Error 0542 - Member Ineligible Serv Date

Error: The member was not eligible for MassHealth on the date of service entered on the claim.

Resolution: To avoid this error, always verify member eligibility using the Eligibility Verification System (EVS) before or on the date of service.

Error 3121 - Invalid Referral Number

Error: The Primary Care Clinician (PCC) referral number entered on the claim does not match the PCC number on the member's file.

Resolution: Use EVS to verify the name and telephone number of the member's PCC. Then contact the PCC to obtain the correct referral number. It is important to verify this information for each date of service as the member's PCC may change.

Error 4013 - Procedure Code Is Not Covered For Date of Service

Error: The service code entered on the claim was not covered on the date of service entered on the claim.

Resolution: Refer to Subchapter 6 of the Acute Outpatient Hospital Manual for code listing.

Error 4021 - Procedure Code Not Covered Under Benefit Plan

Error: The service code entered on the claim is not covered for members enrolled in this coverage type.

Resolution: Based on eligibility requirements, MassHealth members receive benefits according to specific coverage types. EVS provides the member's coverage type as part of the eligibility verification transaction. Refer to the specific MassHealth regulation at 130 CMR 450.105 for a list of covered services by coverage type and for other information and requirements about each coverage type.

Error 5032 - Exact Duplicate-Outpatient Procedures (Oper Room/Emerg Room/Clinic

Error: The claim submitted is a duplicate of a claim previously paid for the same member, pay-to provider number, date of service, and service code. Some software systems will automatically generate "tracers" for claims that have not been posted.

Resolution: To avoid this error, post claims from your remittance advice in a timely manner to avoid rebilling previously paid claims.

Error 5046 - Exact Duplicate Outpatient Procedures (Clinic)

Error: The claim submitted is a duplicate of a claim previously paid for the same member, pay-to provider number, date of service, and service code. Some software systems will automatically generate "tracers" for claims that have not been posted.

Resolution: To avoid this error, post claims from your remittance advice in a timely manner to avoid rebilling previously paid claims.


This information is provided by MassHealth.