EDI Support Services Error Code values for the ...

1 EDI Support ServicesError code values for the professional , Institutional, and Dental 837 Data Interchanges and the 834 Data InterchangeEdit Message837 Prof837 Inst837 Dent834A002 Security Information InvalidXXXXA003 Interchange Date can't be a future dateXXXXA005 Creation Date can't be a future dateXXXXA006 Transaction Set Create Date can't be future dateXXXXA008 Submitter Last Name is invalidXXXA009 Submitter First Name is missingXXXA010 Submitter First Name is invalidXXXA011 Submitter Middle Name is invalidXXXA013 Receiver Name is invalidXXXA014 Billing/Pay-To Prov Specialty code invalidXXXA015 Currency Country code InvalidXXXA017 If Billing Prov Type = 2

2 Then Tax ID must = 24XA018 Billing Provider Last Name is invalidXXXA019 Billing Provider First Name MissingXXA020 Billing Provider First Name is invalidXXA021 Billing Provider Middle Name is invalidXXA022 Billing Provider City is invalidXXXA023 Billing Provider State is invalidXXXA024 Billing Provider Zip code is invalidXXXA025 Billing Provider Country is invalidXXXA026 Tax ID or SSN Number is RequiredXXXA027 Qualifier code can occur only one timeXXXXA028 Pay To Provider Last Name is invalidXXA029 Pay To Provider First Name is MissingXXA030 Pay To Provider First Name is invalidXXA031 Pay To Provider Middle Name is invalidXXA032 Pay To Provider City is invalidXXXA033 Pay To Provider State code is invalidXXXA034 Pay To Provider Zip code is invalidXXXA035 Pay To Provider Country code is invalidXXXA036 Subscriber HL Child code must = zeroXXXA037 Relationship code must = 18 (self)

3 XXXA038 Relationship code must = spacesXXXA039 Patient Information can not be presentXXPage 1 of 17 Last Updated 01-09-2006 EDI Support ServicesError code values for the professional , Institutional, and Dental 837 Data Interchanges and the 834 Data InterchangeEdit Message837 Prof837 Inst837 Dent834A040 Date of Death is a future dateXA041 Patient Weight is invalidXXA042 Subscriber Last Name is invalidXXXA043 Subscriber First Name is missingXXXA044 Subscriber First Name is invalid XXXA045 Subscriber Middle Name is invalidXXXA046 Subscriber Generation contains invalid value XA047 ID qualifier invalid for this payerXXXA048 Subscriber ID contains invalid valuesXXA049 Subscriber City is invalidXXXA050 Subscriber State code is invalidXXXA051 Subscriber Postal Zip code is invalidXXXA052

4 Subscriber Country code is invalidXXXA053 Subscriber Date of Birth is a future date XXXA054 Service Date can not be < Subscriber DOBXXXA055 value of "1W" can not be usedXXXA056 Payer Name is invalidXXXXA057 value of "PI" must be usedXXXA058 Payer City is invalidXXX A059 Payer State code is invalidXXXA060 Payer Zip code is invalidXXXA061 Payer Country code is invalidXXXA062 Responsible Party Last Name is invalidXA063 Responsible Party First Name is missingXXA064 Responsible Party First Name is invalidXXA065 Responsible Party Middle Name is invalidXXA066 Responsible Party City is invalid XXA067 Responsible Party State is invalidXXA068 Responsible Party Zip code is invalidXXA069 Responsible Party Country is invalidXXA070 Credit Card Holder Name is invalidXA071 Credit Card Holder First Name is missingXA072 Credit Card Holder First Name is invalidXA073 Credit Card Holder Middle Name is invalidXPage 2 of 17 Last Updated 01-09-2006 EDI Support ServicesError code values for the professional , Institutional.

5 And Dental 837 Data Interchanges and the 834 Data InterchangeEdit Message837 Prof837 Inst837 Dent834A074 Patient HL can not be present XXXA075 Patient HL must be present XXXA076 Patient Last Name is invalidXXXA077 Patient First Name is missingXXXA078 Patient First Name is invalidXXXA079 Patient Middle Name is invalidXXXA080 Patient City must be A-Z and no space in 1st charXXXA081 Patient State code is invalidXXXA082 Patient Zip code is invalidXXXA083 Patient Country code is invalidXXXA084 Patient Date of Birth can't be a future date XXXA085 Patient Acct # must be A-Z, 0-9, space or, . /-XXA086 Total claim charge amount is invalidXXA087 Total Claim Charges not = to sum of service linesXXXA088 Claim Postal State code is invalidXXA089 Claim Country code is invalidXXA090 Order Date can't be a future dateXA091 Initial Treatment date can't be a future dateXA092 Referral Date can't be a future dateXXA093 Date Last Seen can't be a future dateXA094 Current Illness/Symptom date can't be future dateXA095 Date required when patient condition is acuteXA096 Acute manifestation can't be a future dateXA097 Similar Illness/Symptom can't be a future dateXA098 Accident Date can't be

6 A future dateXXA099 Last Menstrual Period can't be a future dateXA100 Last X-ray Date can't be a future dateXA101 Hearing/Vision RX Date can't be future dateXA102 Date last worked can't be a future dateXA103 Admission Date can't be a future dateXXXA104 Admit Date required with discharge dateXXA105 Discharge Date can't be a future dateXXA106 Discharge Date can't be prior to admit dateXXA107 Assumed/Relinquished Date > File Receive DateXPage 3 of 17 Last Updated 01-09-2006 EDI Support ServicesError code values for the professional , Institutional, and Dental 837 Data Interchanges and the 834 Data InterchangeEdit Message837 Prof837 Inst837 Dent834A108 Attachment control number qualifier missing XXXA109 Attachment control number missing XXXA110 Contract Amount is invalidXXA111 Contract Percentage is invalidXXA112 Terms Discount Percent is invalidXXA113 Credit/Debit Max.

7 Amount is invalidXXA114 Patient amount paid is > claim total chargeXXXA115 Patient amount paid is invalid XXA116 Total purchased service is invalidXA117 Ambulance mileage is invalidXA118 Purpose of round trip req if type transport = XXA119 Treatment series count is invalidXA120 Treatment series period is invalidXA121 Monthly treatment count is invalidXA122 Qualifier code can occur only three timesXA123 Diagnosis code is invalidXXA124 A 3rd Diagnosis submitted w/o a 2nd DiagnosisXXA125 Repriced Allowed Amount is invalid XXA126 Repriced Savings Amount is invalid XXA127 Repricing Flat Rate Amount is invalidXXA128 Repriced Approved Patient Group Amt.

8 Is invalidXA129 Home Health Care # of Visits is invalidXXA130 Home Health Care Frequency count is invalidXXA131 Referring Provider Last Name invalidXXXA132 Referring Provider First Name MissingXXXA133 Referring Provider First Name invalidXXXA134 Referring Provider Middle Name invalidXXXA135 Referring Provider Specialty code is invalidXXXA136 Rendering Provider Name can not be presentXXA137 Rendering Provider Name must be presentXA138 Rendering Provider Last Name invalidXXA139 Rendering Provider First Name missingXXA140 Rendering Provider First Name invalidXXA141 Rendering Provider Middle Name invalidXXPage 4 of 17 Last Updated 01-09-2006 EDI Support ServicesError code values for the professional , Institutional, and Dental 837 Data Interchanges and the 834 Data InterchangeEdit Message837 Prof837 Inst837 Dent834A142 Rendering Provider Specialty code is invalidXXA143 One occurrence must be 1C or 1G for this payerXXA144 Modifier = QB or QU & Facility Name missingXA145 Attending Physician Information is RequiredXA146 Subscriber Information RequiredXXXA147 Service Facility Name is invalidXXXA148 Purchased Service indicated.

9 Provider ID missingXA149 Service Facility Address missingXA150 Service Facility City is invalidXXA151 Service Line Date & Assessment Date both PresentXA152 Must = 485 or 486XA153 Service Facility State code invalid XXA154 Service Facility Postal Zip code invalid XXA155 Service Facility Country code is invalidXXA156 Supervising Provider Last Name is invalidXA157 Supervising Provider First Name is missingXA158 Supervising Provider First Name is invalidXA159 Supervising Provider Middle Name is invalidXA160 Insurance type code of MP invalid in sequence XXA161 Claim Level Adjustment Amount is invalidXXA162 Claim Level Adjustment Quantity is invalidXXA163 Payer Paid Amount is invalid (COB)XXA164 Approved Amount Invalid (COB)XA165 Allowed Amount is invalid (COB)XXA166 Patient Responsibility Amount invalid (COB)XA167 Covered Amount is invalid (COB)XA168 Discount Amount is invalid (COB)XA169 Per Day Limit Amount is invalid (COB)XA170 Patient Paid Amount is invalid (COB)XA171 Tax Amount is invalid (COB)XA172 Total Claim Before Taxes Amount invalid (COB)

10 XA173 Patient signature source code invalidXA174 Outpatient Reimbursement Rate invalidXA175 HCPCS Payable Amount invalidXPage 5 of 17 Last Updated 01-09-2006 EDI Support ServicesError code values for the professional , Institutional, and Dental 837 Data Interchanges and the 834 Data InterchangeEdit Message837 Prof837 Inst837 Dent834A176 ESRD Paid amount is invalidXXA177 Non-payable Prof. Component Billed Amt invalidXXA178 Claim A