ClaimMD-Specific Clearinghouse Rejection Reference

When a claim is rejected by ClaimMD before it reaches the payer, you will see a message in the Claim History panel on the superbill formatted as:

[Date] @ [Time] - REJECTION by CLAIM.MD
• [Rejection message]

These rejections mean the claim never reached the payer for adjudication. You must correct the issue in Elation Billing and resubmit from the Claims Queue. This article covers the most common ClaimMD-generated rejection messages and how to resolve them. For payer-generated denials (CO/PR codes from ERAs), see Common Claim Rejections and Denials.

Category 1 — EDI Formatting & Field Validation

ClaimMD Rejection Message	What It Means	Common Cause	Fix
`Invalid Facility City []`	City field is blank in the claim’s service location	City disappears when a new location is saved in Elation Billing	Go to Settings → Locations → edit the affected location and re-enter the city → save → re-submit the claim
`Tax ID must be 9 digits`	EIN in the claim is missing or malformed	EIN not populated in Practice Settings (HCFA Box 25)	Confirm 9-digit EIN in Settings → Practice Info
`Diagnoses [XXXXX] is valid, but not for this date [MM/DD/YYYY]`	ICD-10 code was valid at some point but is not billable for that date of service	Practice using a retired, deleted, or parent-level ICD-10 that requires a more specific child code (typically after Oct 1 annual or Apr 1 CMS updates)	Update to the correct billable code for that DOS; Elation’s ICD-10 code database updates with CMS annually
`Code 562 — Billing Provider NPI and Taxonomy NOT VALID against State Master File`	NPI + Taxonomy combination fails state-level validation	Provider credentialing not reflected in the state (e.g., Texas) master file	Verify NPI/Taxonomy in NPPES; may need re-credentialing or correction at the state MAC

Category 2 — Submitter / Payer ID Errors

ClaimMD Rejection Message	What It Means	Common Cause	Fix
`Valid [PAYER NAME] submitter ID is required []`	ClaimMD does not have a recognized submitter ID configured for that payer	Missing or incorrect Submitter ID in payer configuration; common with BCBS plans	Confirm the correct Submitter ID in Settings → Insurance for that carrier; contact Elation Support to verify what ClaimMD has on file
`Invalid or Unsupported PayerID [XXXXX]`	The payer ID entered is not recognized by ClaimMD	Wrong or outdated payer ID; payer recently changed their ID	Check the ClaimMD Payer List and update the payer ID in Settings → Insurance
`Invalid or Unsupported OTHER PayerID [ISA04]`	Secondary payer ID is invalid in the secondary claim loop	Secondary payer not configured or using an incorrect ID	Update the secondary payer ID in Elation and verify against the ClaimMD payer list

What is a CAS (Claim Adjustment Segment)? The CAS is the EDI field on a secondary claim that records how the primary payer adjusted the billed amount — including contractual write-offs and patient responsibility such as deductible, coinsurance, and copay. Secondary claims must include accurate CAS data before ClaimMD will accept them.

Category 3 — Secondary / Coordination of Benefits (COB) Errors

ClaimMD Rejection Message	What It Means	Common Cause	Fix
`Medicare Type Code required when Medicare is secondary`	Secondary Medicare claim is missing the Medicare Type Code field	CAS segment not populated when Medicare is billed second, after a primary payer has paid	Enter the Medicare Type Code in the secondary claim before resubmitting (e.g., non-ESRD, TEFRA)
`Atleast one adjustment code required. (primary_paid_amount_1, charge_1)`	Secondary claim is missing the adjustment reason code(s) from the primary ERA	Manual secondary posting submitted without entering primary payment reason codes	Post the primary ERA first, or manually enter adjustment codes (CAS segment) before submitting to the secondary payer
`Adjustment Amounts total [X] but must total the amount "Not Paid" [Y], over by $-Z`	The CAS adjustment amounts on the secondary claim don’t add up to the unpaid balance	Incorrect amounts entered when posting primary payment manually, or a corrected claim has stale adjustment data	Review each Payment via Claim History → Financial Transactions: (1) Only the Primary Payment should include Allowed/Adjustment amounts — adding these to subsequent Payments causes over-adjustment. (2) Every Adjustment amount must include an Adjustment Code, or the claim becomes unbillable. (3) Apply remaining balances to Deductible/Coinsurance/Copay per the ERA/EOB. (4) Avoid posting Denials on Payments; if needed, include only $0 in the Payment field and omit the Allowed amount and Denial Adjustment/Code.

Category 4 — Workers Comp / Specialty Claims

ClaimMD Rejection Message	What It Means	Common Cause	Fix
`Workers comp/auto claim may require attachment. Re-submit claim to bypass this rejection.`	ClaimMD flags workers comp/auto claims as potentially requiring an attachment	Claim is coded with a workers comp or auto-related diagnosis or payer type	Re-submit the claim — ClaimMD’s message explicitly states that resubmitting bypasses this rejection if no attachment is actually needed

Quick Reference — Most Common Rejections

Rank	Rejection	Volume
1	`Invalid Facility City []`	High — recurring after location saves
2	`Diagnoses [XXXXX] is valid but not for this date`	High — triggers on annual ICD-10 updates
3	`Medicare Type Code required when Medicare is secondary`	Medium — recurring across practices
4	`Valid [Payer] submitter ID is required`	Medium — common with BCBS plans
5	Secondary COB adjustment errors	Medium — D-SNP / dual-eligible patients

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ClaimMD-Specific Clearinghouse Rejection Reference

Category 1 — EDI Formatting & Field Validation

Category 2 — Submitter / Payer ID Errors

Category 3 — Secondary / Coordination of Benefits (COB) Errors

Category 4 — Workers Comp / Specialty Claims

Quick Reference — Most Common Rejections

​Category 1 — EDI Formatting & Field Validation

​Category 2 — Submitter / Payer ID Errors

​Category 3 — Secondary / Coordination of Benefits (COB) Errors

​Category 4 — Workers Comp / Specialty Claims

​Quick Reference — Most Common Rejections

​Related Articles

Category 1 — EDI Formatting & Field Validation

Category 2 — Submitter / Payer ID Errors

Category 3 — Secondary / Coordination of Benefits (COB) Errors

Category 4 — Workers Comp / Specialty Claims

Quick Reference — Most Common Rejections

Related Articles