Print Exception Report

With the Print Exception Report function, you can print a report of all procedures that did not pass the claim integrity checks. Every procedure is processed through claim integrity checks before they are placed into the electronic claims transmission file. As indicated in the Processing Insurance Claims Flowchart, you should print the exception report after you perform the Move/Rebuild Transmission File function. You can then proceed to correct the exceptions using the complete list of the electronic claim exception messages provided below.

Upon accessing the Print Exception Report function, the Printers dialog box displays.

NOTE: If claims have been filed or refiled since the last time the Move/Rebuild was done, then another Move/Rebuild is automatically performed and a progress bar will display.

After the Move/Rebuild is complete, click Proceed to print the exception report.

Sample Report

The report is sorted by Insurance Carrier code, then Performing Doctor code, then account number. It includes the account number, patient name, location code, accounting date, date of service, procedure code, whether or not assignment is accepted for that procedure, the charge amount and the exception reason. Subtotals by Insurance Carrier code and Total amount also print.

You must now correct the exceptions. If you do not correct the exceptions the claims will not be sent and will remain in the exception file.
Only one exception per procedure prints at a time. Meaning, there may be more than one exception error on a claim; so you correct one, print the report again and the same claim may appear, but with a different exception to be corrected.
After you correct the exception(s) you must Move/Rebuild the Transmission File. This pulls all of the corrections into the claim and runs the claims through the integrity checks again.
The exception report also shows any procedure that has been transferred to the paper insurance print file because spaces or 'PP' were entered in the procedure modifier field during procedure entry. Some electronic insurance carriers will not accept more than one modifier when filing claims electronically. When you print the insurance forms, these claims will automatically print and no further action is required.

In certain situations you may not be able to correct the exception error but still need to remove the claim(s) from the exception file. In this case, you can Move Exceptions to Paper under Billing, Insurance Billing functions, Electronic Claims, File Maintenance. This removes the procedure from the exception file and places it in the paper insurance print file. You can move either all of the procedures or procedures for specific account numbers.

Claims can be 'excepted' from the transmission file for numerous reasons. Since insurance is constantly changing, the integrity checks can also change. Following is a list of the exception messages for electronic claims and which fields need to be edited to resolve them.

List of Electronic Claim Exception Messages

Exceptions	How to Resolve Exceptions
An Employer Name is required if the Policyholder is an Employer	Employer's Name in the patient's Insurance Policy Information screen (Patient, Change Patient Data)
An Insurance Type is required if the policy is for a Medicare Carrier	Insurance Type in the patient's Insurance Policy Information screen (Patient, Change Patient Data)
Anesthesia procedures cannot span the ICD-10 effective date for this carrier	Through Date attachment on the encounter. Edit the encounter, delete the Through Date Attachment, split the charges into two separate claims - one for each date with the appropriate ICD codes. (Transactions, Edit an Encounter)
Application Sender's Code Req	Direct Connect Clients Only: Application Sender's Code in Electronic Direct Connect Claims Integration (System, Claims Management Menu) EMEDIX Clients: 5010 Submitter ID Rules (System, Claims Management Menu)
A valid Submitter Id is required in Submitter Id Rules for (XX)	Submitter ID in 5010 Submitter ID Rules (System, Claims Management Menu)
Billing Profile Address1 cannot equal Billing Profile Address2	Line 1 and Line 2 of Billing Address in Billing Profile Rules (System, Claims Management Menu)
Carrier Address1 cannot equal Carrier Address2	Address Line One and Address Line Two in Maintain Insurance Carriers (Tables, Insurance Carrier Table)
Carrier - Invalid State Code	State field in Maintain Insurance Carriers (Tables, Insurance Carrier Table)
Carrier Missing State Code	State field in Maintain Insurance Carriers (Tables, Insurance Carrier Table)
Carrier not in effect or changed	If Claim Indicator="J" and Original Carrier Type does not equal the Policy Carrier type. The claim was moved using the Transfer Journal to Current File function and the Carrier Type on the patient's Insurance Policy Information screen (Patient, Change Patient Data) had been changed between the time the claim was first filed and the time it was transferred to current. You must either change the policy information back to what it was and send the claim or move the claim to paper and refile it to the appropriate carrier.
Claim not added to claim file. Contact customer service	This is most commonly due to the Electronic Claims Integration not being setup for the carrier on the claim. Direct Connect clients: Electronic Direct Connect Claims Integration (System, Claims Management Menu) EMEDIX clients: Contact customer service.
CMN Attachment requires Business Phone # for the Ins Dr	The Business Phone # in the CMN attachment on the encounter (Transactions, Edit an Encounter)
CMN Attachment requires Business Phone # for the Referral Src	The Business Phone # in the CMN attachment on the encounter (Transactions, Edit an Encounter)
Diagnosis Code (XX) inactivated	Either reactivate the Diagnosis Code (Tables, Diagnosis Code Table, Maintain Diagnosis Codes) or change the Diagnosis Code on the encounter (Transactions, Edit an Encounter)
Diagnosis Code (XX) invalid	Change the Diagnosis Code on the encounter (Transactions, Edit an Encounter)
Diagnosis Code (XX) invalid	The Diagnosis Code on the charge is not linked to the procedure code that it is tied to in Maintain CPT®/DX Linking (Tables, Procedure Code Table, CPT®/DX Cross Linking Table)
Diagnosis Code (XX) invalid. A more specific code is required	Change the Diagnosis Code on the encounter (Transactions, Edit an Encounter)
Doctor NPI Number Missing (XX)	NPI Number in Maintain Doctor Codes (Tables, Doctor Code Table) and NPI Number in Billing Profile Rules (System, Claims Management Menu)
Doctor Specialty Code Missing (XX)	Specialty Code in Maintain Doctor Codes (Tables, Doctor Code Table)
Doctor Tax ID Must be 9 digits long (XX)	Tax ID Number in Maintain Doctor Codes (Tables, Doctor Code Table) and Tax ID Number in Billing Profile Rules (System, Claims Management Menu)
Dx (XX) in the UB-04 Attachment is an ICD-(9 or 10) and this payer accepts ICD-(9 or 10)	This check confirms that any diagnosis codes entered in the UB-04 attachment match the ICD version accepted by the payer; Admit Dx, Patient Reason Dx a,b,c, External Cause of injury a,b,c. ICD-10 Activation in Maintain Insurance Carriers (Tables, Insurance Carrier Table) or Diagnosis Code on the encounter (Transactions, Edit an Encounter)
Dx (XX) in the UB-04 Attachment is invalid	This check confirms that any diagnosis codes entered in the UB-04 attachment exist in the Diagnosis Code Table; Admit Dx, Patient Reason Dx a,b,c, External Cause of injury a,b,c. Diagnosis Code in Maintain Diagnosis Codes (Tables, Diagnosis Code Table) or Diagnosis Code on the encounter (Transactions, Edit an Encounter)
Dx code 'Sex' does not match Pt Sex (Dx code)	Sex field in Patient Name and Address Information screen (Patient, Change Patient Data)
Entity Name missing from Billing Profile in effect for DOS	Entity Name in Billing Profile Rules (System, Claims Management Menu)
ICD (9 or 10) Diagnosis codes are required for this payer	If the claim type is '2' - See if this payer requires ICD 9 or ICD 10 codes and then see if the correct Diagnosis code pointers are on the line item. ICD-10 Activation in Maintain Insurance Carriers (Tables, Insurance Carrier Table) or Diagnosis Code pointer on the encounter (Transactions, Edit an Encounter)
Insurance Table - Carrier set to Not Bill	Do Not Bill to Insurance check box is selected for the carrier in Maintain Insurance Carriers (Tables, Insurance Carrier Table)
Insurance Doctor Taxonomy Code Missing (XX)	If Claim Type=2 and Electronic ID="H00014" and no taxonomy code entered. Ins Dr Taxonomy on the encounter, which pulls from the Taxonomy Code field in Maintain Doctor Codes (Tables, Doctor Code Table)
Insurance Doctor Taxonomy Code Required	Ins Dr Taxonomy on the encounter, which pulls from the Taxonomy Code field in Maintain Doctor Codes (Tables, Doctor Code Table)
Interchange Sender ID Req	Direct Connect Clients: Interchange Sender ID in Electronic Direct Connect Claims Integration (System, Claims Management Menu) EMEDIX Clients: Contact customer service.
Invalid Address	Address Line One in the Patient Name and Address Information screen (Patient, Change Patient Data)
Invalid Carrier Electronic ID#_NOCD	Electronic ID in Maintain Insurance Carriers (Tables, Insurance Carrier Table)
Invalid City	City in the Patient Name and Address Information screen (Patient, Change Patient Data)
Invalid First Visit Date	Date of First Visit in the Patient Name and Address Information screen (Patient, Change Patient Data)
Invalid Location Address (XX)	Address Line One in Maintain Location Codes (Tables, Location Code Table)
Invalid Location City (XX)	City in Maintain Location Codes (Tables, Location Code Table)
Invalid Location NPI Number (XX)	Location NPI Number in Maintain Location Codes (Tables, Location Code Table) for the Location on the claim
Invalid Location State (XX)	State in Maintain Location Codes (Tables, Location Code Table)
Invalid Modifier, Modifier not 2 characters long	Modifier on the encounter (Transactions, Edit an Encounter)
Invalid or Missing Billing-Profile ZipCode	Zip of Billing Address in Billing Profile Rules (System, Claims Management Menu)
Invalid or Missing Birthdate	Birth Date in Patient Name and Address Information screen (Patient, Change Patient Data)
Invalid or Missing Insurance Doctor NPI Number (XX)	NPI Number in Maintain Doctor Codes (Tables, Doctor Code Table) for the Ins Dr on the claim
Invalid or Missing Organizational NPI Number	NPI Number in Maintain Group NPI Numbers (Tables, Doctor Code Table, Provider Number Table, Group NPI Number Table) NPI Number in Billing Profile Rules (System, Claims Management Menu)
Invalid or Missing Patient Sex	Sex in Patient Name and Address Information screen (Patient, Change Patient Data)
Invalid or Missing Referring Doctor NPI Number for (XX)	NPI Number in Maintain Referral Source Codes (Tables, Referral Source Table) for the Ref Dr on the claim
Invalid or Missing Zip Code	US Addresses only - Zip Code in Patient Name and Address Information screen (Patient, Change Patient Data)
Invalid State	US Addresses only - State Code in Patient Name and Address Information screen (Patient, Change Patient Data)
Invalid Referring Doctor code found (XX)	Ref Dr on the encounter (Tables, Referral Source Table, Maintain Referral Source Codes) If no Ref Dr on the encounter (Tables, Doctor Code Table, Maintain Doctor Codes)
Location ZipCode must contain 9 digits (XXXXX)	Zip Code in Maintain Location Codes (Tables, Location Code Table)
Location Address1 cannot equal Location Address2	Address Line One and Address Line Two in Maintain Location Codes (Tables, Location Code Table)
Location Code requires Admit Date	Missing ADM/DIS Attachment or Admit Date in the attachment (Transactions, Edit an Encounter)
Missing Database Phone Number	Phone Number in Change Database Parameters (System, Database Maintenance Menu)
Missing Electronic ID # for Ins Carrier	Electronic ID# in Maintain Insurance Carriers (Tables, Insurance Carrier Table) Professional Claims – If the Electronic Form Number selected for the Insurance Carrier generates electronic claims and the Electronic ID # field is blank or contains ‘00000’, the claim will be placed on the Exception Report. Institutional Claims - If the Electronic Form Number selected for the Insurance Carrier generates electronic claims and the UB Electronic ID # field is blank or contains ‘00000’, the Electronic ID # will be used instead. If the Electronic ID # field is blank or contains ‘00000’, the claim will be placed on the Exception Report.
Missing or Invalid Place of Service for Location (XX)	Equivalent Place of Service Code in Maintain Location Codes (Tables, Location Code Table). Applies to Professional and Institutional (UB) Claims
No Payment from Primary Carrier	If Secondary Claim: Patient's Insurance Ledger (Patient, Change Patient Data). No payment entered from the primary carrier that the claim was sent to
No Payment from Secondary Carrier	If Tertiary Claim: Patient's Insurance Ledger (Patient, Change Patient Data). No payment entered from the secondary carrier that the claim was sent to
No Primary Carrier on the Account	If a Case is stored for the encounter, Insurance Primary in the Case Management Record, otherwise the Insurance policies on the patient's account (Patient, Change Patient Data)
Other Carrier Address1 cannot equal Other Carrier Address2	Address Line One and Line Two in Maintain Insurance Carriers (Tables, Insurance Carrier Table) for the other carrier on the patient's account
Patient Address1 cannot equal Patient Address2	Address Line One and Two in Patient Name and Address Information screen (Patient, Change Patient Data)
Patient File - Carrier set to Not Bill	Bill this Carrier=N for this carrier in the patient's Insurance Policy Information screen (Patient, Change Patient Data)
Pat. Rel to Policy Holder Required	Pat. Rel to Policy Holder in the patient's Insurance Policy Information screen (Patient, Change Patient Data)
PO Box in Billing-Profile Address Profile Rules	Line 1 and/or Line 2 of Billing Address in Billing Profile Rules (System, Claims Management Menu) PO Box not allowed in address line 1 or 2
Policy Number not Valid	Policy Number in the patient's Insurance Policy Information screen (Patient, Change Patient Data) Policy Number must be greater than 2 digits
Policy Number Required	Policy Number in the patient's Insurance Policy Information screen (Patient, Change Patient Data) Policy Number must be greater than 2 digits
Profile Pay To Address1 cannot equal Address2	Line 1 and Line 2 of Pay To Address in Billing Profile Rules (System, Claims Management Menu)
Revenue Code (XX) must be 4 digits long	If the claim type is '2'. Default Revenue Code in the UB-04 Integration (System, Claims Management Menu) Revenue Code in Maintain Procedure Codes (Tables, Maintain Procedure Codes) Revenue Codes in the Paper Claim Editor (System, Claims Management Menu)
Service Date is Before First Visit Date	Date of Service must be the same as or later than the Date of First Visit in the Patient Name and Address Information screen (Patient, Change Patient Data)
Tax Id missing from Billing Profile in effect for DOS	Tax ID Number in Billing Profile Rules (System, Claims Management Menu)
The Admission Hour in the UB-04 Attachment must be entered in Military format (13:00) or using the 12 hour clock format (01:00PM)	The ADM/DIS Attachment on the encounter Edit an Encounter (Transactions)
The Date of Ill,Inj,Lmp (XX) in Case (ID) cannot be for a future date of service	The Date of Ill,Inj,Lmp in the Case Attachment on the encounter Edit an Encounter (Transactions)
The Discharge Hour in the UB-04 Attachment must be entered in Military format (13:00) or using the 12 hour clock format (01:00PM)	The Discharge Hour in the UB-04 Attachment on the encounter Edit an Encounter (Transactions)
The Initial Tx Date (XX) cannot be for a future date of service	The Initial Tx Date in the Chiro Attachment on the encounter Edit an Encounter (Transactions)
The Through Date cannot be a date prior to the Date of Service	The Through Date Attachment on the encounter Edit an Encounter (Transactions)
Tricare Policy number must be 9 or 11 digits long	If Carrier Form Type ="H" and Policy number is not 9 or 11 digits long. Policy Number in the patient's Insurance Policy Information screen (Patient, Change Patient Data)