Line
Charge Amount.
2400 SV207 837I 00220
8220001 Only 'BR' should be used for Principal Procedure Qualifier. Only 'BR' should be used for Principal Procedure Qualifier. 2300 HI 837I 00220
8220001 Principal Procedure Date must be within the Statement Dates or equal to/greater than the
Admission Date.
Principal Procedure Date must be within the Statement Dates or
equal to/greater than the Admission Date.
2300 HI 837I 00220
8220001 Service Date DTP03 must be greater than or equal to Patient's Date of Birth. Service Date DTP03 must be greater than or equal to Patient's
Date of Birth.
2400 DTP03 837P 00720
8220001 SV104 Quantity, zero '0' is not a valid value. Zero '0' is not a valid value for quantity (SV104). 2400 SV104 837P 00720
8220001 The Patient Paid Amount (AMT02) must not exceed the Claim Charge Amount (CLM02). The Patient Paid Amount (AMT02) must not exceed the Claim
Charge Amount (CLM02).
2300 AMT 837I 00220
C113P The billing provider tax ID (2010AA, REF02) and the rendering provider tax ID (2310B, REF02)
must be identical.
The billing provider tax ID and the rendering provider tax ID must
be identical.
2010AB REF02 837P 53589
D102I Claim should not have a negative submitted charge amount (SV203) at the service
line (loop 2400). All values should be zero or a positive number
Claim charge cannot have a negative amount. 2400 SV203 837I 07003
D102P Claim should not have a negative submitted charge amount (SV102) at the service line (loop
2400). All values should be zero or a positive number
Claim charge cannot have a negative amount. 2400 SV102 837P 07003
0x39392ec Element PER07 is used. It is expected to be used only when element PER05 is used. Contact Information fields must not be skipped. 2010AA PER07 837P
837I
77027
3938aef Segment DTP is missing. It is required when claim was adjudicated and loop 2430 is not used Segment DTP is missing. It is required when claim was
adjudicated and loop 2430 is not used
2330B DTP 837I
837P
68050, 68053
68057, 68058
SHP11
3938aef Segment DTP is missing. It is required when claim was adjudicated and loop 2430 is not used. Claim Adjudication date is required when payer identified has
previously adjudicated the claim. The claim adjudication date is
also known as the EOB date or Check date.
2330B DTP 837P 14163, 14164
77027
3938aef Segment DTP is missing. It is required when claim was adjudicated and loop 2430 is not used Claim Adjudication date is required when line level adjudication
segment is not used. Claim Adjudication date at claim level is
required.
2320 DTP 837I
837P
CNTNM
3938af0 Segment AMT (COB Payer Paid Amount) is missing. It's expected to be used when segment
CAS is used (claim has been adjudicated).
Segment AMT (COB Payer Paid Amount) is missing. It's
expected to be used when segment CAS is used (claim has been
adjudicated).
2320 AMT02 837P 63665, 66893
80705, 95379
95388, 95412
95569
3938b00 Segment CRC (EPSDT Referral) is missing. Segment CRC for EPSDT Referral is required when CLM12 is
‘01’
2300 CRC 837P 38520, 57106
61125, 95827
HCDPBC
3938b00 Segment CRC (EPSDT Referral) is missing. It is required when element CLM12 is '01'. CRC Segment is missing 2300 CLM12 837P 35174, 95827
HCDPBC
3938b00 Segment CRC (EPSDT Referral) is missing. It is required when element CLM12 is '01'. CLM12 = ‘01’ (EPSDT), but 2300 CRC segment for EPSDT
Referral (CRC01 = ‘ZZ’) is missing.
2300 CRC 837P SHP11, 68053
68050, 95827
HCDPBC, 61160
3938b00 Segment DTP (Date - Last X-ray) is missing. It is required when element CR212 is 'Y' X-ray date (DTP01 = 455) is required when spinal manipulation is
indicated.
2300 DTP 837P 77027
3938b02 Segment CRC (DMERC Condition Indicator) is missing. It is required when segment CR3 is
used.
If DME certification (2400,CR3) is present on the claim, then the
DMERC Condition Indicator (2400,CRC) is required.
2400 CRC 837P 68050, 68053
68057, 68058
SHP11
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Error Codes Error Messages Error Descriptions Loop Element Trans
Types
Payers
3938b0f Segment DMG is missing. It is required when Other Subscriber is a person (NM102 in loop
2330A is '1')
Other subscriber demographic information is required when Other
Subscriber is a person (2330A, NM102 is 1).
2320 DMG 837P
837I
38520, 57106
61125, WA001
00835, 00836
HPN11, GTPA1
MCA11, VFP11
INET1. KLSY1
SCOK1. WITH1
TX1ST, NWDC1
PPMO1, FMCHP
SSC11, CIPA1
KMG11, GHEDI
71063, TOPA1
AZ001, 03102
00831, 05130
OR001, 04120
04202, 04302
04402, 00952
00953, 13350
09102, 94036
3938b10 Subscriber Demographic Information is required when Subscriber is a Patient. When subscriber is the patient, date of birth and gender is
required.
2000B DMG 837P 95827, HCDPBC
3938b13 Segment REF is missing. It is required when elements NM108/09 are not used in this loop. Referring provider tax id is required when NM108/09 are missing. 2310A REF02 837P 14163, 14164
3938b4d Segment REF (Original Reference Number (ICN/DCN)) is used. It is not expected to be used
when CLM05-03 is not '7','8','X' or 'Y'
Original Reference Number (ICN/DCN)' should only be used
when the 'Claim Submission Reason Code' (CLM05-3) is 7, or 8
2300 REF = F8 837P 80705, 63665
66893, 95379
95388, 95412
95569, 14163
14164, SHP11
68053, 68057
68058
3938b4d Segment REF (Original Reference Number (ICN/DCN)) is used. It is not expected to be used
when CLM05-03 is not '7','8','X' or 'Y'.
Segment REF (Original Reference Number (ICN/DCN)) is used. It
is not expected to be used when CLM05-03 is not '7','8','X' or 'Y'.
2300 REF 837P 68050, 68053
68057, 68058
SHP11
3938b51 Segment DTP (Date - Last Menstrual Period) is used. It is not expected to be used when
patient is not female (element DMG03 in loop 2010BA is not 'F').
Last Menstrual Period date can only be present when Subscriber
Gender code is Female.
2010BA DMG03 837P 80705,63665
66893,95379
95388,95412
95569, 95827
HCDPBC
3938b60 Segment PAT is used. It is expected to be used only when Subscriber is the same person as
Patient (loop 2000B, SBR02 = '18').
Segment PAT is used. It is expected to be used only when
Subscriber is the same person as Patient (loop 2000B, SBR02 =
'18').
2000C PAT 837P SHP11, 68057
68053, 68050
68058
3938bb4 Segment AMT (Coordination of Benefits (COB) Patient Responsibility Amount) is missing. It is
required if patient is responsible for payment according to another payer's adjudication (CAS01
with 'PR' is used in loop 2320).
Segment AMT (COB Patient Responsibility Amount) is missing.
It's required if patient is responsible for payment according to
another payer's adjudication (CAS01 with 'PR' is used in loop
2320).
2320 AMT 837P
837I
80705, 63665
66893, 95379
95388, 95412
95569, NANPR
NAELM, NAHOI
NAHIN, NAHLX
NAING, NANWC
NAOAK, NASCR
NASWD, 14163
16164, CNTNM
3938bc5 Segment REF (Billing Provider Secondary Identification) is missing. Either EIN or SSN of
Provider must be carried in this REF segment when NM108 is 'XX'.
Segment REF (Billing Provider Secondary Identification) is
missing.
2010AA REF01 837P 48145, 95827
HCDPBC
3938bc5 Segment REF (Pay-To Provider Secondary Identification) is missing. Either EIN or SSN of
Provider must be carried in this REF segment when NM108 is 'XX'.
Segment REF (Pay-To Provider Secondary Identification) is
missing
2010AB REF01 837P 48145, 95827
HCDPBC
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Error Codes Error Messages Error Descriptions Loop Element Trans
Types
Payers
3938c4c Loop 2320 is missing. It's expected to be used when other payers are known to be involved in
paying claim (SBR01 is 'S' or 'T').
Other payer information was received on the claim, but
information about the subscriber in the 2320 Loop was missing.
2320 SBR01 837P
837I
01260, NIA11
77027, 00934
93093, SHP11
68057, 68053
68050, 68058
94036
3938c57 Loop 2310C is missing. It is required when segment AMT (Total Purchased Service Amount) is
used
The Purchased Service Provider Name is required when the Total
Purchased Service Amount (2300 AMT*NE) is present.
2310C AMT01 837P 38520, 57106
61125, 35174
68050, 68053
68057, 68058
SHP11, 38338
HPN11, GTPA1
MCA11, VFP11
INET1. KLSY1
SCOK1. WITH1
TX1ST, NWDC1
PPMO1, FMCHP
SSC11, CIPA1
KMG11, GHEDI
71063, TOPA1
3938c58 Loop 2310B (Rendering Provider Name) is missing. It is expected to be used when loop
2420A is used with the same value in every loop 2400.
Loop 2310B (Rendering Provider Name) is missing. It is expected
to be used when loop 2420A is used with the same value in every
loop 2400.
2310B NM1 837P SHP11, 68057
68053, 68050
68058
3938c5f Loop 2420D (Supervising Provider Name) is used. It is not expected to be used when loop
2310E is not used.
Loop 2420D (Supervising Provider Name) is used. It is not
expected to be used when loop 2310E is not used.
2420D NM1 837P SHP11, 68057
68053, 68050
68058
3938c6b Loop 2430 (Line Adjudication Information) is used. It is not expected to be used when loop
2320 is not used.
Loop 2430 (Line Adjudication Information) is used. It is not
expected to be used when loop 2320 is not used.
2430 CAS
SVD
837P 00720
3938c7e Loop 2310E is missing. It is required when Billing/Pay-To Provider address is PO Box Loop 2310E is missing. It is required when Billing/Pay-To Provider
address is PO Box
2310E N3 837I LS328
3938ed5 Claim balancing is failed: total charge amount (CLM02) does not equal sum of line charge
amounts (SV102).
Claim balancing is failed: total charge amount (CLM02) does not
equal sum of line charge amounts (SV102).
2400 SV102 837P 00720, 10775
11345
3938ed5 COB service line balancing is failed : charge amount (SV102) does not equal sum of paid
amount (SVD02) and all line adjustment amounts (CAS)
COB service line balancing CLM02 SV102 837P 10775
3938edc COB claim balancing has failed (NM109 in loop 2330B): total charge amount (CLM02) does
not equal sum of paid amount (AMT02 in loop 2320) and all adjustment amounts (CAS in 2320
and 2430)
COB claim balancing has failed (NM109 in loop 2330B): total
charge amount (CLM02) does not equal sum of paid amount
(AMT02 in loop 2320) and all adjustment amounts (CAS in 2320
and 2430)
2320 AMT02 837I
837P
68050, 68053
68057, 68058
SHP11, D0328
00220, 00720
07003
3938edc COB claim balancing is failed for payer (NM109 in loop 2330B): total charge amount (CLM02)
does not equal sum of paid amount (AMT02 in loop 2320) and all adjustment amounts (CAS in
2320 and 2430).
COB Service Line Balancing Failed for payer - Total Charge
amount (CLM02) does not equal sum of paid amount (AMT02 in
Loop 2320) and all adjustment amounts (CAS in 2320 and 2430)
2320 AMT02 837P
837I
94036, 77027
00934, 93093
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3938edd COB service line balancing is failed : charge amount (SV102) does not equal sum of paid
amount (SVD02) and all line adjustment amounts (CAS). Segment SVD is defined in the
guideline at position 540.
COB Service Line Balancing Failed
Charge amount (SV102) does not equal sum of paid amount
(SVD02) and all lines adjustment amounts (CAS).
2300
2430
2430
SV102
SVD02
CAS
837P 00611, 00851
00932, 01260
93221, 68053
NIA11, 26374
26375, 26378
SHP11, 68050
14163, 14164
NANPR, NAELM
NAHOI, NAHIN
NAHLX, NAING
NANWC, NAOAK
NASCR, NASWD
00934, 93093
HPN11, GTPA1
MCA11, VFP11
INET1. KLSY1
SCOK1. WITH1
TX1ST, NWDC1
PPMO1, FMCHP
SSC11, CIPA1
KMG11, GHEDI
71063, TOPA1
3938edd COB service line balancing is failed : charge amount (SV102) does not equal sum of paid
amount (SVD02) and all line adjustment amounts (CAS). Segment SVD is defined in the
guideline at position 540.
COB Service Line Balancing Failed for payer
- Charge amount (SV102) does not equal sum of paid amount
(SVD02) and all lines adjustment amounts (CAS).
2430 SVD02 837P
837I
94036, 38520
57106, 61125
95112, 35174
35174, 37330,
54160
39392cb Element NM104 is missing. It is required when Other Subscriber is a person (NM102=1) Other subscriber name and policy number are required. 2330A NM1 837P
837I
14163, 14164
39392cb Element NM104 is missing. It is required when Referring Provider is a person. NM104 is present, must contain at least 1 alpha/numeric
character.
2310B NM104 837P 26374, 26375
26378
39392cb Element NM104 is missing. It is required when Referring Provider is a person. When name is present, must contain at least 1 alpha/numeric
character.
2310A NM104 837P 26374, 26375
26378
39392d1 Element CLM10 is missing. It is required when CLM09 is not 'N'. Patient signature source code (CLM10) is required when the
release of information (CLM09) is not N - No.
2300 CLM10 837P AIDWA, LABOR
95827, HCDPBC
53120, 00720
91121, 91051
39392ec Element PER07 is used. It is expected to be used only when element PER05 is used. PER data elements must not be skipped. 2010AA PER07 837P 14163, 14164
39392ef Element NM104 is used. It is not expected to be used when Billing Provider is not a person
(NM102 is not '1').
First Name (Element NM104) is used. It is not expected to be
used when Billing Provider is not a person (NM102 is not '1').
2010AA
2010AB
NM104 837P 94036, 00934
93093, 91051
AIDWA, 68058
SHP11, 68057
68053, 68050
39392ef Element NM105 is used. It is not expected to be used when Billing Provider is not a person
(NM102 is not ‘1’).
Element NM105 is used. It is not expected to be used when
Billing Provider is not a person (NM102 is not ‘1’).
2010AA
2010AB
NM105 837P 94036, 00934
93093
39392f1 Element PAT09 is used. It is not expected to be used when patient is not female (DMG03 in
loop 2010CA is not 'F').
If the Pregnancy Indicator equals 'Y', then Patient Gender Code
must equal 'F'
2000C PAT09 837P 80705, 63665
66893, 95388
95412, 95569
95379
39392f8 Element CR109 is used. It should not be used when CR103 is not 'X'. CR109 (Ambulance Round Trip Purpose Description) should not
be present unless CR103 (Ambulance Transport Code) equals ‘X’
(Round Trip).
2300 CR109 837P 04102, 04202
04302, 04402
68050, 68053
IL621, SHP11
09102
393931d Value of CL102 is incorrect. Expected value is from external code list - Admission Source
Code.
Admission source code must be valid as listed on the code
source.
2300 CL101 837I 26375, 26374
26378
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393931e Admission Source Code is invalid When Point of Origin Admission Code is 7 and the transaction
create date is on or after July 1, 2010.
2300 CL1 837I 00220
393933b National Drug Code must be 11 numeric LIN03 should contain 11 numeric 2410 LIN 837P 00932, 93221
00851, 00611
393933e Value of element SV105 is incorrect. Expected value is from external code list - Place of
Service Code (237).
Based upon Code Source 237, Place of Service code is invalid. 2400 SV105 837P 95827, HCDPBC
393938b Value of element REF02 (CLIA Number) is incorrect. Expected value is CLIA number (format
is '10 characters where the third character is 'D'').
When the CLIA ID present, it has to be 10 characters and the
third byte is a D.
2300 REF 837P 68050, 68053
68057, 68058
SHP11
393939e The identification code qualifier (loop 2010AB, segment NM108) must equal XX and the pay-to
provider identifier (loop 2010AB, segment NM109) must be a valid NPI. The payer does not
accept a tax ID as the pay-to provider identifier.
The identification code qualifier (loop 2010AB, segment NM108)
must equal XX and the pay-to provider identifier (loop 2010AB,
segment NM109) must be a valid NPI. The payer does not accept
a tax ID as the pay-to provider identifier.
2010AB NM108
NM109
837I 38338
393939e The National Provider ID (NPI) is required for this payer. Expected value for NM108 is 'XX.'
Please add the Provider's NPI to this transaction and resubmit for processing. Providers can
apply for an NPI online at https://nppes.cms.hhs.gov.
The National Provider ID (NPI) is required for this payer. 2010AA, 2010AB
2310A , 2310B
2310C, 2310D
2310E, 2420A
2420B, 2420C
2420D
NM108 837P 48145, 38338
39393AD Value of element PER06 is incorrect. Expected value is E-mail address when PER05='EM'. When the contact information (2010AA, PER) is 'EM' the email
address has to be in a valid email format.
2010AA PER 837P
837I
68050, 68053
68057, 68058
SHP11
39393b0 Value of element PER06 is incorrect. Expected value is Facsimile number (format is '10 digits')
when PER05='FX'.
When present or indicated, fax number must be 10 numeric. 2010AA PER05 837P 00611, 00851
00932, 68050
68053, 68057
68058, SHP11
39393b8 Value of element PER04 is incorrect. Expected value is Telephone number (format is ’10
digits’) when PER03 = ‘TE’
When present, telephone numbers must be 10 digits. 2010AA PER04 837P 00934, 93093
95827, HCDPBC
39393b8 Value of element PER04 is incorrect. Expected value is Telephone number (format is ’10
digits’) when PER03 = ‘TE’.
Communication telephone numbers must be 10 digits. 1000A, 2010AA
2330B, 2420E
PER04 837P
837I
38520, 57106
61125, 35174
95827, HCDPBC
94036
39393cb Value of element CRC03 is incorrect. Expected value is 'NU' when CRC02 is 'N'. When Certification Condition Indicator equals N-No, a condition
indicator is not required.
2300 CRC03 837P 95827, HCDPBC
39393cd Value of element SVD01 is incorrect. It must match corresponding Other Payer Identifier in
NM109 in 2330B loop.
Line adjudication payer id must match secondary payer id. 2430 SVD01 837P
837I
14163, 14164
77027, 95379
80705, 63665
66893, 95388
95412, 95569
61160
39393cf Value of element CRC03 is incorrect. Value ‘NU’ is not expected to be used when CRC02 is
not ‘N’
Value NU is not allowed when an EPSDT referral was given to the
patient.
2300 CRC03 837P 14163, 14164
77027, 95827
HCDPBC, 68050
68053, 68057
68058, SHP11
39393d0 Value of element NM109 is incorrect. It should be different from value of element SBR03
(group number)
Member id must not be the same as the member’s group
number.
2010BA NM109 837P
837I
CNTNM 14163
14164, 77027
68050, 68053
68057, 68058
SHP11
39393d0 Value of element NM109 is incorrect. It should be different from value of element SBR03
(Group or Plan Number).
When present, the group/plan number must be different from the
subscriber id.
2010BA SBR03 837P
837I
SHP11, 68057
68053, 68050
68058
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39393d1 Value of element N403 is incorrect. It should be formatted as 'XXXXXX' or 'XXX XXX' for
Canadian Zip Code.
If Country code (N404) is equal to CA, then the Postal code
(N403) must be in the correct format.
2010AA, 2010AB
2010BA, 2010BB
2010BC, 2010CA
2310D, 2330A
2420C, 2420E
N403 837P 80705, 63665
66893, 95379
95388, 95412
95569
39393d1 Value of element N403 is incorrect. It should be formatted as 'XXXXXX' or 'XXX XXX' for
Canadian Zip Code.
If Country code (N404) is equal to CA, then the Postal code
(N403) must be in the correct format.
2010AA, 2010AB
2010BA, 2010BB
2010BC, 2010CA
2310E, 2330A
2330B
N403 837I 80705, 63665
66893, 95379
95388, 95412
95569
39393ed Value of element REF01 has been already used in loop 2300. Elements REF01 are expected
to have unique values within loop 2300.
Duplicate REFs not allowed in Loop 2300. 2300 REF 837P
837I
00611, 00851
00932
39393f0 Value of element REF01 is incorrect. Value ‘EI’ should not be used when the referring
provider (2310A, NM108/09) is not used.
If Referring Provider Tax ID is present, then the NPI must be
present.
2310A REF01 837P 68050, 68053
68057, 68058
SHP11
39393f5 Rendering Provider Secondary Identification is a duplicate of Primary ID When the Rendering Provider Primary Identifier (2310B – NM109)
contains a qualifier of ‘24’ (Employer’s Identification Number), the
Rendering Provider Secondary Identification (2310B – REF01)
should not contain ‘EI’ (Employer’s Identification Number).
2310B REF02 837P 00934, 93093
38520, 57103
61125, 77027
53589, 00720
AIDWA
39393f5 Rendering Provider Secondary Identification is a duplicate of Primary ID. When the Rendering Provider Primary Identifier (2310B – NM109)
contains a qualifier of ‘34’ (Social Security Number)., the
Rendering Provider Secondary Identification (2310B – REF01)
should not contain ‘SY’ (Social Security Number)
2310B REF02 837P 00934, 93093
38520, 57106
61125, 77027
AIDWA
39393f5 Subscriber Secondary Identification is a duplicate of Primary ID. When the Subscriber Identifier contains a qualifier of ‘MI’
(Member ID), the secondary identifier (REF01) should not contain
‘1W’ (Member ID).
2010BA
2010CA
2330A
2330C
REF01 837I 53589, 00220
39393f5 Subscriber Secondary Identification is a duplicate of Primary ID. When the Subscriber Identifier contains a qualifier of ‘MI’
(Member ID), the secondary identifier (REF01) should not contain
‘1W’ (Member ID).
2010BA
2010CA
2330A
2330C
REF01 837P 53589, AIDWA
39393f5 Value of element REF01 is incorrect. Value '2U' should not be used when element NM108 is
'PI'. Segment REF is defined in the guideline at position 355.
The Other Payer Secondary Qualifier (2330B – REF01) should
not contain a ‘2U’ (Payer Identification Number) when 2330B –
NM109 contains a qualifier of ‘PI’ (Payer Identification Number).
2330B REF01 837P
837I
00611, 00851
00932, 93221
38520, 57106
61125, IL621
77027, AIDWA
39393f8 Value of element REF01 has been already used in loop 2010AA. Elements REF01 are
expected to have unique values within loop 2010AA. Segment REF is defined in the guideline
at position 035.
Element REF01 must be unique within Loop 2010AA, 2010AB
2010BA, 2010BB
2010BD, 2010CA
2310A, 2310B
2310C, 2310D
2310E, 2330A
2330B, 2330C
2330D, 2330E
2330G, 2330H
2420A, 2420B
2420C, 2420D
2420E, 2420F
REF01 837P
837I
00611, 00851
00932, 01260
93221, LS328
75137, 00932
01260, NIA11
77027, 68050
68053, 68057
68058, SHP11
TCHD1, SHMAP
EPNSH, SHPCH
WCMAP, UHSCH
CMSEB, UT3F
HLTHQ, SHCAR
SHEBP
39393fb Value of element CRC03 has been already used. Condition Indicator should be unique for
every CRC segment.
Multiple condition indicator values cannot be duplicated within the
same segment.
2300 CRC03 837P
837I
SHP11, 68057
68053, 68050
68058
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393945f Value of element SBR01 has been already used in loops 2000B/2300. Elements SBR01 are
expected to be different from SBR01 specified in loop 2000B and to have unique values within
loop 2300 excluding 'T' value.
Payer responsibility sequence number code can not be
duplicated.
2000B SBR01 837P
837I
80705,63665
66893,95379
95388,95412
95569, CNTNM
09102
393945f Value of element SBR01 has been already used in loops 2000B/2300. Elements SBR01 are
expected to be different from SBR01 specified in loop 2000B and to have unique values within
loop 2300 excluding 'T' value.
Payer responsibility sequence number code can not be
duplicated.
2320 SBR01 837I
837P
68050, 68053
68057, 68058
SHP11, CNTNM
393946e Value of element DTP03 (Service Line Date) is incorrect. Expected value for date should be
within a Statement Dates range.
Service Line Date should be with in dates of Service 2300 DPT03 837I LS328
39395df Sub-element SV101- 05 is used. It is not expected to be used when sub-element SV101-04 is
not used.
First available modifier field should be used. 2400 SV101 837P 14163, 14164
95827, HCDPBC
77027, AIDWA
39395df Sub-element SV201- 05 is used. It is not expected to be used when sub-element SV202-04 is
not used.
First available procedure modifier field should be used 2400 SV202 837I 14163, 14164
63665, 66893
80705, 95379
95388, 95412
95569, 00851
00611, 00932
93221
39395df Sub-element SV202-04 is used. It is not expected to be used when sub-element SV202- is not
used. Segment SV2 is defined in the guideline at position 375.
SV101-05 is not expected when SV101-04 is not used 2400 SV101-05 837P 26374, 26375
26378, 77027
39395df When a procedure modifier SV202-04 is used. It is not expected to be used when procedure
modifier SV202-03 is not used.
When a procedure modifier SV202-04 is used. It is not expected
to be used when procedure modifier SV202-03 is not used.
2400 SV202 837I 68050, 68053
68057, 68058
SHP11
39395df When procedure modifier SV101-05 is used. It is not expected to be used when procedure
modifier SV101-04 is not used.
When procedure modifier SV101-05 is used. It is not expected to
be used when procedure modifier SV101-04 is not used.
2400 SV101 837P 68050, 68053
68057, 68058
SHP11
39395df Sub-element SV101- 05 is used. It is not expected to be used when sub-element SV101-04 is
not used.
Modifier fields must not be skipped. 2400 SV101 837P 38520, 57106
61125, 35174
37330, 54160
39395ec Value of sub-element HI03-02 has been already used. Diagnosis Codes (primary and
secondary) are expected to be unique within claim.
Duplicate Diagnosis Codes are not allowed. 2300 HI 837P 14163, 14164
CNTNM, 68050
68053, 68057
68058, SHP11
39395ec Value of sub-element HI03-02 has been already used. Diagnosis Codes (primary and
secondary) are expected to be unique within claim.
Value of sub-element HI03-02 has been already used. Diagnosis
Codes (primary and secondary) are expected to be unique within
claim.
2300 HI 837I 68050, 68053
68057, 68058
SHP11
39395ee Duplicate procedure modifier. Procedure modifiers can not be duplicated. 2400 SV202 837I 14163, 14164
95827, HCDPBC
39395ee Duplicate procedure modifier. Duplicate Procedure Modifier Code found. 2400
2430
SV101
SVD03
837P 14163, 14164
95827, HCDPBC
39395ef Value of sub-element CLM11-03 has been already used. Related-Causes Codes are expected
to be unique within composite CLM11.
Value of sub-element CLM11-02 has been already used. Related-
Causes Code should be unique within composite CLM11.
2300 CLM11 837P 80705, 63665
66893, 95379
95388, 95412
95569, 77027
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39395f6 Value of sub-element SV107-01 is incorrect. Expected value is 1 through 8, inclusive.
Segment SV1 is defined in the guideline at position 370.
If present, the SV107 (Diagnosis Code Pointer) must contain a
value of 1 – 8 and reference an existing diagnosis code.
2400 SV107 837P IL621, 26374
AIDWA, 13350
94036, SHP11
68050, 68053
95112, 14163
00611, 00851
00932, 93221
05130, WA001
OR001, 00835
00831, 03102
AK001, 00836
CHPWA, 77027
LABOR, 91051
91121, M3IL1
M3IL2, M3FL2
M3FL3, M3FL4
M3FL5, M3FL6
M3FL7, M3FL8
M3CA1, 14164
26375, 26378
AIDOR, 95827
HCDPBC, 10775
01260, 38520
57106, 61125
53120
HPN11, GTPA1
MCA11, VFP11
INET1. KLSY1
SCOK1. WITH1
TX1ST, NWDC1
PPMO1, FMCHP
SSC11, CIPA1
KMG11, GHEDI
71063, TOPA1
393961a Value of sub-element HI01-02 is incorrect. Expected value is from external code list - ICD-9-
CM Diagnosis code (131) and a decimal point should not be used. Segment HI is defined in
the guideline at position 231.
Value of sub-element HI01-02 is incorrect 2300 HI 837P ALL
393962f Value of sub-element HI01-02 is incorrect. It looks like a local code from external code list 132 -
NUBC, Occurrence Codes. It is not allowed to use local codes after compliance date under the
HIPAA rules.
AmeriChoice allows occurrence code 54. 2300 HI01-02 837I 95378
393963c Composite HI02 is missing. Admitting Diagnosis is required on all inpatient admission claims
and encounters.
Admitting Diagnosis is required on all inpatient admission claims
and encounters.
2300 HI 837I 26374, 26375
26378, 00851
00932, 93221
00611
393963d Composite CLM11 is missing. It is required when segment DTP (Date - Accident) is used. When there is an accident date present, related cause
information is required.
2300 CLM11 837P 95827, HCDPBC
81002a Sub-Element SV101-04 length is '1'. The minimum allowed length is '2'. Segment SV1 is
defined in the guideline at position 370
Modifier fields must be two bytes in length 2400 SV101 837P All
81002b The length of Element SV105 is '3'. The maximum allowed length is '2'. Segment SV1 is
defined in the guideline at position 370.
Facility codes/Place of Service must be two bytes in length 2400 SV105 837P All
C100P LMP Date Missing. When the pregnancy indicator is Y-Yes, a last menstrual period
(LMP) date is required.
2000B
2000C
PAT09 837P 00720
C101I The attending physician name (loop 2310A, NM103, NM104) is required for Home Health
services.
Attending physician name is required for Home Health services. 2310A NM103
NM104
837I 00220, 07003
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C103I Qualifier code BR or BQ (loop 2300, HI01-1) is not allowed unless the type of bill (loop 2300,
CLM05-1) is an inpatient admission (11, 12, 18, 21, 28, 41, 65, 66, or 84).
ICD9-CM surgery procedure codes are not allowed on outpatient
claims. The surgery procedure code must be a CPT-4 procedure
code listed on the detail line charge.
2300 HI01-1 837I 00220, 07003
C104I Qualifier code BP or BO (loop 2300, HI01-1) is not allowed. Institutional claims with surgery must be coded with the ICD9-CM
Procedure Code rather than the CPT-4 procedure code.
2300 HI01-1 837I 00220, 07003
C105I A claim code segment (loop 2300, CL1) including admission type code, admission source
code, and patient status code is required for hospital inpatient admissions.
Claims for hospital inpatient admissions must include information
for admission type code, admission source code, and patient
status code.
2300 CL1 837I Edit Relaxed
00220, 07003
C106I The admission type code (loop 2300, CL101) is required for hospital inpatient admissions. The inpatient admission type code is missing. 2300 CL101 837I 00220, 07003
C107I The admission source code (loop 2300, CL102) is required for hospital inpatient admissions. The inpatient admission source code is missing. 2300 CL102 837I 00220, 07003
C108I The patient status (loop 2300, CL103) is required for hospital inpatient admissions. The inpatient admission patient status is missing. 2300 CL103 837I 00220, 07003
C109I The admitting diagnosis code (loop 2300, HI02-1) is required for hospital inpatient admissions. An admitting diagnosis code is required for inpatient admissions. 2300 HI02-1 837I 00220, 07003
C110I When the condition code qualifier BG is used (loop 2300, HI01-1), the condition code in HI01-2
must be a value other than 12 through 16 or 62 through 65. Please correct and resubmit the
claim.
Condition Codes 12 through 16 or 62 through 65 are not valid. 2300 HI 837I 38520, 57106
61125
C111P Invalid Character [^] received in Other Payer Name (loop 2330B, NM103). Invalid Character [^] received in Other Payer Name (loop 2330B,
NM103).
2330B NM103 837P SHP11, 68057
68053, 68050
68058
C112P Invalid Character [^] Received in Other Subscriber Address (loop 2330A, N301). Invalid Character [^] Received in Other Subscriber Address (loop
2330A, N301).
2330A N301 837P 00835, 00836
03102, 00831
C114I Invalid character (^) received in Other Payer Name (loop 2330B, NM103). Please correct and
resubmit.
Other Payer Name must not contain special characters. 2330B NM1 837I 38520, 57106
61125
C114P Invalid character (^) received in Other Payer Name (loop 2330B, NM103). Please correct and
resubmit.
Other Payer Name must not contain special characters. 2330B NM1 837P 38520, 57106
61125
C117P Other Payer Primary ID (loop 2330B, NM109) is invalid. Must contain at least two characters. Other Payer Primary ID (loop 2330B, NM109) is invalid. Must
contain at least two characters.
2330B NM1 837P 00836
C118P Invalid Character [^] Received in Other Insured Group Name (loop 2320, SBR04). Please correct and resubmit|Invalid Characters are not allowed for Other Insured Group Name
(loop 2320, SBR04)
2320 SBR 837P 00611, 00851
00932, 93221
C120P A prescription date (loop 2300, DTP*471) is required when billing for replacement lenses or
frames (loop 2300, CRC*E1, E2, or E3).
Prescription date is required when billing for replacement lenses
or frames.
2300 DTP 837P 3852, 57106
61125
D100P If the quantity for oxygen therapy certification (loop 2400, CR511) is greater than 88, then an
oxygen test find code must be present in either CR513, CR514, or CR515
Oxygen therapy certification cannot be greater than 88. 2400 CR511 837I IL621
D101P Total Purchased Service Amount (loop 2300, AMT-01=NE) is required when
Purchase Service Information (loop 2400, PS1) is present.
Total Purchased Service Amount (loop 2300, AMT-01=NE) is
required when Purchase Service Information (loop 2400, PS1) is
present.
2300 AMT01 837P 65055
D104I The ending date of service at the line level (loop 2400, DTP*472*RD8) must not be in the
future compared to the date Availity processed the claim.
The detail thru service date of service can not be in the future. 2400 DTP 837I 00720
D105P The approved amount' (2400-AMT*AAE) should be greater than or equal to the service line
paid amount (2430-SVD02).
The approved amount should be greater than or equal to the
service line paid amount.
2400 AMT 837P 00882, 04102
04202, 04302
04402, 00904
inst.3AM Secondary Claims Not Accepted Electronically For This Payer|2320 If the 2320 Loop (Other Subscriber Information) has Medicare
listed as the other coverage, reject the claim.
2320 SBR 837I CNTNM
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Error Codes Error Messages Error Descriptions Loop Element Trans
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Payers
inst.CLM01
MaxLength
Length of element CLM01 cannot exceed 20 characters. Patient control number cannot be greater than 20 characters in
length.
2300 CLM01 837I HPN11, GTPA1
MCA11, VFP11
INET1. KLSY1
SCOK1. WITH1
TX1ST, NWDC1
PPMO1, FMCHP
SSC11, CIPA1
KMG11, GHEDI
AHS01, 71063
TOPA1, 68050
68053, 68057
68058, SHP11
52629, WIMCE
00220
inst.H1B National Drug Code must be an 11 digit numeric value NDC code must be 11 numeric. 2410 LIN03 837I 52629, 01260
inst.HIE Value Code 80 not valid in this ANSI version. Continue to use QTY segment. Rejects institutional claims when Value Code of 80 is used on
ANSI format.
2300 HI02 837I 38520, 57106
61125
inst.K301 Invalid POA indicator. 4th Character must be Y, N, U, W or 1 and last character must be Z. When the fourth position in the POA does not equal Y, N, U, W or
1.
2300 K301 837I 53589
inst.SED In compliance with Minnesota statutes, Availity cannot submit paper claims to health plans on
behalf of Minnesota providers. As a result, Availity's Print-to-Paper service is no longer
available to Minnesota providers.
Print to paper service is not available for providers in the state of
Minnesota.
2010AA N402 837I PRINT
inst.SEF Availity cannot submit paper claims to health plans in the State of South Carolina. As a result,
Availity's print to paper service is no longer available for payers with South Carolina addresses.
Print to paper service is not available for payers in the state of
South Carolina.
2010BC N402 837I PRINT
inst.SEH The group/plan PHYSICIANS HEALTH PLAN OF SOUTH MICHIGAN (PHPSM) is no longer a
valid group/plan under payer ID 37330. If you have any questions, please call 1-800-394-7569.
For payer code 37330, claims submitted on or after 11/1/2009
(BHT04) will be rejected when the group/plan number begins with
"J" (2000B SBR03).
2000B
2000C
SBR03 837I 37330
inst.SEI The patient or subscriber ID in segment NM109 in loop 2010BA and/or loop 2010CA must
contain three numeric characters followed by three alpha characters
Applies to 2010BA loop only 2010BA NM109 837I MRCHP
inst.SEJ The patient or subscriber ID in segment NM109 in loop 2010BA and/or loop 2010CA must
contain eight alphanumeric characters
Applies to 2010BA loop only 2010BA NM109 837I MRIPA
inst.SEK The patient or subscriber ID in segment NM109 in loop 2010BA and/or loop 2010CA must
contain three numeric characters followed by three alpha characters
Applies to 2010CA loop only 2010CA NM109 837I MRCHP
inst.SEK The patient or subscriber ID in segment NM109 in loop 2010BA and/or loop 2010CA must
contain three numeric characters followed by three alpha characters
Applies to 2010CA loop only 2010CA NM109 837I MRCHP
inst.SEL The patient or subscriber ID in segment NM109 in loop 2010BA and/or loop 2010CA must
contain eight alphanumeric characters
Applies to 2010CA loop only 2010CA NM109 837I MRIPA
inst.SEP The patient or subscriber social security number (SSN) must contain nine numeric digits.
These nine digits cannot be identical and the first digit cannot be a '8' or '9'.
The patient or subscriber social security number (SSN) must
contain nine numeric digits. These nine digits cannot be identical
and the first digit cannot be a '8' or '9'.
2330A REF02 837I 68050, 68053
68057, 68058
SHP11
inst.SFA A date (loop 2300, HI) is required only when an ICD-9-CM code is received (element HI01-1
equal to BR). For all other values, do not provide a date.
Only send a date when an ICD-9-CM code is received and a
value of 'BR' is received.
2300 HI 837I 68050, 68053
68057, 68058
SHP11
inst.SFL Secondary Claims Not Accepted Electronically For This payer Secondary Claims are not accepted electronically for this payer. 2320 SBR 837I 39151
inst.SFM The date of service is required for all service lines (loop 2400, segment DTP03) on institutional
outpatient claims.When a facility claim type of bill is 13 (outpatient), the date
of service is required on all service lines.
2400 DTP03 837I 68057, 68053
68050, 68058
SHP11, D0328
inst.SFP Claim should not have a negative submitted charge amount (SV102) at the service line (loop
2400). All values should be zero or a positive number
Claim should not have a negative submitted charge amount
(SV102) at the service line (loop 2400). All values should be zero
or a positive number
2400 SV102 837I 68057, 68053
68050, 68058
SHP11
inst.U2A Payer requires admission type code. Regardless of value in CLM05-01, admission type code is
required when CL101 is present.
2300 CL101 837I CNTNM
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inst.WCE Your encounter was received with an incorrect payer ID. If this is an encounter, resubmit with
payer ID 59354. If this is not an encounter, use CH in Claim or Encounter Indicator field.
Encounters for Wellcare must be submitted using payer id 59354. BHT BHT06 837I 14163, 14164
P100I The value submitted for patient ID (loop 2010CA, NM109) is invalid. The patient id is invalid. 2010CA NM109 837I HPN11, GTPA1
MCA11, VFP11
KLSY1, SCOK1
WITH1, TX1ST
NWDC1, PPMO1
FMCHP, SSC11
CIPA1, KMG11
GHEDI, TOPA1
P100P The value submitted for patient ID (loop 2010CA, NM109) is invalid. The patient id is invalid. 2010CA NM109 837P HPN11, GTPA1
MCA11, VFP11
KLSY1, SCOK1
WITH1, TX1ST
NWDC1, PPMO1
FMCHP, SSC11
CIPA1, KMG11
GHEDI, TOPA1
prof.2GE01 The Information in Address 2 should not match the information in Address 1 The billing provider’s address in Address 2 should be different
than the one given in Address 1.
2010AA N302 837P 00934, 93093
prof.2GE02 The Information in Address 2 should not match the information in Address 1 The subscriber’s address in Address 2 should be different than
the one given in Address 1.
2010BA N302 837P 00934, 93093
prof.2GE03 The Information in Address 2 should not match the information in Address 1 The responsible party’s address in Address 2 should be different
than the one given in Address 1.
2010BC N302 837P 00934, 93093
prof.2GE04 The Information in Address 2 should not match the information in Address 1 The ordering provider’s address in Address 2 should be different
than the one given in Address 1.
2420E N302 837P 00934, 93093
prof.3AD Secondary Claims Not Accepted Electronically For This Payer If the 2320 Loop (Other Subscriber Information) is received, reject
the claim
2320 SBR 837P AIDOR, 39151
prof.3AM Secondary Claims Not Accepted Electronically For This Payer|2320 If the 2320 Loop (Other Subscriber Information) has Medicare
listed as the other coverage, reject the claim
2320 SBR 837P CNTNM
prof.5CH Referring Provider Org or Last Name Invalid Referring provider last name in 2310A NM103 cannot be all
numbers
2310A NM103 837P 53120
prof.BA5 Rendering Provider NPI Missing Rendering Provider NPI Missing 2310B NM109 837P GCVCP
prof.BAH Rendering Provider Name (Loop 2310B) is used. It's not required when segment PRV (loop
2000A) is used
Rendering Provider Name is not required when 2000A PRV is
used
2310B PRV 837P M3IL1, M3IL2
M3FL2, M3FL3
M3FL4, M3FL5
M3FL6, M3FL7
M3FL8, M3CA1
61160, NASWD
NASCR, NANPR
NAOAK, NANWC
NAING, NAHLX
NAHIN, NAHOI
NAELM, 10775
65055, SC359
prof.BCM Payer Requires Rendering Provider Tax ID Line level rendering provider requires tax id. 2420A REF 837P CNTNM
prof.BCN Payer requires rendering provider tax ID If 2310B loop is present, reject claim if rendering provider tax is
missing.
2310B REF01 837P CNTNM
prof.BCT10 Provider Secondary ID (Provider Commercial Number) Contains Non Numeric Characters. Provider number must not have alpha characters 2010AA, 2010AB
2310B, 2310A
2310C, 2310D
2310E, 2420A
2420C, 2420D
2420E, 2420F
REF = G2 837P 48145
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Error Codes Error Messages Error Descriptions Loop Element Trans
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Payers
prof.BDE Invalid Character [^] Received in Referring Provider Organization/Last Name Unprintable character ‘^’ not acceptable in Referring Provider
Organization and/or last name
2310A NM103 837P 00836, 00835
00831, 03102
WA001, OR001
AZ001
prof.BDF Invalid Character [^] Received in Referring Provider First Name Unprintable character ‘^’ not acceptable in Referring Provider first
name
2310A NM104 837P 00836, 00835
00831, 03102
WA001, OR001
AZ001
prof.BDG Invalid Character [^] Received in Subscriber's Address. Unprintable character ‘^’ not acceptable in Subscriber's Address. 2010BA N301 837P 00836, 00835
00831, 03102
WA001, OR001
AZ001
prof.BMK Facility Prov Name Cannot Be the Same as Billing Prov Name Facility Provider Name 2310D cannot be the same as Billing
Provider Name 2010AA
2010AA
2310D
NM103 837P AIDOR
prof.CLM01
MaxLength
Length of element CLM01 cannot exceed 20 characters. Patient control number cannot be greater than 20 characters in
length.
2300 CLM01 837P HPN11, GTPA1
MCA11, VFP11
INET1. KLSY1
SCOK1. WITH1
TX1ST, NWDC1
PPMO1, FMCHP
SSC11, CIPA1
KMG11, GHEDI
AHS01, 71063
TOPA1, 68050
68053, 68057
68058, SHP11
52629, WIMCE
00720
prof.COC Coordination of Benefits (COB) Total Claim Before Taxes Amount was not expected because
the Payor Paid Amount (2320/AMT) is not present.
When total claim before tax amount is present, payer paid
amount is required.
2320 AMT01 837 94036
prof.COOKCHILDR
ENSSTAR
BBSBR
Rendering Provider Medicaid Number Must Be 9 Numeric Rendering Provider Medicaid ID must be 9 numeric characters
when present
2310B REF02 837P CCHP9
prof.COOKCHILDR
ENSSTAR
BBSBR
Rendering Provider Medicaid Number Must Be 9 Numeric The Billing Provider Medicaid TPI number must be present and 9
numerics.
2010AA REF02 837P CCHP9
prof.GBA Original Reference Number (ICN/DCN) Required Original Reference Number (ICN/DCN) Required. 2300 REF01 837P CHPWA, LABOR
00934, 93093
AIDOR
prof.GC4 Total Purchase Service Amount Missing AMT*NE - Required when Purchased Service Provider loop
2310C is present.
2300 AMT 837P 38520, 57106
61125, 35174
HPN11, GTPA1
MCA11, VFP11
INET1, KLSY1
SCOK1. WITH1
TX1ST, NWDC1
PPMO1, FMCHP
SSC11, CIPA1
KMG11, GHEDI
71063, TOPA1
prof.GFA The sum of service lines OTAF (2400 CN102) should equal claim OTAF amount (2300
CN102)
The sum of the service lines for OTAF must = the claim level
OTAF
2300 CN102 837P 04102, 04202
04302, 04402
00952, 00953
09102
prof.GHB Invalid Character [^] Received in Claim Note Text Unprintable character ‘^’ not acceptable in narrative and/or note at
the claim level.
2300 NTE02 837P 00836, 00835
00831, 03102
WA001, OR001
AZ001
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prof.GHC Value of element SV104 is incorrect, its value should be to a maximum of 999 Anesthia minutes must be 3 bytes or less. 2400 SV104 837P 91051
prof.GHE REF segment exists but NM109 primary ID is missing Service Facility Primary ID is required when Service Facility
Secondary ID is present.
2310D NM109 837P & 837I 35174
prof.GHI Invalid Character [^] Received in Claim Note Text Unprintable character ‘^’ not acceptable in narrative and/or note at
the service line.
2400 NTE02 837P 00836, 00835
00831, 03102
WA001, OR001
AZ001
prof.H1B National Drug Code Must Be 11 Numerics National Drug Code Must Be 11 Numerics. 2410 LIN03 837P 53120
prof.H1BSBR National Drug Code must be an 11 digit numeric value NDC code must be 11 numeric. 2400 LIN02 837P 52629
prof.HR2 Diagnosis Pointer Missing or Out of Sequence Diagnosis code pointer fields must not be skipped. 2400 SV107 837P COMMF, 26374
26375, 26378
00720
prof.HRP Diagnosis Code Missing For Pointer Diagnosis code missing 2400 SV107 837P 35174, 38520
57106, 61125
prof.NDC1 Invalid NDC code format. Must be 11 numeric. Spaces and / or hyphens not accepted. Please
correct and resubmit.
NDC code must be 11 numeric. 2400 LIN02 837P 00932, 93221
00851, 00611
13350, 61101
61102, 61105
65018, 72127
95348, 95885
HUMAR, Z0005
38333, OCH01
38334, CIMSA
NM505, 20149
20554, UNMSC
38336, 51062
MHHNP, 95092
95093, 00590
53589, 84980
00790, 00621
00840, 53120
14163, 14164
01260
prof.NDC2 Invalid NDC code according to Availity NDC code set. Please correct and resubmit. NDC code must be valid as listed on the current code set. 2400 LIN02 837P 13350, 61101
61102, 61105
65018, 72127
95348, 95885
HUMAR, Z0005
38333, OCH01
38334, CIMSA
NM505, 20149
20554, UNMSC
38336, 51062
MHHNP, 95092
95093, 53589
84980, 00790
00621, 00840
53120, 14163
14164
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Payers
prof.NDC3 The NDC is not active for this date of service. Please correct and resubmit. Based upon the current code set, the NDC is not active for this
date of service.
2400 LIN02 837P 13350, 61101
61102, 61105
65018, 72127
95348, 95885
HUMAR,Z0005
38333, OCH01
38334, CIMSA
NM505, 20149
20554, UNMSC
38336, 51062
MHHNP, 95092
95093, 53589
84980, 00790
00621, 00840
53120, 14163
14164
prof.POB Payer requires physical address for where services were rendered Rejection occurs when Billing provider address is a PO Box and
the facility address is not present or also has a PO Box listed.
2010AA
2310D
N301 837I 38520, 57106
61125
prof.QBB Billing Provider Secondary Id Missing or Invalid The billing provider REF segment must be present and the
REF01 must contain a qualifier of ‘LU’. Also, the REF02 must
contain an 8 digit alpha/numeric value.
2010AA REF01 837P GCVCP
prof.QGA Billing Provider NPI Missing The billing provider NPI must be present within Loop 2010AA
(NM108/NM109). The billing provider identification qualifier
(NM108) must be ‘XX’ and the billing provider NPI must be
present in NM109
2010AA NM108 837P GCVCP
prof.QGA Billing Provider NPI missing and is required The QGA message requires the 'XX' qualifier in LOOP ID -
2010AA (Billing Provider Name) segment ID, NM108 and the
National Provider Identifier in segment ID NM109.
2010AA NM109 837P 83490, 00079
00621
prof.RENREQ
SBR
Rendering Provider Name (Loop 2310B) is used. It's not required when segment PRV (loop
2000A) is used
2310B Rendering Provider Name is not required when 2000A
PRV is used.
2310B NM103
PRV03
837P PRIME
prof.RENREQ
SBR
Rendering Provider Name (Loop 2310B) is used. It's not required when segment PRV (loop
2000A) is used.
2310B Rendering Provider Name is not required when 2000A
PRV is used.
2310B NM1 837P 35174, 37330
48055, 54160
TOPTN, LS328
01260, NIA11
CHPWA, 94036
63665
prof.SA0 Patient relationship must be self If 2000B loop (Subscriber Information) does not list the patient
relationship as self, reject the claim.
2000B SBR02 837P CNTNM, 77072
prof.SCE Member ID must be a minimum of 9 characters. Member ID must be a minimum of 9 characters. 2010BA NM109 837P HCDPBCprof.SCF Member ID must be a minimum of 6 characters. Member ID must be a minimum of 6 characters. 2010BA NM109 837P 95827prof.SCO Subscriber ID invalid. Must be 9, 10 or 14 numeric If member id is not numeric and not 9, 10 or 14 digits, reject the
claim
2010BA NM109 837P CNTNM
prof.SCQ Subscriber ID Must Be 9, 10, or 11 Digit Alpha-Numeric. Subscriber ID Must be 9,10,or11 Digit Alph-Numeric 2010BA NM109 837P 94999
prof.SED In compliance with Minnesota statutes, Availity cannot submit paper claims to health plans on
behalf of Minnesota providers. As a result, Availity's Print-to-Paper service is no longer
available to Minnesota providers.
Print to paper service is not available for providers in the state of
Minnesota.
2010AA N402 837P PRINT
prof.SEF Provider Secondary ID (Provider Commercial Number) Contains Non Numeric Characters. Print to paper service is not available for payers in the state of
South Carolina.
2010BB N402 837P PRINT
prof.SEH The group/plan PHYSICIANS HEALTH PLAN OF SOUTH MICHIGAN (PHPSM) is no longer a
valid group/plan under payer ID 37330. If you have any questions, please call 1-800-394-7569.
For payer code 37330, claims submitted on or after 11/1/2009
(BHT04) will be rejected when the group/plan number begins with
"J" (2000B SBR03).
2000B
2000C
SBR03 837P 37330
prof.SEI The patient or subscriber ID in segment NM109 in loop 2010BA and/or loop 2010CA must
contain three numeric characters followed by three alpha characters
Applies to 2010BA loop only 2010BA NM109 837P MRCHP
prof.SEJ The patient or subscriber ID in segment NM109 in loop 2010BA and/or loop 2010CA must
contain eight alphanumeric characters
Applies to 2010BA loop only 2010BA NM109 837P MRIPA
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prof.SEK The patient or subscriber ID in segment NM109 in loop 2010BA and/or loop 2010CA must
contain three numeric characters followed by three alpha characters
Applies to 2010CA loop only 2010CA NM109 837P MRCHP
prof.SEL The patient or subscriber ID in segment NM109 in loop 2010BA and/or loop 2010CA must
contain eight alphanumeric characters
Applies to 2010CA loop only 2010CA NM109 837P MRIPA
prof.SEM The patient or subscriber social security number (SSN) must contain nine numeric digits.
These nine digits cannot be identical and the first digit cannot be a '8' or '9'
The secondary ID has to be nine characters and cannot be the
same digit.
2010BA REF 837P
837I
68050, 68053
68057, 68058
SHP11
prof.SEP The patient or subscriber social security number (SSN) must contain nine numeric digits.
These nine digits cannot be identical and the first digit cannot be a '8' or '9
The patient or subscriber social security number (SSN) must
contain nine numeric digits. These nine digits cannot be identical
and the first digit cannot be a '8' or '9
2330A REF02 837P 68050, 68053
68057, 68058
SHP11
prof.SFB The patient (2010CA) or subscriber (2010BA) first and last name fields can contain letters and
spaces only. Special characters are not allowed.
Special characters are not allowed in the subscriber/patient name
fields.
2010BA NM103
NM104
837P 68050, 68053
68057, 68058
SHP11
prof.SFF The patient and subscriber ID number in segment NM109 in loop 2010BA and/or 2010CA
must contain at least two alpha number characters.
Applies to 2010BA loop only 2010BA NM109 837P IL621
prof.SFH The patient signature source code (loop 2300, segment CLM10) is not required when the
release of information code is 'N' (loop 2300, segment CLM09)
The patient signature source code (loop 2300, segment CLM10)
is not required when the release of information code is 'N' (loop
2300, segment CLM09)|
2300 CLM10 837P 53120
prof.SFI The identification code qualifier (loop 2010AB, segment NM108) must equal XX and the pay-to
provider identifier (loop 2010AB, segment NM109) must be a valid NPI. The payer does not
accept a tax ID as the pay-to provider identifier.
The identification code qualifier (loop 2010AB, segment NM108)
must equal XX and the pay-to provider identifier (loop 2010AB,
segment NM109) must be a valid NPI. The payer does not accept
a tax ID as the pay-to provider identifier.
2010AB NM108
NM109
837P 38338
prof.SFJ The identification code qualifier (loop 2010AA, segment NM108) must equal XX and the billing
provider identifier (loop 2010AA, segment NM109) must be a valid NPI. The payer does not
accept a Tax ID as the billing provider identifier.
The identification code qualifier (loop 2010AA, segment NM108)
must equal XX and the billing provider identifier (loop 2010AA,
segment NM109) must be a valid NPI. The payer does not accept
a tax ID as the billing provider identifier.
2010AA NM108
NM109
837P 38338
prof.SFK When an internal control number (ICN/DCN) is included on the claim, it must contain 12
alphanumeric characters
When an internal control number (ICN/DCN) is included on the
claim, it must contain 12 alphanumeric characters
2300 REF02 837P 68057, 68053
68050, 68058
SHP11
prof.SFO Claim should not have a negative submitted charge amount (SV102) at the service line (loop
2400). All values should be zero or a positive number
Claim should not have a negative submitted charge amount
(SV102) at the service line (loop 2400). All values should be zero
or a positive number
2400 SV102 837P 68057, 68053
68050, 68058
SHP11
prof.SS2 Subscriber First Name is Invalid The first position of the Subscriber’s first name cannot be a
space. The first position must be alpha or numeric
2010BA NM104 837P 53120
prof.WCE Your encounter was received with an incorrect payer ID. If this is an encounter, resubmit with
payer ID 59354. If this is not an encounter, use CH in Claim or Encounter Indicator field.
Encounters for Wellcare must be submitted using payer id 59354. BHT BHT06 837P 14163, 14164
prof.Y7DSBR Rendering Provider Taxonomy Code Missing or Invalid Rendering Provider Taxonomy Code Missing or Invalid 2310B PRV03 837P EPF03, EPF02
prof.YED LMP Date Missing When the pregnancy indicator is Y-Yes, a last menstrual period
(LMP) date is required.
2000B
2000C
PAT09 837P 00934, 93093
S101P The member ID (Loop 2010BA, Segment NM109) must be nine numeric digits. Member ID must be nine numeric 2010BA NM109 837P HCDPBC
S102P The member ID (Loop 2010BA, Segment NM109) must be eight numeric digits. Member ID must be eight numeric 2010BA NM109 837P 95827
S103P The payer does not accept a subscriber secondary ID (REF segment) in loop 2010BA The payer does not accept a subscriber secondary ID (REF
segment) in loop 2010BA
2010BA REF 837P
837I
39151
S104P The subscriber ID (loop 2010BA, MN109) must be six characters in the following format: the
first character must be a letter, the second character must be a letter or number, and the
remaining four characters must be numbers
The inmate CDCR number must be six characters in the following
format: the first character must be a letter; the second character
must be a letter or number; and the remaining four characters
must be numbers
2010BA NM1 837P
837I
CCIH
S105P The patient address is invalid (loop 2010BA, segment N3). Select an abbreviation from the
Institutional Abbreviation List located at http://www.correctcare.com/portal
The patient address should be the institutional abbreviation from
the Institutional Abbreviation List located at
http://www.correctcare.com/portal.
2010BA N3 837P
837I
CCIH
S108P Invalid character (^) received in Insured Group Name
(loop 2000B, SBR04). Please correct and resubmit.
Invalid character (^) received in Insured Group Name
(loop 2000B, SBR04). Please correct and resubmit.
2000B SBR04 837P 00851, 00611
00932, 93221
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Payers
S109P Insured City (loop 2010BA, N401) invalid. Must contain two alpha characters. Please correct
and resubmit.
Insured city must be two consecutive alpha characters. 2010BA N401 837P 91121, 91051
S110P Payer City (loop 2010BB, N401) invalid. Must contain two alpha characters. Please correct and
resubmit.
Payer city must be two consecutive alpha characters. 2010BB N401 837P 91121, 91051
S111P Invalid Character [^] Received in Subscriber Middle Name (Loop 2010BA, NM105) Invalid Character [^] Received in Subscriber Middle Name (Loop
2010BA, NM105)
2010BA NM1 837P AIDWA
S113I The value submitted for member ID (loop 2010BA, NM109) is invalid. The subscriber id is invalid. 2010BA NM109 837I HPN11, GTPA1
MCA11, VFP11
KLSY1, SCOK1
WITH1, TX1ST
NWDC1, PPMO1
FMCHP, SSC11
CIPA1, KMG11
GHEDI, TOPA1
S113P The value submitted for member ID (loop 2010BA, NM109) is invalid. The subscriber id is invalid. 2010BA NM109 837P HPN11, GTPA1
MCA11, VFP11
KLSY1, SCOK1
WITH1, TX1ST
NWDC1, PPMO1
FMCHP, SSC11
CIPA1, KMG11
GHEDI, TOPA1
S114I The value submitted for the member Id (loop 2010BA, NM109) is invalid. The member id must be 9, 10, or 14 digits and must not be equal
to all one's, two's, three's, etc.
2010BA NM1 837I CNTNM
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