The wording of enrollment rejections can vary greatly from payer to payer. Enrollment rejections include, but are not limited to the following:

These are almost exclusively payer rejections, as the clearinghouse does not check the validity of provider or office information before passing the claim off to the payer.

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If the information that the payer has on file for the office or provider does not line up perfectly, a claim submitted to the payer will reject with an enrollment rejection.

Items to double check when receiving an enrollment rejection

Is the proper billing method being used to send claims for the provider?

One of the most common reasons for this type of rejection, is a result of the provider being on file to either bill under the group or bill as individual and the setting for such somehow being altered within MacPractice. If a provider is on file with the payer to bill as group, any claim sent to this payer where the provider is set to bill as individual, the claim will reject, because individual provider information is populating the section of the claim where the office's information should be.

Conversely, if a provider is on file to bill as individual with the payer, but the office also has a group NPI, if that NPI is entered within MacPractice, but the provider is not set to bill as individual for this payer, the claim will reject, because the office information will populate the section of the claim where the individual provider information is expected.

Has the provider's or the office's information changed at all?

If the office or provider is assigned a new NPI or has changed the Tax ID with which they bill, for whatever reason, it is important that this new information be updated with all payers to which claims are submitted. If the office has moved or changed names, this information as well needs to be updated with all payers to which claims are submitted. If the information is updated in MacPractice, but hasn't been updated at the payers, this will cause claims to receive enrollment rejections. 

Does the payer require recertification?

Some payers require that offices and providers periodically obtain a recertification from them. It may be that the time for recertification has occurred and the notification from the payer was somehow missed or not received by the office. When this occurs, all claims to that payer from the provider or office that requires recertification will receive enrollment rejections.