Insurance Claim Error Cheat Sheet
In chiropractic billing, claim errors result in either rejections or denials and overcoming these can be challenging. Even small errors like missing or incorrect patient demographic information can lead to claim denials and payment delays. As a chiropractic practice, your goal should be to avoid common claim errors and get paid faster. Fortunately, you can handle the claim submission process smoothly and do so much more with zHealth's EHR and billing software. Click the attachment below to download our insurance claim error cheat sheet and learn how to get each claim right the first time.
RC-Series: Claim-Level Validation Errors
| Code | Error Description | Root Cause | Resolution | Prevention |
| RC07 | Duplicate claim | Claim already submitted | Use frequency code 7 or 8 | Track submission status |
| RC13 | Invalid insured relationship | Invalid relationship code | Fix Box 6 | Validate insurance intake |
| RC20 | Subscriber ID missing/invalid | Missing insurance ID | Fix Box 1a | Verify insurance card |
| RC21 | Patient DOB missing/invalid | Missing DOB | Fix patient demographics | Intake validation |
| RC22 | Patient gender missing | Missing gender | Fix patient profile | Required field validation |
| RC23 | Patient name missing | Missing name | Fix patient record | Mandatory intake fields |
| RC25 | Invalid diagnosis pointer | CPT not linked to diagnosis | Fix Box 24E | Automatic pointer assignment |
| RC29 | Invalid CPT code | CPT invalid | Use valid CPT | CPT validation engine |
| RC30 | Invalid CPT modifier | Modifier incorrect | Fix modifier | CPT rules validation |
| RC31 | Invalid diagnosis code | ICD invalid | Fix Box 21 | ICD-10 validation |
| RC32 | Diagnosis missing | No diagnosis present | Add ICD code | Required validation |
| RC33 | Diagnosis not valid for DOS | ICD not active | Use correct ICD version | ICD version validation |
| RC34 | Invalid referring provider | NPI invalid | Fix Box 17 | NPI validation |
| RC35 | Missing referring provider | Required but missing | Add referring provider | Specialty rules |
| RC36 | Invalid rendering provider | NPI invalid | Fix Box 24J | Provider validation |
| RC37 | Rendering provider missing | Required but missing | Add rendering provider | Required field |
| RC38 | Billing provider missing | Missing billing provider | Fix Box 33 | Provider setup validation |
| RC39 | Invalid billing provider NPI | Invalid NPI | Correct NPI | NPI validation |
| RC41 | Invalid tax ID | EIN incorrect | Fix EIN | Tax ID validation |
| RC44 | Missing place of service | POS missing | Fix Box 24B | Required field |
| RC45 | Invalid place of service | POS invalid | Use valid POS code | POS validation |
| RC46 | Missing service facility | Facility missing | Fix Box 32 | Provider setup |
| RC47 | Invalid facility NPI | Facility NPI invalid | Fix Box 32a | NPI validation |
| RC48 | Missing charge amount | CPT charge missing | Add charge | Required field |
| RC49 | Invalid charge amount | Charge invalid | Fix charge | Charge validation |
| RC50 | Invalid total charge | Total incorrect | Fix Box 28 | Automatic calculation |
| RC51 | Unknown/invalid payer | Wrong payer ID | Fix payer ID | Maintain payer list |
| RC52 | Missing payer ID | Payer missing | Add payer ID | Required field |
| RC53 | Invalid payer ID | Incorrect payer ID | Correct payer mapping | Clearinghouse mapping |
| RC54 | Provider not enrolled | Enrollment missing | Complete enrollment | Track enrollments |
| RC55 | Invalid claim frequency | Frequency invalid | Fix Box 22 | Claim resubmission logic |
| RC56 | Missing claim frequency | Required but missing | Add frequency code | Resubmission workflow |
| RC57 | Invalid authorization number | Authorization invalid | Fix Box 23 | Verify authorization |
| RC58 | Missing authorization number | Required but missing | Add authorization | Intake validation |
| RC73 | Line item mismatch total | Total ≠ line sum | Fix Box 28 | Auto-calculate |
| RC80 | Invalid referring NPI | Referring provider invalid | Fix Box 17b | NPI validation |
| RC136 | Facility NPI missing | Facility NPI missing | Fix Box 32a | Provider configuration
|
FE-Series: Field-Level Errors
| Code | Error | Root Cause | Resolution | Prevention |
| FE01 | Invalid patient name | Name invalid format | Fix patient name | Input validation |
| FE02 | Missing patient name | Missing name | Add name | Required field |
| FE03 | Invalid DOB | DOB invalid | Fix DOB | Format validation |
| FE04 | Missing DOB | Missing DOB | Add DOB
| Required field |
| FE05 | Invalid gender | Gender invalid | Fix gender | Controlled field |
| FE06 | Missing gender | Missing gender | Add gender
| Required field |
| FE07 | Invalid subscriber ID | Insurance ID invalid | Fix ID | Insurance verification |
| FE08 | Missing subscriber ID | Missing ID | Add ID | Required field |
| FE09 | Invalid payer ID | Payer invalid
| Fix payer | Clearinghouse mapping |
| FE10 | Missing payer ID | Missing payer | Add payer | Required field |
| FE64 | Missing charge | CPT charge missing | Add charge | Required field |
| FE65 | Invalid charge | Charge invalid | Fix amount | Charge validation |
| FE66 | Missing CPT code | CPT missing | Add CPT | Required field |
| FE67 | Invalid CPT code | CPT invalid | Fix CPT | CPT validation |
| FE68 | Invalid gender code | Gender invalid | Fix gender | Demographic validation |
| FE69 | Invalid diagnosis | ICD invalid | Fix ICD | ICD validation |
| FE70 | Missing diagnosis | Diagnosis missing | Add ICD | Required field |
| FE71 | Invalid modifier | Modifier invalid | Fix modifier | CPT validation |
| FE72 | Missing modifier | Modifier required | Add modifier | CPT rules |
| FE73 | Diagnosis required | Diagnosis missing | Add ICD | Required field |
| FE74 | Invalid NPI | NPI invalid | Fix NPI | NPI validation |
| FE75 | Missing NPI | Missing NPI | Add NPI | Required field |
| FE76 | Invalid zip code | Zip invalid | Fix zip | Address validation |
| FE77 | Missing zip code | Zip missing | Add zip | Required field |
| FE78 | Invalid state | State invalid | Fix state | Address validation |
| FE79 | Missing state | State missing | Add state | Required field |
| FE89 | Missing billing provider | Missing provider | Fix Box 33 | Provider setup |
| FE357 | Invalid zip/state mismatch | Zip/state mismatch | Fix address | Address validation
|
Diagnosis Validation Errors
| Code | Error | Cause | Fix |
| DX01 | Diagnosis invalid | Invalid ICD | Use valid ICD |
| DX02 | Diagnosis not billable | Non-billable ICD | Use billable ICD |
| DX03 | Diagnosis invalid for gender | Gender mismatch | Correct ICD |
| DX04 | Diagnosis invalid for age | Age mismatch | Correct ICD |
| DX05 | Diagnosis inactive | ICD inactive | Use valid ICD
|
CPT Validation Errors
| Code | Error | Cause | Fix |
|---|
| CPT01 | CPT invalid | Invalid CPT | Fix CPT |
| CPT02 | CPT inactive | CPT inactive | Use valid CPT |
| CPT03 | CPT not allowed by payer | Payer restriction | Verify payer rules |
| CPT04 | Modifier required | Missing modifier | Add modifier |
| CPT05 | Modifier invalid | Modifier incorrect | Fix modifier
|
Provider Errors
| Code | Error | Cause | Fix |
|---|
| PR01 | Invalid billing NPI | NPI incorrect | Fix NPI |
| PR02 | Missing billing NPI | Missing NPI | Add NPI |
| PR03 | Invalid rendering NPI | NPI invalid | Fix NPI |
| PR04 | Missing rendering NPI | Missing rendering provider | Add provider |
| PR05 | Provider not enrolled | Enrollment missing | Complete enrollment |
Payer Errors
| Code | Error | Cause | Fix
|
|---|
| PY01 | Unknown payer | Invalid payer ID | Fix payer ID |
| PY02 | Payer not enrolled | Enrollment missing | Enroll provider |
| PY03 | Invalid payer ID | Incorrect payer | Fix payer mapping
|
If you are unsure how to resolve the rejection, or if the rejection persists after correction, our support team is available to assist.
Please contact zHealth Support with the following details:
Email Support
support@zhealthehr.com
Phone Support
(800) 459-0302
Submit Support Ticket
Help Center → Submit a Request inside zHealth Support Portal
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