Invalid Mbr: Handling Claim Rejections
Invalid Mbr: It means the insurance company cannot find the member. With this type of error, you may need to call the insurance company to check on why they cannot find the member. There might few reasons why you may be getting this error. While on the phone with the insurance company, open the copy of the submitted CMS-1500 claim in front of you. You can use the information on the CMS-1500 to verify what you sent versus what the insurance company has on their file.
Possible cause could be mismatched insurance information that you have entered in CMS-1500. Or it could be incorrect patient information i.e., incorrect patient demographics.
Insurance Coverage Expired
There are some cases in which patient is no longer covered under that insurance plan. If this is the case, you will either need to get new insurance information from your patient or bill the session to your patient i.e., patient responsibility. You should always verify patient benefits or patient eligibility before submitting any claim.
In such rejected claims double check payer ID on CMS-1500. You might be submitting claim to wrong payer (insurance company). You can call the phone number on the copy of the patient’s insurance card and ask them for their EDI Payor ID. Resubmit the claims with correct payer ID.
Incorrect Insured ID Number
Recheck insurance ID number (Box 1a) on CMS-1500 claim and patient’s insurance card. This is the unique ID that identifies the patient. Make sure that is entered correctly. Make sure you don’t have any invalid characters in the primary ID. Some of insurance companies will have trailing numbers at the end of their primary ID separated by a dash or a space. You may want to ask the payer if they want the trailing numbers in Box 1a of the CMS-1500.
Incorrect Insured’s Information
Cross-check insurance information with an insurance card. It is always best to make sure you enter it correctly on CMS-1500. Sometimes you could have misspelled a name or entered the wrong birthdate.
We hope that this article has given you a clear idea of how to handle ‘Invalid Mbr’ rejection. CMS-1500 form is definitely tough to master. Simply contact E2E Medical Billing Services at 888-552-1290 / [email protected] and forget about your billing worries. We are one of the leading medical billing service providers for solo practitioners and small group practices. With our assistance, you can simply focus on your patients and you don’t have to worry about insurance reimbursements.