Claim Rejection Reasons (Change Healthcare Portal)

When a payer or the clearinghouse disagrees with how a claim is being submitted, you’ll receive a claim rejection. We have created a spreadsheet you can use to help further define rejection reasons, organized by subject. Important: If you do not know how to handle a rejection reach out to the payer or clearinghouse directly. This ensures the quickest resolution time.

Claim Rejection Spreadsheet (Click to download)

The spreadsheet has been divided into four types of rejections; Claim Form/EDI File, Provider, Insurance, Subscriber.

Type of Rejection
Rejection relates to:
Claim Form/ EDI File Coding or the actual claim form/EDI file information submitted
Provider Credentialing/EDI enrollment information specific to a provider
Insurance Incorrect submission according to the patient's plan or payer requirements; payer has different information on file
Subscriber Patient/subscriber information

Note: Remember that some types of claim rejections can be worded differently, but ultimately mean the same thing. Often, claims that are rejected by the payer can be corrected and resubmitted. Clearinghouse rejections can be fixed and resubmitted immediately

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