Certified on NPHIESGroupCoding and billing
Who usually fixes itBilling
Deadline15 days from the rejection
What it means
For example: A line was corrected from 350 to 300, but the claim total still says 350.
The rejection is about the claim as it was sent, not about whether the care was right.
Why it usually happens
- A line was changed but the total wasn’t.
- The patient’s share was worked out with the wrong percentage.
- Discounts or tax were applied inconsistently.
How to fix this claim
- Recalculate each line and the total.
- Check the patient’s share against their class.
- Resend the corrected claim.
Mind the deadline. You have 15 days from the rejection to answer it (CHI Unified Health Insurance Contract, clause 5.4). Your contract with the insurer may set a different window, so check it.
How to stop it next time
Let the system calculate totals and shares from the contract and the cover answer.
This page explains the common causes. Your insurer’s policy and your contract decide each claim.
