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.

The rejection will likely begin with Operation Successful with claim validation errors i.e.

• 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.

• Provider's License number is required - Rendering Provider

The license number for the provider needs to be added to the practice database OR the license

number in the database has extra spaces/incorrect characters. Please call Tops Support at

770.627.2527 for assistance.

• Invalid Zip Code. This payer requires a zip + 4 digit zip code. 

If you receive this error, please contact Tops Support at 770.627.2527 so the team can update

your zip code in the database.

If you continue to receive this error after the database is updated, contact DentalXChange at

1.800.576.6412 extension 452 and request that the Auto-Add Provider feature be enabled for

your account.

• 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

  DentalXChange provides this error to let you know that the claim has been submitted more than once within the past 10 days. In Tops Ortho version 9.11.1, we will no longer be stopping any claims that appear to be duplicate claims.

• 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.

  If you receive this error, please contact Tops Support at 770.627.2527.

• An attachment is required for this line item

  If you receive this error, please contact Tops Support at 770.627.2527.

• 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
  • Until you are updated to Tops Ortho version 9.11.1, minimum and maximum treatment months will be required when submitting a records claim.

• Deficient Request - Required fields are missing. Please review your request and try again

  This is a rejection directly from MetLife. Try the following to correct the error:

  • Review the patient chart and look for any missing information
  • Review the policy holder details and look for any missing information (i.e Review, verify and update the patient subscriber ID; ensure the patient relationship to the policy holder is correct)
  • Review the employer policy details and look for any missing information

• 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.

• Loop Error

  Please refer to our Common Loop e-Filing Errors article for more information.

Additional Rejections:

• If the message states DXC eClaim Group ID, then your Group ID in TopsOrtho > Practice Setup > eClaim is not valid. The Group ID is also referred to as the Account # in DentalXChange. It should be preceded by a – which Tops auto-populates. Make sure to tab out of the GroupID field to populate the hyphen. Example: -12345

• If the message states Invalid User i.e. ( ); verify your Login ID and Password in TopsOrtho > Practice Setup > eClaim. The Login ID is your DentalXChange username. The Password is your DentalXChange password.

• If the message states Operation Failed but does not display a reason for the rejection, this means the claim never made it to DentalXChange. In this situation, please contact Tops Support at 770.627.2527 for assistance.

• If the message states Malformed Document Sent, it means that the claim did not match DentalXChange's required formatting. Ensure that the format is correct and all required data is present. One example of a malformed document error is too many characters in a field. If you cannot make the necessary edits in the Tops Ortho chart, please contact Tops Support at 770.627.2527 for assistance.

• • If the message states Invalid PMS i.e ( ); it either means you have not selected Tops as the Practice Management System in the Account settings of your DentalXChange account; or the username and password for the DentalXChange account is associated with more than one account number. In this case, your practice will need to create a new username and password associated with the account. To do this, DentalXChange will need to allow permissions. A ticket, call or email will need to be submitted to DentalXChange to start this process.
  • To update your account with Tops as the PMS, login to DentalXChange, click Account, Under the Services tile, click Add or Remove Services/Packages.

• If the message states Service Not Contracted i.e ( ) it means that you have not selected the Tops RCM Bundle as your registered solution in your DentalXChange account. Login to DentalXChange, click Account, Under the Services tile, click Add or Remove Services/Packages.

• If the message states Operation Successful, Validation Errors <No additional detail> it means that the claim reached DentalXChange without any general formatting errors, but DentalXChange identified errors regarding the payer requirements. Since no explanation is given, please contact Tops Support at 770.627.2527 for assistance.

If you do not see your Rejection reason listed and are unable to resolve the claim error, please contact Tops Support at 770.627.2527 or by email at [email protected] for assistance.

Please visit our Claims with Rejected by Clearing House Status article to see how to handle rejections and other possible Clearinghouse Rejected status errors.