EDI Rejection

Electronic Data Interchange (EDI) is the electronic interchange of business information using a standardized format; a process which allows one company to send information to another company electronically rather than with paper.

EDI REJECTION REASONS:

1. Invalid member ID/subscriber number
2. Provider NPI not on file at payer
3. Payee NPI not on file at payer
4. Admit/referring provider NPI not on file at payer
5. Invalid primary procedure
6. Payee ID # must not equal the provider ID #
7. Patient loop not accepted

To avoid EDI Rejection we perform quality checks to ensure that data conforms to the EDI standards, the receiver's specifications, and the business rules.