Processed according to contract provisions (Contract refers to provisions that exist between the Health Plan and a Provider of Health Care Services).
This error appears as a rejection in the in the Electronic Module. The error is coming directly from UCare so you will need to address it directly with them. It may be that the provider is not affiliated with the facility, location, or the client's plan product type, however the most common cause is that the taxonomy on the claim (the billing/facility or staff) does not match the NPI on file. You will want to verify the NPI and Taxonomy combination from the claim with UCare and how it's been registered with them.
Contact UCare for each client with this rejection to determine why the payer will not accept the claims. When calling them, select the prompt for EDI Claim Rejections and their EDI team will be able to provide details on the rejection.
If the rep states that everything appears normal, please send a ticket to Procentive, with the following information:
- The Phone number you called
- The Rep you spoke with
- The call reference number
- A copy of the client's ID card.
All of these items are required by the clearinghouse in order for Procentive to open a case.