EDI consistently receives rejections due to invalid subscriber ID numbers, especially for Medicare and VACCN. When a subscriber ID does not follow a specific pattern for the payer chosen, it should flag the member when the data is being inputted in the EMR with an error stating the pattern that is required. The system should not allow values such as 999999999 or 1X11X11XX11 to be saved.
I've provided payer examples below as well as the rejection messages we see frequently. These are just a few examples as there are multiple payers who have similar requirements.
Medicare: SUBSCRIBER ID 123456789A DOES NOT MATCH ALLOWABLE PATTERN (s) (1N1A1X1N1A1X1N1A1A1N1N) WHERE A IS A LETTER, N IS A NUMBER, AND X IS A LETTER OR NUMBER.
Optum VACCN: SUBSCRIBER ICN 17 CHARACTERS, EDI PI 10 DIGITS OR SOCIAL SECURITY NUMBER 9 DIGITS ARE REQUIRED
VA: SUBSCRIBER PRIMARY ID# MUST BE 9 DIGITS FOR THIS PAYER
Hello, and thanks for your Idea portal submission! Providing an error message when a subscriber ID does not match the allowable pattern for a payer is a feature that we don’t currently have planned, but may consider in the future. We’ll make sure to let you know if this feature is delivered.
In the meantime, if you have any further questions feel free to leave a comment or contact WebPT Support using firstname.lastname@example.org.
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