Source of Payment and Type of Insurance Rejections

Over the past few weeks we have been seeing an increase in 999 rejections (4010’s 997 twin). One such rejection is: “PSBR0901 MISSING SUBSR FILING IND CODE or PSBR0902 MISSING OTHER SUBSCR CLM FILING”.  These rejections are difficult to sort out in that they’re trying to alert you of multiple errors in a single message, leaving you with the task of trying to discern which is applicable to your claim. But don’t fret, we’re here to help.

The message is suggesting that there’s an issue with your Source of Payment (SOP) and/or your Type of Insurance (TOI). You can navigate to this screen by going to Master files > Carriers > Carriers > EDI/Other.

The most common mistake we see is the SOP/TOI being set to a Medicare-specific setting on secondary payors when Medicare isn’t secondary, settings such as:

SOP: Medicare and HMO Medicare Risk

TOI: Medicare Primary, Medicare Policy and Medicare Cond Policy.

We frequently see this happen on Medicare supplement policies. Most supplement policies for Medicare do not merit a Medicare SOP/TOI unless indicated by the carrier. For those instances we suggest using “Commercial” for your SOP/TOI. Please engage your carrier(s) to validate these settings.

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