Why are a provider’s claims being rejected?
BMC HealthNet Plan rejects initial claims submissions for only three reasons: unrecognized member IDs, unrecognized NPIs (i.e., mis-typed NPIs or NPIs not registered at BMC HealthNet Plan), or a pay-to tax ID that doesn’t match the pay-to tax ID BMC HealthNet Plan has on file for the submitted NPI. For electronic claims, those IDs/NPIs must be in certain locations in the 837 files with certain qualifiers. We often find that a provider’s software shows the correct IDs/NPIs on the screen, but the 837 file that we receive from the clearinghouse has the IDs/NPIs in the wrong location or with the wrong qualifier. For corrected claims (see Question 12 below), there are additional criteria that must be satisfied to prevent a claim from rejecting.
