Understanding Claim Warnings & Errors

Occasionally, you may see red or yellow warnings on the Submit Electronic Claims or Submit Secondary Claims page.

A red warning banner indicates an error with the information on the claim that needs to be fixed before the claim can be submitted. To correct these errors, you can just click on the hyperlinked appointment information to edit the corresponding data, or when applicable, click on the hyperlinked text in the warning to be taken to the appropriate page in TherapyNotes to make your corrections.

A yellow warning banner indicates potential discrepancies in claim or non-crucial information. For example, this may appear when you are billing as a supervisor, but one claim is billing as the rendering clinician or when a client has a hospitalization date inputted. You can still submit a claim with the yellow error if the information is correct. 

Practice Level Errors

Missing Subscription Payment Method Error

The following error is shown when the practice does not have a trial account or a payment method in its subscription setting:

Your payment method must be entered on the Subscription Settings page in order to submit claims electronically.

To correct this error, visit Settings > TherapyNotes Subscription > Payment Method and provide a payment method for your subscription. 

Missing Practice Information Error

The following error is shown if clinician billing setting overrides exist for any clinician or the practice is missing either name, address, city, state, zip code, NPI, tax ID number, or place of service code:

Your Practice Settings are missing your [practice name, practice address, practice city, practice state, practice postal code, practice NPI, practice tax ID number, and practice place-of-service code]. This is/These are required to submit claims. You may also update some of these settings in the Clinician Billing Setting Overrides for the Clinician if they do not apply to the entire practice.

To correct this error for the practice, visit Settings > Practice Information and Locations (under Account and Access) > In the Billing Information Section, enter the desired information > Save Practice Settings.

To correct this error for an existing override from any clinician, visit Staff > Clinician’s name > Billing tab > Edit Clinician Billing Setting Overrides > Enter the desired information > Save Changes.

9-digit Zip Code Error

The following errors are shown if the existing clinician setting overrides from any clinician or the practice does not have a 9-digit zip code:

Your Practice Settings/The Clinician Billing Setting Overrides for the Clinician are missing your full 9-digit zip code, which many insurers now require to process your claim. You should add your full 9-digit zip code before submitting claims. If you do not know your 9-digit zip code, you can look it up on the USPS website.

To correct this error for the practice, visit Settings > Practice Information and Locations (under Account and Access) > and provide the 9-digit zip code. If you do not know your 9-digit zip code, you can look it up on the USPS website. 

To correct this error for an existing override from any clinician, visit Staff > Clinician’s name > Billing tab > Edit Clinician Billing Setting Overrides > Enter the 9-digit zip code information > Save Changes.

PO Box Error

The following error is shown if there are existing clinician billing setting overrides from any clinician or the practice's address lines contain the words "PO box" or "p.o. box”:

A PO Box address will prevent you from being able to submit electronic claims. Please update your Practice Settings to avoid a PO Box.

To correct this error for the practice, visit Settings > Practice Information and Locations (under Account and Access) > Review Address Line 1 and Address Line 2.

To correct this error for an existing override from any clinician, visit Staff > Clinician’s name > Billing tab > Edit Clinician Billing Setting Overrides > Review Address Line 1 and Address Line 2. 

Alternate Billing Address Error

The following error is shown if the practice has an alternate billing address that's missing either practice name, address, city, state, or zip code:

Your Practice Billing Settings are missing your [billing contact name, billing contact address, billing contact city, billing contact state, billing contact postal code]. These are/This is required to submit claims.

To correct this error, visit Settings > Practice Billing > Alternate Billing Address > Update the information for your alternate billing address > click Save Billing Settings. 

Alternate Billing Address 9-digit Zip Code Error

The following error is shown if the practice's alternate billing zip code is not 9 digits long:

The alternate billing contact address in your Practice Billing Settings is missing your full 9-digit zip code, which many insurers now require to process your claim. You should add your full 9-digit zip code before submitting claims. If you do not know your 9-digit zip code, you can look it up on the USPS website.

To correct this error, visit Settings > Practice Billing > Alternate Billing Address > Provide the 9-digit zip code > Save Billing Settings. If you do not know your 9-digit zip code, you can look it up on the USPS website. 

Patient Level Warnings & Errors

Missing Patient Information Error

The following error is shown when the patient does not have one of the following: last name, address, city, state, zip code, date of birth, administrative sex, or signed HIPAA agreement:

This patient's Patient Information is missing the [patient's last name, patient's address, patient's city, patient's state, patient's postal code, patient's date of birth, and patient's administrative sex]. These are/This is required to submit claims.

To correct this error, visit Patients > Select the patient’s name > Edit Patient Information > Fill in Missing Information > Save Changes. 

Missing Insurance Policy Information Error

The following error is shown when the patient does not have an active primary policy or is missing the following information on their policy:

• Primary policy: payer, member ID, insured's name (if the relationship is not self), insurance type, relationship to insured, signature on file.
• Secondary policy: member ID, Medicare type (if the payer is Medicare), insurance type, insured's name (if the relationship is not self), relationship to insured.

This item is missing primary/secondary insurance information. Open the appointment and update to the payer assigned in patient billing settings.

To correct this error, click Patient’s name > Billing Settings tab > Edit Primary or Secondary Insurance > Update Patient’s insurance information > Save Changes.

Referring Provider Error

The following error is shown when the practice's NPI is the same as the patient's referring provider's NPI:

This patient's Billing Settings list the practice or facility on the claim as the patient's referring provider, which is not allowed. The referring provider can only be a different practice that is not on the claim.

To correct this error, go to Patient > Billing Settings > Additional Claim Information and correct the referring NPI. 

Hospitalization Dates Warning

The following error is shown when the patient has hospitalization dates set in billing settings under the Additional Claim Information:

This patient's Billing Setting have hospitalization dates set. TherapyNotes includes this information on electronic claims. If you do not wish these dates to be included on the claim, please remove them from the patient's billing settings. This should only be used for inpatient services.

To review or correct this date, review the patient’s Billing Settings > Additional Claim Information > Patient was hospitalized with this illness from [date range] > Save Changes. 

Missing Claim ID Error

The following error is shown when a payer without an address is missing a claim ID:

There is no Payer ID or mailing address on file for the patient's primary insurer. We can submit a claim electronically if a Payer ID is provided, or we can print and mail the claim for you if a mailing address is provided. Visit the [Payer Name] page to add a Payer ID or address.

To correct this error, review and update the payer’s information by going to Payers > Select payer > Edit Payer Information > Enter the Payer ID or address (to mail the claim) > Save Changes. 

For more information, read Payers Supported by Clearinghouse or No Payer ID.

Unknown Claim ID Error

The following error is shown when the payer ID does not match any ID on our supported payers page:

There is no Payer ID or mailing address on file for the patient's primary insurer. We can submit a claim electronically if a Payer ID is provided, or we can print and mail the claim for you if a mailing address is provided. Visit the [Payer Name’s] page to add a Payer ID or address.

To correct this error, visit the payer’s page to add a Payer ID by going to Payers > Select payer > Edit Payer Information > Enter the Payer ID > Save Changes. 

Invalid Patient/Insured Name Characters Warning

The following error is shown when the patient’s or insured’s first, middle, or last name contains characters that are not supported by insurance claims (e.g., emojis):

The patient's name contains the characters � and �. Insurance claims generally require the patient's name to be spelled with the English alphabet, matching the way it is printed on the patient's insurance card. You may want to make sure this patient's name matches their insurance card exactly before submitting this claim.

To correct this error, visit Patients > Patient name > Edit Patient Information and verify the patient or insured’s legal name is correct and matches their insurance card on file.

Missing Control Number on Claim Pending Resubmission Error

The following error is shown when a user is trying to void/amend a claim and the payer claim control number is missing:

A payer claim control number is required for this resubmission type.

To correct this error, locate the payer claim control number from the ERA or EOB received in TherapyNotes or the payer’s provider portal. If the ERA was received in TherapyNotes, locate it by completing the following:

1. Click Patients > Patient Name > Billing tab.
2. Click the date of service.
3. Click the dollar amount next to Payer Paid. This will bring you to either the original payment or the History tab. If you are taken to the billing activity history, you will need to click the correct payment.
4. In the upper right, click View ERA.
5. At the top of the ERA, choose the correct patient from the dropdown.
6. Find the date of service and click Show Claim Details and Remarks.
7. Under Claim Totals (second blue box), locate the Payer Claim Control Number.
8. Copy this number.
9. Return to the Submit Electronic Claims page and paste the number in the box for Payer Claim Control Number.

Line-item Level Warnings and Errors

Missing Information in Clinician Billing Setting Override Error

The following error is shown if overrides exist for any clinician and the practice is missing either name, address, city, state, zip code, NPI, tax ID number, or place of service code:

Your Practice Settings are missing your {practice name, practice address, practice city, practice state, practice postal code, practice NPI, practice tax ID number, and practice place-of-service code}. This is/These are required to submit claims. You may also update some of these settings in the Clinician Billing Setting Overrides for the Clinician if they do not apply to the entire practice.

To correct this error, the Clinician Billing Setting Overrides for the clinician may be updated by going to Staff > Clinician’s name > Billing tab > Edit Clinician Billing Setting Overrides > Enter the desired information > Save Changes.

Unknown Insurance Rate Error

The following error is shown when the insurance rate for the appointment is empty:

The insurance rate for [service code] is not known. Please enter this rate before creating this claim.

To correct this error, select the date of service > Enter the insurance rate inside the Rate field > Select Save Changes.

Invalid Diagnosis Code Error

The following error is shown when the diagnosis code on the Date of Service note does not match any existing ICD-9 or ICD-10 code:

The note for this date of service does not have any valid ICD-10 diagnosis codes. One of these codes is required to submit claims.

To correct this error, have the assigned clinician edit the note to select the Diagnosis Code from the drop-down menu, rather than typing it in manually. They can do so by completing the following:

1. Click Patients > Patient Name > Documents tab > Edit.
2. Click the Diagnosis field and begin typing the desired diagnosis code for the dropdown to appear. Select the appropriate diagnosis code from the dropdown.
3. Re-sign and save the note.

Modifier Count Error

The following error is shown when there were more than four modifier codes found for the date of service:

Your settings created more than four modifiers for this date of service. Please check that the included modifiers are the codes you would like to submit.

To correct this error, manually remove one of the modifiers by clicking the date of service. If the modifier is included with the service code, you may add a duplicate service code without the modifier by going to Settings > Service Codes > + Add Service Code.

Item Not Billed as Supervisor Warning

The following warning is shown when the assigned clinician’s Billing settings is set to Bill as Supervisor, but the appointment’s note is set to Bill as Clinician:

This item is not set up to "Bill as Supervisor" though the Clinician is set up to "Bill as Supervisor" for this payer. To adjust the Supervisor's Role for this item, please edit this item's note.

To correct this issue, the note header for the date of service must be updated to include the supervisor’s information on the billing item. The supervisee would need to complete the following:

1. Click Patients > Patient Name > Documents tab
2. Click the edit icon (pencil) to the right of the note.
3. Click Edit on the upper right of the header.
4. Make sure the correct Supervisor is listed in the Supervision dropdown.
5. From the dropdown below, select Signature Required; Billing as Supervisor (Incident-To).
6. Click the Update Note Header button.
7. Re-sign and save the note.  

The Supervisor will receive a To-Do list item to review and sign the note. Once the Supervisor signs and saves the note, the claim will be ready to bill. To learn more, read Set Up Supervision.

Supervisor Not In-Network Warning

The following warning is shown when the appointment and clinician are set up to bill as supervisor, and the payer is in-network, but the supervisor is not in-network with the payer:

This item is set up to "Bill as Supervisor" for an In-Network payer, but the chosen Supervisor is not In-Network with the payer. To adjust the Supervisor for this item, please edit this item's note. Or, to adjust the Rate Schedule for the Billing Supervisor, please edit the supervisor's rate schedules.

To correct this issue, update the Supervisor listed within the note header to an In-Network Supervisor for the payer. Navigate to Patients > Patient Name > Documents tab > Click the Edit icon (pencil) to the right of the note > Click Edit on the upper right of the header.

If the listed Supervisor is In-Network with the payer, update their Payer settings to reflect this by going to Staff > Supervisor’s name > Billing tab > Edit Payers > Update Network > Save Changes. 

Missing Clinician or Supervisor NPI Error

The following error is shown when the clinician or supervisor is missing an NPI in their staff profile:

The User Settings for clinician/supervisor are missing an NPI. This is required to submit claims.

To correct this error, add the NPI in their staff profile by navigating to Staff > Staff name > Info tab > Edit User Information > Enter NPI > Save Changes.

Missing Primary Insurance Information Error

The following error is shown when the primary policy for the appointment is missing a payer:

This item is missing primary insurance information. Open the appointment and update to the payer assigned in patient billing settings.

To correct this error, select the patient’s name > Update the Primary Policy > Save Changes.