The Department processes individual case information and fee-for-service bills every week. Files received by 5:00 p.m. on Monday are processed that week and sent to the Comptroller for processing by the following Monday. Files received after the deadline are processed during the next weekly cycle.

Below is a list of the most common reasons bills for developmental disabilities services are rejected, along with recommendations for correcting and retransmitting the bills. Also included is information about the Toll-Free Number and the MEDI Web Site that the Department of Healthcare and Family Services maintains so that enrolled providers can verify Medicaid information for individuals they serve. 

After correcting these problems, rejected bills must be re-transmitted to DHS.

Reject Code Description
14  Administrative Hold
55  No ROCS case opening found for individual
56  All fee-for-service programs are terminated for SSN
See Reject Code 75 for correction guidance 
6P Individual is in the Aging Community Waiver
6Q Individual is in DRS Waiver (brain injury, AIDS, physical disability)
6R Individual is in the DSCC Children's Waiver
6S Individual is in the Supportive Living Waiver
61 Name mismatch with HFS Medicaid
65 Service dates overlap with another bill
67  Provider not enrolled as waiver provider for the service
7A  Individual SSN not authorized for this program
See Reject Code 75 for correction guidance.
7B Bill includes dates before or after authorized dates
7C  Program authorized at a different provider
71 Bill exceeds monthly combined maximum (HBS)
72 Appropriate professional credentials not on file
73  Program exceeds fiscal year maximum
74  Program exceeds combined fiscal year maximum or bedhold max
75 No fee-for-service ever authorized for SSN
86  ROCS case opening lacks income information for service date
9B  NPI not on file for service provider
9C Foster Care - Not Eligible for DD Child Waivers
95 Individual not enrolled in Medicaid
96  RIN lacking or incorrect in ROCS
97  Individual does not need active treatment
98  Active treatment field is blank or service date is before active treatment effective date
99  No current waiver redetermination