Common eClaim Rejection Reasons

Sometimes when you submit an eClaim, it shows as "Rejected by Clearing House." Hover over the yellow caution sign icon to view the reason for the rejection. Here are some common rejection reasons explained.

• Provider's NPI number is required - Rendering Provider

  The NPI for the provider needs to be added to the practice database OR the NPI in the database has extra spaces/incorrect characters. Please call Tops Support at 770.627.2527 for assistance.

• No insurers found for this selection - payer

The payer ID needs to be updated in Tops Ortho. Some payer IDs are unique to DentalXChange. To locate payer IDs, follow these steps:

a. Right-click on the claim and select Open Employer Policy.

b. When the Employer Policy window opens, click the blue eClaim Insurance Payer List link. This will bring you to the DentalXChange Payer List.

c. Search for the insurance company and take note of the payer ID listed.

d. Update the Employer Policy with the correct payer ID.

e. Refresh the Claims > Unpaid Claims > Rejected by Clearing House list.

f. The resolved claims will move to Matrix > Claims > Unpaid Claims > Open Claims Only.

g. You can re-submit the claims from this new location!

• Invalid zip code for this city and state - <location>

  There are a few possibilities with this rejection.

  • The state may be formatted incorrectly - for example, there could be a space after the two-character state abbreviation.
  • The state and zip code combination may be incorrect.
  • The 4-digit zip code extension may be required. If this is a change that needs to be made in your practice database, please call Tops Support at 770.627.2527 for assistance.

• Duplicate Claim

  In this case, the claim has been accepted by the payer; however, DentalXChange provides this error to let you know that the claim has been submitted more than once within the past 10 days.

• Original reference number (ICN/DCN) is required when CLM05-3, is 6, 7, or 8 - Insured or Subscriber

  This rejection reason will come up if your practice attempts to file a secondary, tertiary or quaternary claim during the first phase of the Tops/DentalXChange integration.

• The sequence number code is not primary when there are no additional subscribers - Insured or Subscriber

  This rejection reason will come up if your practice attempts to file a secondary, tertiary or quaternary claim during the first phase of the Tops/DentalXChange integration.

• The total number of charge lines for a claim cannot exceed 15. Please split the charge lines into multiple claims.

  Box 24 of the claim contains more than 15 procedures. This means that the claim is most likely a date-range claim. If you need to submit more than 15 procedure codes, please generate two or more date-range claims to split up the procedure codes into groups of 15 or less.

• A narrative attachment is required for this procedure code and payer. An attachment is required for this line item. An X-ray attachment is required for this procedure and payer.

  In this case, the payer requires an X-ray attachment. Tops Ortho will bypass this requirement and still submit the claim. However, we recommend finding this claim on the DentalXChange portal. In the portal, you can add an attachment to the claim and re-submit it.

• An attachment is required for this line item

  In this case, the payer requires an attachment. Tops Ortho will bypass this requirement and still submit the claim. However, we recommend finding this claim on the DentalXChange portal. In the portal, you can add an attachment to the claim and re-submit it.

• Date appliance placed and Treatment Months are required

  No information pulled into boxes 41 and 42 of the claim. Enter this information in Tops Ortho and re-submit the claim.

• Date appliance placed, Treatment Months and Remaining Months required

  No information pulled into boxes 41 and 42 of the claim. Enter this information in Tops Ortho and re-submit the claim.

• Ortho Remaining months should not be greater than Total Months and Ortho remaining, or total months cannot be greater than 99

There are a few possibilities with this rejection:

• The patient chart in Tops Ortho is missing the Max and Min months for the estimated treatment length
• There are extra numbers and/or characters in the Max and Min month fields for the estimated treatment length

• For a claim defined as an Actual Claim, there must be assigned dates of service for every charge line

  This rejection will indicate which charge line is missing a date so that you can correct the error.

• Operation Failed

The claim did not make it to DentalXChange; please call Tops Support at 770.627.2527 for

assistance.