Common Failed Claims and Resolutions

Visit records that do not pass Pavillio's validations will display with in Financials > Claims Management under the Failed card. The table below contains the most common reasons for claims to fail. Follow the directions provided to make the necessary corrections, move the records to the Ready card, and submit your claims successfully.

Failure Reason	Reason and Action to Take
Care Document is not available for this Service date for this line.	The client does not have an active care delivery (SPA, Care Plan, Plan of Care) on the Care tab under Care Period for the service. Care Documents are required in Pavillio. Add the Care Delivery and re-validate the records. Alternatively, turn on the override for no Care Delivery: Allow Scheduling/Timesheet ( Inactive Service Agreement).
Claims already exists for this Client and Specified Date.	There is already a claim that was sent from Pavillio for these dates of service. This happens if time was approved/entered after a claim was already sent. Use the filters to narrow down the information that displays, locate the claim, if applicable move the claim to the workbench to rework the claim. Once you have clicked Resubmit or Replacement, the claim will pick up the record from the Failed card so that you can send the claim back to the Payor for consideration of payment.
Client is not eligible/active.	The Client is not eligible in the Client Profile. You can check the eligibility by clicking the Ellipses by the Client name and clicking Check Eligibility. Eligibility runs automatically every Sunday evening, but there may be times you need to check the eligibility manually.
Client is not active in the specified Period. Only service records is processed for the dates where the client is active.	The Client admission date is after some of the service records, and only dates after the Admission Date is sent to the Payor. Correct the Admission Date and re-validate the records. It could also be that the client's Assessment Date is after the dates of service. Go to the Client Profile Assessment and/or Admission tab and click Edit to edit the date.
Failed to get SA details.	The Service Agreement was changed and Pavillio did not link to the Service Agreement. Re-validate the records.
MA Number should be 8 digit character length.	The MA/MCO number in the Service Agreement is not valid. This happens most often when the Service Agreement was entered prior to the MA/MCO Number on the Payor tab in the Client Profile. Verify and update the payor information on the Payor tab, edit the Service Agreement, and then re-validate the records.
Missing Service Code for Processing	As it relates to DSS, when Service Agreements are entered, the Auto Priority should ALWAYS be set to Yes. The reason for this is that when the attendance is entered, a service type is selected. When Auto Priority is set to Yes, the service code is attached based on the service type selected. There is no other location to independently attach a service code. By having Auto Priority set to No for DSS, you receives this message as the system does not have a way to pick up the service code.
No Active Service Agreement or line items exists in the given Date range	The Service Agreement in Pavillio is not active or no line item exists for the date of the service record. In the Client Profile Service tab, locate the service agreement for the date(s) of service. On the Line Item tab, verify that the dates for the service code cover the dates of service. You may need to turn the Override on for Edit Closed Agreement if the Service Agreement or Line Items are closed. When finished, turn the Override off and re-validate the records from the Failed card.
No valid line items available in SA	There is no Line Item for the services that were provided for the associated Service Agreement. This generally happens when the line item is deleted or changed in the Service Agreement. Locate the Service Agreement, click Edit, go to the Line Items and enter the Service Lne. Click Finish and Ok to re-validate the records in the Failed card.
Please enter a value for UMPI/NPI Number.	An employee identifying number is required for certain services. In Minnesota, this is known as an UMPI. The employee UMPI/NPI number is not entered into Pavillio. Enter the UMPI/NPI number on the Employee's General Info tab and click OK in the message indicating the number of transactions that is affected. This sends the records through re-validation.
Please enter a value for MA/MCO Number.	The MA/MCO number in the Service Agreement is not valid. First verify the payor information on the Payor tab in the Client Profile, then edit the Service Agreement to pull in the MA/MCO number, and then re-validate the records. To avoid this failed message always enter the MA/MCO Number on the Payor tab before entering a Service Agreement.
Please enter a value for Agency Payor Provider Number.	The Payor was removed from the Manage Payors tab in the Agency setup. Go to Administration > Agency > Manage Payors and verify that the Payor is setup. Then go to the Service Agreement for each individual and relink the Payor information. Re-validate the records.
Please enter a value for ReceiverID. / Please enter a value for ReceiverName. / Please enter a value for SenderID.	The communication channel for the MCO Clearing house has not been completed on the Administration > Agency > Communication. Submit a Support Request to have our support team assist you.
Service Minutes exceeded Max hours per day/ SA Units exhausted for Client.	The max number of hours set in the Service Agreement for the Line Item has been reached. Adjust the Max Number of Hours for the service line in the Service Agreement and re-validate the records if applicable.
Service records other than active Service agreement cannot be processed.	An Interim Service Agreement was entered. The records will stay in the Failed card until the Interim Service Agreement is changed to an Active Service Agreement and the details are edited. Once the Finish button is clicked in the Active Service Agreement, the records is sent for re-validation after clicking OK in the displayed message.
Service records are not in between active Service agreement line items.	The dates are outside of the specific line item in the Service Agreement. Ensure the dates are correct for the Service Agreement Lines Items for the Service Line and re-validate the records.
Service records are not valid as they are having minutes less than the required time based on Unit of Measure.	The number of minutes is less than allowed for billing the record. Delete the record and re-enter the timesheet data (if applicable).
The client is not eligible for the services on [date], check with agency admin to verify service status details.	On this specific date Pavillio had an ineligible status. We run eligibility for all clients every Sunday afternoon, and at the beginning of every month. This file has the status of ineligible or eligible for services from DHS. After researching if the Client was eligible for services, you can turn the Override on for The Client is Not Eligible and re-validate the records. Once they are in the Ready card you can turn of the Override. If the Client was ineligible, you as an Agency can use the Write-Off under Perform Actions or choose to turn the Override on knowing that the claim may be denied.