If a consumer’s service authorization comes back as rejected, double click the Service Authorization and scroll down to view the rejection reason. Below is a list of the rejection errors, descriptions, and resolutions.
06 - Recipient not Eligible
Consumer lost Medicaid eligibility before service authorization (SA) sent to FMMIS
Check consumer's eligibility and address the issues for eligibility to be restored
10 - Duplicate PA
There is another SA in FMMIS that overlaps with the newly created SA
Check FMMIS to see which PA needs to be addressed
75 - Sum of claims greater
SA allocation is lower than what the provider has billed on the PA in FMMIS
Check PA claims in FMMIS to see if the provider has over billed or increase the allocation on SA to at least the amount of the paid claims
79 - no description given
SA has been cancelled in ABC, but not in FMMIS due to the fact that the provider has billed against the PA
Check FMMIS to find the PA and re-create the SA in ABC. Email APD Help Desk with a request to have the PA number re-assigned. Address the issue of
whether or not the provider was authorized to bill
L3 - Line item not found
SA balance in FMMIS is zero
If funds were added to the SA, the provider needs to void the last paid claim. Then the SA needs to be re-sent to FMMIS to update the PA balance
L4 - Invalid authorized amount
Allocation on the SA is zero
Enter the correct allocation and re-send to FMMIS for PA number
L5 - Invalid unit rate
Unit rate on SA is zero
Enter the correct rate and re-send
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