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 |
