WPS Health Insurance

Common Claim Codes Explained

What follows is a breakdown of common claim codes that may appear on your Explanation of Benefits.

If your claim indicates the following reject code:

CX = ANSI 16
Claim/Service lacks information which is needed for adjudication. You recently received a letter requesting additional information. Your claim will be processed when the information is received.

This is what you need to do: If you received a letter from us requesting information, complete it and drop it in the mail. If not, contact us at 800-765-4977.
UF = ANSI 125 (Providers)
Submission/Billing Error(s). Our records indicate that the provider is a HealthEOS/Multiplan provider. We have forwarded this claim to HealthEOS/Multiplan and we will process the claim as soon as we receive the negotiated fee amount from them.

This is what you need to do: No action needed.
46 = ANSI 96
Non-covered Charge(s). The service provided is not a covered benefit under your policy. See your exclusions for more information (Members who have already registered to access their account can view a summary of their benefits by logging in)

This is what you need to do: Based on your plan benefits, you are responsible for these charges.
17 = ANSI 17
Requested information was not provided or was insufficient/incomplete. Several weeks ago, you received a letter asking for additional information. We have not received that information or it was insufficient/incomplete. Your claim will not be processed until the information is received.

This is what you need to do: If you received a letter from us requesting information, complete it and drop it in the mail. If not, contact us at 800-765-4977.
MA = ANSI 22
This care may be covered by another payer per coordination of benefits. Medicare has denied payment on this claim. Please work with Medicare to resolve this issue. Once you determine your benefits through Medicare, they will send you an updated benefit explanation which must be forwarded to us for processing.

This is what you need to do: Contact Medicare to resolve this issue. Then forward a copy of the updated Medicare Explanation of Benefits to us for processing.
EM = ANSI 22
This care may be covered by another payer per your coordination of benefits. This claim may be covered by Medicare; if so, send us Medicare's notice of payment or denial so we can appropriately process this claim.

This is what you need to do: Send us a copy of your Medicare Explanation of Benefits and we'll complete the processing of your claim.