Claim exception finder
Search by a symptom or filter by workflow stage. Each category includes an example, evidence to look for and a next step.
A required record is missing or cannot be located.
The invoice is available, but the applicable authorization record is not.
Identify the missing record, assign an owner and confirm it through an approved source before deciding whether the claim needs correction.
Record type, source owner and the applicable requirement.
Missing evidence is a question to investigate, not proof that a claim is invalid.
Member, provider or claim identifiers do not agree.
The member identifier on the draft differs from the source record.
Compare the values with the authoritative record and confirm which identifier the payer expects.
The source used, fields compared and reviewer decision.
Do not overwrite an identifier solely because another system displays a different value.
Services, dates or units may fall outside an applicable authorization.
The proposed service date is outside the dates shown on the received authorization.
Check the authorization, amendments and payer guidance. Resolve the difference with the billing owner before deciding on a correction.
Authorization version, covered period and applicable payer rule.
A populated authorization field does not establish that the service is authorized.
A required field, structure or value format appears incomplete.
A required provider field is blank in the claim file.
Identify the claim format and submission route, then check the current implementation and payer requirements.
The field, source requirement and validated correction.
A format check alone does not establish payer acceptance.
The claim appears inconsistent with an applicable payer instruction.
A referral reference does not match the applicable payer's required format.
Confirm the payer, program and effective date. Record the exact source section and have the billing reviewer decide the next step.
Current source, section, effective period and applicability.
Do not apply a rule from a different program or jurisdiction.
There is no confirmed sending record or the destination is uncertain.
A claim file was generated, but no transport confirmation is available.
Check the submission route, enrollment and transport evidence before treating the claim as transmitted.
Transport response, destination and correlation reference.
Generating a file does not mean it was submitted.
A received or accepted status lacks a clear sender or meaning.
The clearinghouse reports receipt, but payer acceptance is not yet confirmed.
Read the original response, identify its sender and match it to the correct submission attempt.
Original response, sender, timestamp and claim correlation.
Clearinghouse receipt is not proof of payer approval or payment.
Claim lines, adjustments, remittance and cash cannot be reconciled.
A remittance is available, but its deposit has not been matched.
Compare the claim and remittance at the appropriate level, then reconcile the deposit separately. Keep unexplained differences open.
ERA/EOB, adjustment detail and deposit reference in the secure system.
Remittance information is not proof that cash reached the bank.
An unresolved item has no responsible person or verified due date.
A correction is waiting, but the applicable filing rule has not been checked.
Assign an owner, locate the payer's applicable deadline source and agree the next follow-up.
Owner, applicable rule, source date and next action.
Do not use a universal deadline across payers or programs.
An alert repeats an existing check or has no actionable finding.
The billing team has already verified the item with current evidence.
Document why no change is needed and distinguish a duplicate check from a false alert.
Prior check, reviewer explanation and rule version.
More alerts do not necessarily mean more useful work.
No categories match. Try a shorter search or clear the filters.
Record the question, applicable source, reviewer decision, owner and next step in your approved secure system. Missing evidence needs investigation before it can be called an error.
Download an exception-log template ↓These categories help organize a review. They are not measured error rates, a severity score or a substitute for payer-specific instructions.
See the payer-rule method →