EDI Claim Error-Pmts Adj Pt Resp Does Not Balance to Zero

EDI Claim Error-Pmts Adj Pt Resp Does Not Balance to Zero

Reasons that Claims Don’t Balance Error Message Occurs

The signs in the transactions (-) may be incorrect

Must have patient responsibility lines 

Adjustment Codes may not be mapped in the database to a CO 45 or PR code, will need to check with Development. Look at the adjustment code, is it a code that is not commonly used. 

The Insurance that pays from the Primary must be the same insurance that is currently in the system. You can’t just delete, you should always terminate and add new insurance plans.

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