Error Message

Patient eligibility not found with entity. Member pick reject.    

Description

This error is found in the Electronic module on an invoice send to Optum/Medica/UBH/UHC with a status of Has Rejections. It appears because the client's policy with Optum is actually an EAP policy and the Optum EDI system doesn't recognize the policy as a typical Optum/Medica/UBH/UHC policy. 

Resolution

No action steps are needed. 

Optum EAP is a tricky one for electronic claims submission. You will get this Member Pick Reject 99% of the time, however there isn't anything you actually need to do. The payer sends this back because the claim has to go through the EAP route process and it's not part of their general claim submission route.

Despite the fact that it appears rejected, it actually is not rejected and the payer is processing the claim. It does take much longer for the claim to process and the reps don't always see it on their end. Procentive and the clearinghouse have confirmed that the Member Pick Reject is an invalid rejection due to how Optum processes their EAP claims and it will eventually pay out.  It just takes awhile.  Expect to wait at least 60 days for payment.