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Coverage and eligibility

CV-2-1 Patient not a covered member

The insurer can’t match the patient to an active member on the policy for the date of the visit.

What the insurer’s message says: “[NPHIES display text for CV-2-1]”

In our own words, from the NPHIES Codeable Concept list v5.4. Reviewed by [name, role], [date].

GroupCoverage and eligibility
Who usually fixes itFront desk, at check-in
Deadline15 days from the rejection

What it means

For example: A patient’s employer changed insurers last month; the claim went to the old one.

The rejection is about the claim as it was sent, not about whether the care was right.

Why it usually happens

  • The policy had lapsed, or hadn’t started, on the visit date.
  • The ID or member number on the claim doesn’t match the insurer’s record.
  • The patient has moved to another insurer or employer.

How to fix this claim

  1. Verify cover again for the visit date and compare the member details.
  2. Correct the ID or member number and resend.
  3. If cover had lapsed, speak to the patient before billing them.
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

Verify cover on the day of the visit, not only at booking.

This page explains the common causes. Your insurer’s policy and your contract decide each claim.

Before sending

Nabdah catches this before you send.

Cover is verified with NPHIES at check-in, and the answer is kept on the visit.

Book a 30-minute demoChat on WhatsApp
CLM-2026-01067 · Nasser Al-MutairiChecked before sendingHeld
Patient’s cover activeFix
Price matches the contractChecked
NPHIES fields completeChecked
Sample · fix 1, then send

Often seen with

CV-1-4

Service not covered by the policy

The patient’s policy doesn’t include this service, so the insurer won’t pay for it under this claim.

Front desk, at check-in
AD-2-5

Sent after the time limit

The claim reached the insurer after the time allowed for sending it.

Billing

All rejection codes