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

When to Contact zHealth Support

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:

Patient Name
Date of Service
Claim ID (if available)
Screenshot of rejection message (recommended)

Contact Options

Email Support

support@zhealthehr.com

Phone Support
(800) 459-0302

Submit Support Ticket
Help Center → Submit a Request inside zHealth Support Portal

Guidelines for Billing BCBS Illinois (HCSC) and Blue Shield of California

Insurance Claim Error Cheat Sheet

Insurance Claim Error Cheat Sheet

RC-Series: Claim-Level Validation Errors

FE-Series: Field-Level Errors

Diagnosis Validation Errors

CPT Validation Errors

Provider Errors

Payer Errors

When to Contact zHealth Support

Contact Options

Related Article: