Common Rejections - 30 Day Adjudication (Medicare/BCBS)

Owned by Dylan Nigh
May 09, 2023
1 min read

30 Day Adjudication (Medicare/BCBS)

Rejection messages include but are not limited to:

  • Category- Acknowledgement/Returned as unprocessable claim The Claim/Encounter has been rejected and has not been entered into the adjudication system Status- Other Entity's Adjudication or Payment/Remittance Date Entity- Payer

  • Payer/Trading Partner REJ Payer Response ACKNOWLEDGEMENT/RETURNED AS UNPROCESSABLE CLAIM^Adjudication or Payment Date^Payer

This rejection is most commonly associated with claims submitted with a primary of Medicare and a secondary of Blue Cross Blue Shield (BCBS). The rejection is stating that the secondary claim cannot be submitted for 30 days after the primary has paid. This is to ensure there is enough time for a crossover claim to be created and sent to the secondary by Medicare. If after that 30 days there is no claim response/payment, then a secondary claim can be created and sent from MacPractice.