Audit Professional Edit Explanation Document
12 pages
Serbian

Audit Professional Edit Explanation Document

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12 pages
Serbian
Le téléchargement nécessite un accès à la bibliothèque YouScribe
Tout savoir sur nos offres

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PROFESSIONAL EDIT EXPLANATION DOCUMENTERROR AUDIT REPORT MESSAGE EXPLANATIONNUMBER001 INVALID SUBMITTER ID IN ISA05 THERE IS MORE THAN ONE SPACE IN THE AGENCY ID FIELD.003 SUBMITTER ID NOT APPROVED FOR THE SUBMITTER ID SUBMITTED IS NOT APPROVED TO SEND PRODUCTION PRODUCTION FILES.004ION/TESTING INDICATOR IN THE THE ISA 15 DOES NOT MATCH THE FILE NAME (EX. ISA15 SHOWS P, ISA DOES NOT MATCH THE FILE NAME BUT THE FILE NAME IS TBCP001.CLM).109 NPI NUMBER IS MISSING AN NPI MUST BE SUBMITTED ON ANY ELECTRONIC CLAIM.111 THIS LINE/CLAIM/BILLING NPI THIS IS ISSUED WHEN NPI IS IN AN INVALID FORMAT. (XXXXXXXXXX) IS AN INVALID FORMAT200 INVALID CONTRACT NUMBER FORMAT THE FORMAT FOR CONTRACT NUMBERS MUST CONTAIN AN ALPHABETIC PREFIX, NOT NUMERIC, OR THE CONTRACT NUMBER IS NOT VALID TO BE PROCESSED IN ALABAMA AND IS NOT PART OF THE BLUECARD NETWORK.201201 IINNVALILIDD CCOONTNTRACTRACT NUMNUMBER CONTCONTRRACTACT NUMNUMBER DBER DOESOES NNOTOT MMATCCH BLUE H BLUE SHIELDELD CONTCONTRACTRACT NUMBER IN THE SYSTEM FOR SUBSCRIBER. THIS EDIT IS BYPASSED FOR FEP PREFIXES (R) AND WRI ALONG WITH NASCO PROGRAM CONTRACTS.202 INSUR(XXXXXXXXXXXX) INVALID THE NAME OR VALUE INCLUDED IN THE PARENTHESIS WAS RECEIVED IN THE INSURED’S LAST NAME FIELD. IF THE CHARACTERS ARE THE INSURED’S FIRST NAME, THEN THE LAST AND FIRST NAMES ARE MOST LIKELY REVERSED. IF THE PARENTHESES ARE BLANK, THEN THE INSURED’S LAST NAME FIELD WAS LEFT BLANK. ANY CHARACTERS WITHIN THE PARENTHESES REFLECT ...

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ERROR NUMBER
001
003
004
109
111
200
202
203
PROFESSIONAL EDIT EXPLANATION DOCUMENT AUDIT REPORT MESSAGE EXPLANATION
INVALID SUBMITTER ID
SUBMITTER ID NOT APPROVED FOR PRODUCTION PRODUCTION/TESTING INDICATOR IN THE ISA DOES NOT MATCH THE FILE NAME
NPI NUMBER IS MISSING
THIS LINE/CLAIM/BILLING NPI (XXXXXXXXXX) IS AN INVALID FORMAT
INVALID CONTRACT NUMBER FORMAT
INV LID
NTR
T NUMBER
INSUR(XXXXXXXXXXXX) INVALID
"XAD" PREFIX INVALID  DNTL USE ONLY
LastupdatedJuly2010
IN ISA05 THERE IS MORE THAN ONE SPACE IN THE AGENCY ID FIELD.
THE SUBMITTER ID SUBMITTED IS NOT APPROVED TO SEND PRODUCTION FILES. THE ISA 15 DOES NOT MATCH THE FILE NAME (EX. ISA15 SHOWS P, BUT THE FILE NAME IS TBCP001.CLM).
AN NPI MUST BE SUBMITTED ON ANY ELECTRONIC CLAIM.
THIS IS ISSUED WHEN NPI IS IN AN INVALID FORMAT.
THE FORMAT FOR CONTRACT NUMBERS MUST CONTAIN AN ALPHABETIC PREFIX, NOT NUMERIC, OR THE CONTRACT NUMBER IS NOT VALID TO BE PROCESSED IN ALABAMA AND IS NOT PART OF THE BLUECARD NETWORK. NTR T NUMBER D E N T M T H BLUE HIELD NTR T NUMBER IN THE SYSTEM FOR SUBSCRIBER. THIS EDIT IS BYPASSED FOR FEP PREFIXES (R) AND WRI ALONG WITH NASCO PROGRAM CONTRACTS. THE NAME OR VALUE INCLUDED IN THE PARENTHESIS WAS RECEIVED IN THE INSURED’S LAST NAME FIELD. IF THE CHARACTERS ARE THE INSURED’S FIRST NAME, THEN THE LAST AND FIRST NAMES ARE MOST LIKELY REVERSED. IF THE PARENTHESES ARE BLANK, THEN THE INSURED’S LAST NAME FIELD WAS LEFT BLANK. ANY CHARACTERS WITHIN THE PARENTHESES REFLECT WHAT WAS ACTUALLY SUBMITTED ON THE CLAIM.
THE XAD PREFIX IS ASSIGNED TO DENTAL CONTRACTS ONLY AND IS NOT A VALID CONTRACT PREFIX FOR PHYSICIAN CLAIMS.
Page1of12
ERROR NUMBER
204
206
207
208
209
PROFESSIONAL EDIT EXPLANATION DOCUMENT AUDIT REPORT MESSAGE EXPLANATION
DATE OF BIRTH MISSING OR INVALID
PATIENT TOO YOUNG TO BE SUBSCRIBER
PATIENT TOO YOUNG TO BE SPOUSE
SEX OR PATIENT RELATIONSHIP TO INSURED INVALID
CLAIMS MUST FIRST BE FILED WITH MEDICARE
LastupdatedJuly2010
IF PATIENT DOB IS MISSING OR BIRTH MONTH IS LESS THAN 01 OR GREATER THAN 12, OR BIRTHDAY IS LESS THAN 01 OR GREATER THAN 31, THEN THE CLAIM WILL BE REJECTED. DATE FORMAT IS CCYYMMDD. THE RELATIONSHIP CODE SUBMITTED INDICATES SUBSCRIBER. ONLY CHILDREN UNDER AGE 14 COVERED UNDER THE ALABAMA CARING PROGRAM FOR CHILDREN, ALL KIDS, AND ANY COBRA CONTRACT THAT HAS BEEN CREATED FOR A CHILD UNDER 14, SHOULD BE FILED AS A SUBSCRIBER.
IF THE PATIENT’S YEAR OF BIRTH INDICATES THAT THE PATIENT IS UNDER 14, AND THE PATIENT IS SHOWN AS THE SUBSCRIBER’S SPOUSE, THE CLAIM WILL ERROR. THE RELATIONSHIP CODE INDICATES THE RELATIONSHIP BETWEEN THE INSURED AND THE PATIENT. THE SUBMITTED RELATIONSHIP CODE (SUBSCRIBER/PATIENT) AND THE SUBMITTED SUBSCRIBER GENDER CODE DO NOT MATCH THE BLUE CROSS SUBSCRIBER FILE.
AFTER A SEARCH OF THE BLUE CROSS SUBSCRIBER FILE, IF A CONTRACT NUMBER INDICATES THAT THE PATIENT HAS C PLUS COVERAGE AND THE DATES OF SERVICE ARE WITHIN THE CONTRACT COVERAGE PERIOD, THEN THE CLAIM SHOULD BE FIRST FILED WITH MEDICARE. ALSO OCCURS IF THE CLAIM FILING INDICATOR FOR PRIMARY PAYER DOESN'T INDICATE MEDICARE BUT SECONDARY CONTRACT IS C+.
Page2of12
ERROR NUMBER
210
211
212
215
301
302
303
304
PROFESSIONAL EDIT EXPLANATION DOCUMENT AUDIT REPORT MESSAGE EXPLANATION
FEP CONTRACT NUMBER FORMAT INVALID THE FEP ‘R’ PREFIX SHOULD BE FOLLOWED WITH A 9DIGIT NUMBER (THE 8DIGIT CONTRACT NUMBER PRECEEDED BY ZERO 012345678) OR THE ACTUAL 8DIGIT CONTRACT NUMBER (12345678). DO NOT USE BLUE SHIELD PREFIXES SUCH AS XAA ON AN FEP CONTRACT. DATE OF BIRTH GREATER THAN SERVICE DATE OF SERVICE PRECEDES DATE OF BIRTH LISTED ON THE DATE SYSTEM FOR THE INSURED. FEP CONTRACT NUMBER NOT ON FILE  CONTRACT NUMBER SUBMITTED IS INVALID. CALL FEP CUSTOMER CALL FEP CUSTOMER SERVICE AT 800492 SERVICE AT 1 800 4928872. 8872 TO VERIFY AND HAVE OUT OF STATE CONTRACT ADDED TO LOCAL SYSTEM INVALID CLAIM FILING INDICATOR FOR THE CLAIM FILING INDICATOR (SEGMENT SBR09) IS SOMETHING THE PAYER REQUESTING THE PAYMENT  OTHER THAN ‘BL’ FOR BLUE CROSS. MUST BE 'BL' FOR BLUE CROSS CLAIMS
 : HAS BEEN ACCEPTED FOR PROCESSING
NO ORIGINAL CLAIM NUMBER SUBMITTED ON CORRECTED BILL
ASSIGNMENT OF BENEFITS INDICATOR MUST BE A,B,C OR P ACCIDENT DT FORMAT INVALID(CCYYMMDD)
WORK RELATED INJURY FILED WITHOUT ACCIDENT DATE
LastupdatedJuly2010
FOR PROCESSING.
ORIGINAL CLAIM NUMBER SUBMITTED IS NOT NUMERIC OR DOES NOT MATCH A CLAIM UNDER THE CONTRACT OF THE CORRECTED CLAIM. PROVIDER ACCEPT ASSIGNMENT CODE MUST BE A, B, C OR P.
INVALID MONTH OR DAY SUBMITTED. FORMAT SHOULD BE CCYYMMDD. ANY CHARACTERS WITHIN THE PARENTHESIS REFLECT WHAT WAS ACTUALLY SUBMITTED ON THE CLAIM.
CLAIM SUBMITTED AS WORKER’S COMPENSATION CLAIM (WRI PREFIX) WITHOUT AN ACCIDENT DATE.
Page3of12
ERROR NUMBER
305
311
313
314
315
317
318
319
320
PROFESSIONAL EDIT EXPLANATION DOCUMENT AUDIT REPORT MESSAGE EXPLANATION
DIAG CODE (XXXXX) INVALID NOT ON FILE DIAGNOSIS CODE SUBMITTED CONTAINS “.”, SPACES OR ZEROES OR IS NOT A CURRENT VALID ICD9 CODE. ANY CHARACTERS WITHIN THE PARENTHESIS REFLECT WHAT WAS ACTUALLY SUBMITTED ON THE CLAIM. REFERRING PROVIDER NAME AND THE SUBMITTED REFERRING PROVIDERS' LAST NAME DOES NOT REFERRING PROVIDER IDENTIFIER DO NOT MATCH THE LAST NAME ON THE REFERRING PROVIDER NPI FILE. MATCH ACCIDENT STATE CODE INVALID STATE ABBREVIATION FOR THE LOCATION OF THE ACCIDENT WAS INVALID. RELATED CAUSE REQUIRED WHEN AN ACCIDENT DATE WAS PRESENT ON THE CLAIM, BUT NO ACCIDENT DATE IS PRESENT ACCIDENT REASON WAS SELECTED. PRIMARY INSURANCE INFORMATION MUST ELEMENT SBR01 WAS FILED AS SECONDARY ‘S’, BUT NO PRIMARY BE SUBMITTED FOR A BLUE SHIELD INFORMATION WAS FILED. SECONDARY CLAIM. PRIMARY/SECONDARY PAYER PAID NO PRIMARY PAYER PAID AMOUNT WAS INDICATED ON THE CLAIM. AMOUNT REQUIRED FOR ZERO IS A VALID AMOUNT FOR A PAID AMOUNT. SECONDARY/TERTIARY CLAIM MORE THAN ONE DEDUCTIBLE NOT CLAIM WAS FILED WITH MORE THAN ONE DEDUCTIBLE AMOUNT. ALLOWED ON CLAIM WHEN MEDICARE ONLY ONE DEDUCTIBLE CAN BE PRESENT WHEN PRIMARY PAYER IS WAS PRIMARY/SECONDARY PAYER MEDICARE. CLAIMS SHOULD HAVE LINE LEVEL SECONDARY CLAIM FILED WITH MEDICARE PRIMARY MUST HAVE PAYMENT INFORMATION WHEN LINE LEVEL PAYMENTS AND ADJUSTMENTS. PRIMARY/SECONDARY PAYER WAS MEDICARE MORE THAN ONE CO SECONDARY CLAIM FILED WITH MEDICARE PRIMARY CAN ONLY PAYMENT/COINSURANCE NOT ALLOWED CONTAIN ONE COPAYMENT OR COINSURANCE AMOUNTS. ON CLAIM WITH MEDICARE PRIMARY/SECONDARY
LastupdatedJuly2010
Page4of12
ERROR NUMBER
321
322
323
324
325
326
327
PROFESSIONAL EDIT EXPLANATION DOCUMENT AUDIT REPORT MESSAGE EXPLANATION
MEDICAID CLAIMS CAN NOT BE CLAIM FILING INDICATOR SENT WAS MEDICAID AND CAN ONLY BE SUBMITTED AS A PRIMARY OR SUBMITTED AS A PAYER OF LAST RESORT. SECONDARY PAYER PRIMARY/SECONDARY ALLOWED AMOUNT WHEN MEDICARE IS THE PREVIOUS PAYER, THE MEDICARE REQUIRED FOR SECONDARY/TERTIARY ALLOWED AMOUNT IS REQUIRED FOR PROCESSING. CLAIM WHEN PRIMARY/SECONDARY PAYER WAS MEDICARE (2400 AMT)
CLAIM BILLING/ RENDERING/REFERRING /SERVICE FACILITY NPI (XXXXXXXXXX) INVALID
MISSING LINE LEVEL DATA FOR PRIMARY/SECONDARY PAYER. IF LINE LEVEL INFORMATION IS SENT ON ONE LINE, IT MUST BE SENT ON ALL LINES.
NATIONAL PROVIDER IDENTIFIER SUBMITTED IN ONE OF THESE LOOPS IS INCORRECT.
IF LINE LEVEL INFORMATION IS SENT ON ONE LINE, IT MUST BE SENT FOR EACH SERVICE LINE FILED FOR CONSIDERATION.
WHEN CLAIM LEVEL PAID AMOUNT IF BOTH CLAIM LEVEL AND LINE LEVEL PAID AMOUNTS ARE SENT, PRESENT IT MUST MATCH THE SUM OF THE THE SUM OF THE LINE LEVEL AMOUNTS MUST MATCH THAT SENT LINE LEVEL PAID AMOUNTS. AT THE CLAIM LEVEL. WHEN CLAIM LEVEL ALLOWED AMOUNT IF BOTH CLAIM LEVEL AND LINE LEVEL ALLOWED AMOUNTS ARE PRESENT IT MUST MATCH THE SUM OF THE SENT, THE SUM OF THE LINE LEVEL AMOUNTS MUST MATCH THAT LINE LEVEL ALLOWED AMOUNTS. SENT AT THE CLAIM LEVEL.
PROVIDER TAX ID REQUIRED WITH CLAIM BILLING/CLAIM RENDERING/LINE RENDERING NPI (XXXXXXXXXX)
LastupdatedJuly2010
PROVIDER TAX ID REQUIRED WHEN SENDING NPI.
Page5of12
ERROR NUMBER
328
331
332
334
335
336
340
342
347
351
PROFESSIONAL EDIT EXPLANATION DOCUMENT AUDIT REPORT MESSAGE EXPLANATION
STREET ADDRESS DOES NOT MATCH BCBS FILE FOR CLAIMBILLING/PAYTO/CLAIM BILLING/CLAIM RENDERING/CLAIM SERVICE FACILITY NPI (XXXXXXXXXX)
PROVIDER PHYSICALADDRESS REQUIRED WITH NPI.
CLAIM FILING INDICATOR ZZ IS NOT ‘ZZ’ IS NOT A VALID CLAIM FILING INDICATOR SUBMITTED IN SPECIFIC ENOUGH. SUBMIT A MORE SBR09. YOU MUST USE SOMETHING MORE SPECIFIC. DESCRIPTIVE VALUE. ALLOWED AMOUNT MUST BE EQUAL TO WHEN MEDICARE IS PRIOR PAYER, THE ALLOWED AMOUNT MUST OR GREATER THAN PAID AMOUNT WHEN BE EQUAL TO OR GREATER THAN THE PAID AMOUNT. MEDICARE WAS PRIOR PAYER. PRIMARY MAMMOGRAPHY CODE MUST BE THE PRIMARY MAMMOGRAPHY CODE MUST BE FILED. BILLED ON SAME CLAIM MEDICARE DEDUCTIBLE AMOUNT THE DEDUCTIBLE AMOUNT SUBMITTED IS GREATER THAN THE SUBMITTED EXCEEDS MEDICARE ANNUAL ANNUAL MEDICARE AMOUNT. AMOUNT BILLING NPI SUBMITTED IS NOT VALID FOR THE BILLING NPI SUBMITTED IS VALID, BUT THE RENDERING SERVICES RENDERING/SERVICE FACILITY ADDRESS SUBMITTED IS NOT SET UP IN THE BLUE CROSS SYSTEM. MEDICARE ALLOWED AMOUNTS EXCEEDS MEDICARE ALLOWED AMOUNT SUBMITTED IS GREATER THAN THE TOTAL SUBMITTED CHARGE TOTAL CHARGE SUBMITTED. SECONDARY CPLUS CLAIM WHERE SECONDARY CPLUS CLAIM WHERE MEDICARE WAS NOT PRIOR MEDICARE WAS NOT PRIOR PAYER PAYER CORRECTED CLAIM NOT ACCEPTED, THE ORIGINAL CLAIM NUMBER FILED IS NOT FOUND ON THIS ORIGINAL CLAIM NUMBER NOT FOUND ON CONTRACT. THIS CONTRACT CLAIM LEVEL LOCATION OF SERVICES A PHYSICAL ADDRESS MUST BE SUBMITTED. RENDERED MUST BE A PHYSICAL ADDRESS
LastupdatedJuly2010
Page6of12
ERROR NUMBER
352
353
354
355
356
357
359
360 361
362 399
400
401
402
PROFESSIONAL EDIT EXPLANATION DOCUMENT AUDIT REPORT MESSAGE EXPLANATION
SERVICES RENDERED MUST BE PERFORMED AT A PHYSICAL LOCATION
RENDERING PROVIDER TAX ID NOT ON FILE SERVICE FACILITY ADDRESS MUST BE MORE SPECIFIC (XXXXXXXXXXXXXXXX)
BILLING ADDRESS MUST BE MORE SPECIFIC (XXXXXXXXXXXXXXXX) FILE TWO CLAIMS  ONE PER CALENDER YEAR PATIENT RELATIONSHIP CODE MUST BE VALID FOR ITS HOST CLAIMS.
INVALID SUBMITTER ID FOR NPI NUMBER OR TAX ID CLAIM IN PROCESSING DUPLICATE CLAIM
CONTRACT NOT FOUND CLAIM CONTAINED LINE ERRORS (NO DISPLAY) DATE INVALID OR NOT NUMERIC
LOCATION UNKNOWN FOR PROVIDER SUBMITTED. SERVICES RENDERED AFTER PROVIDER INACTIVE
LastupdatedJuly2010
A PHYSICAL ADDRESS MUST BE SUBMITTED.
THE TAX ID SUBMITTED IS NOT ON FILE WITH BLUE CROSS.
THE CLAIM SERVICE FACILITY ADDRESS MUST BE MORE SPECIFIC.
THE CLAIM BILLING ADDRESS MUST BE MORE SPECIFIC.
FILE TWO CLAIMS  ONE PER CALENDER YEAR
PATIENT RELATIONSHIP CODE TO INSURED MUST BE PRESENT AND VALID ON CLAIM.
INVALID SUBMITTER ID FOR NPI NUMBER OR TAX ID
ORIGINAL CLAIM STILL IN PROCESS. ONLY ONE CORRECTED CLAIM ALLOWED FOR AN ORIGINAL CLAIM NUMBER PER DAY. CONTRACT NOT FOUND LOOK FOR 400 RANGE ERROR MESSAGE. THIS ERROR SHOULD NOT BE DISPLAYED. SUBMITTED DATE IS NOT IN THE CORRECT FORMAT (CCYYMMDD) OR IS NOT NUMERIC. LINE ITEM PROVIDER IS NOT LISTED ON THE BLUE CROSS PROVIDER MASTER FILE. SERVICE DATE IS AFTER PROVIDER CANCEL DATE ON PROVIDER MASTER FILE.
Page7of12
ERROR NUMBER
403
404
405
406
407 408
409
410
412
413
414
415
PROFESSIONAL EDIT EXPLANATION DOCUMENT AUDIT REPORT MESSAGE EXPLANATION
FROM SERVICE DATE IS GREATER THAN THE SUBMITTED SERVICE FROM DATE IS GREATER THAN THE THRU SERVICE DATE SUBMITTED SERVICE THRU DATE OR THE DATE IS IN AN INVALID FORMAT (CCYYMMDD). FROM SERVICE DATE IS GREATER THAN THE SUBMITTED FROM SERVICE DATE IS GREATER THAN THE DATE CLAIM RECEIVED RECEIPT DATE OF THE CLAIM. FUTURE DATED CLAIMS CANNOT BE SUBMITTED. THRU SERVICE DATE IS GREATER THAN THE SUBMITTED THRU SERVICE DATE IS GREATER THAN THE DATE CLAIM RECEIVED RECEIPT DATE OF THE CLAIM. FUTURE DATED CLAIMS CANNOT BE SUBMITTED. NUMBER OF SERVICES IS LESS THAN DAYS THE SUBMITTED NUMBER OF SERVICES IS LESS THAN THE NUMBER IN BILLING PERIOD OF DAYS IN THE SUBMITTED BILLING PERIOD. PLACE OF SERVICE IS BLANK NO SERVICE LOCATION WAS FILED AT THE LINE LEVEL. INVALID TO BILL CRNA SERVICES CANNOT BILL MODIFIERS WL OR WM ALONG WITH OTHER SEPARATELY ANESTHESIA CHARGES. SERVICE DATE OUTSIDE SERVICE FROM OR THRU DATE DOES NOT FALL WITHIN THE ADMISSION/DISCHARGE DATE ADMISSION AND DISCHARGE DATES. SPECIFIC AMBULANCE CODE NEEDED A0999 NONSPECIFIC HCPCS CODE SUBMITTED. MORE SPECIFIC HCPCS CODE NEEDED. NOTE SEGMENT REQUIRED FOR THIS DETAILED DESCRIPTION REQUIRED WITH NOT OTHERWISE PROCEDURE CODE (XXXXX) CLASSIFIED (NOC) PROCEDURE CODES. NDC REQUIRED FOR THIS PROCEDURE FOR HOME HEALTH PROVIDERS, AN NDC NUMBER IS REQUIRED FOR CODE PROCEDURE SUBMITTED. PROC (XXXXX) INVALID FOR SEX THE PROCEDURE CODE SUBMITTED IS NOT ALLOWED FOR THE SEX CODE SUBMITTED ON THE CLAIM. CHECK THE SEX CODE AND PROCEDURE DESCRIPTION FOR EXPLANATION. ANY CHARACTERS WITHIN THE PARENTHESIS REFLECT WHAT WAS ACTUALLY SUBMITTED ON THE CLAIM. THE SAME PROVIDER CANNOT BILL AS THE SAME PROVIDER CANNOT BILL AS BOTH SURGEON AND BOTH SURGEON AND ASSISTANT SURGEON ASSISTANT SURGEON ON THE SAME CLAIM. ON THE SAME CLAIM
LastupdatedJuly2010
Page8of12
ERROR NUMBER
417
419
420
421
422
424 425
427
428
PROFESSIONAL EDIT EXPLANATION DOCUMENT AUDIT REPORT MESSAGE EXPLANATION
INVALID PROCEDURE CODE (XXXXX)
SUBMIT THRU NASCO PREPAID DRUG PROG
ANESTHESIA INFORMATION IS MISSING
MORE THAN ONE ANESTHESIA CHARGE FILED ON CLAIM
INVALID PLACE OF SERVICE FOR PROCEDURE NEGATIVE CHARGE SUBMITTED DIAG CODE ( IS BLANK ) INVALID / DIAG CODE (PTR(9), 9999 ) INVALID FOR SVC DATE MM/DD/YYYY
SERVICE PAST FILING LIMIT
MODIFIER (XX) INVALID
LastupdatedJuly2010
PROCEDURE CODE IS NOT VALID FOR THE SERVICE DATE SUBMITTED. ANY CHARACTERS WITHIN THE PARENTHESIS REFLECT WHAT WAS ACTUALLY SUBMITTED ON THE CLAIM.
FOR NASCO GROUPS (17603, 37600, 38007, 38008, 38081, 38082), OR PREFIX WITH NCH AND IF THE PROCEDURE CODE IS 95135 THRU 95155, THEN THE CLAIM MUST BE FILED WITH NASCO AT:
NASCO DEDICATED PROCESSING P.O. BOX 13427 BIRMINGHAM, AL 352023427 ANESTHESIA UNITS WERE SUBMITTED FOR PROCEDURE CODE REQUIRING MINUTES. FOR ANESTHESIA PROCEDURE CODES, A CLAIM CANNOT CONTAIN MORE THAN ONE CHARGE FOR THE SAME PROVIDER. ANESTHESIA SERVICES MUST BE BILLED SEPARATELY IN ORDER TO ACCURATELY REFLECT TIME. THE SUBMITTED PLACE OF SERVICE IS NOT VALID FOR THE SUBMITTED PROCEDURE CODE. NEGATIVE CHARGE AMOUNTS CANNOT BE SUBMITTED. DIAGNOSIS CODE SUBMITTED CONTAINS “.”, SPACES OR ZEROES OR IS NOT A CURRENT VALID ICD9 CODE. ANY CHARACTERS WITHIN THE PARENTHESIS REFLECT WHAT WAS ACTUALLY SUBMITTED ON THE CLAIM. IF THE YEAR OF THE SERVICE DATE IS MORE THAN 10 YEARS PRIOR TO THE CURRENT DATE, CONTACT CUSTOMER SERVICE FOR ASSISTANCE. MODIFIER SUBMITTED IS NOT A VALID MODIFIER.
Page9of12
ERROR NUMBER
430
431
432
435
436
437
438
439
440
441
PROFESSIONAL EDIT EXPLANATION DOCUMENT AUDIT REPORT MESSAGE EXPLANATION
MEDICAID PAID AMOUNT MISSING OR INVALID
MULTIPLE BILLING PROVIDERS NOT ALLOWED AT LINE LEVEL  REFILE AS SPLIT CLAIMS
PROCEDURE REQUIRES EITHER LT OR RT MODIFIER DIAG CODE (99999) MORE SPECIFIC PRIMARY DIAGNOSIS CODE NEEDED
BCBSAL DOES NOT RECOGNIZE THIS NDC (XXXXXXXXXXX)
RX NUMBER REQUIRED FOR THIS PROCEDURE CODE DIAG (XXXXX) REQ ACCID DATE / DIAG (XXXXX) REQ ACCID DATE AND/OR CONDITION INDICATOR (BLOCK 10)
SERVICE FACILITY ADDRESS REQUIRED FOR FACILITY TYPE CODE (XX) SUBMITTED
THE MEDICAID PAID AMOUNT IS MISSING OR INVALID. IF MEDICAID IS LISTED AS THE PRIMARY PAYER PAID THEN THE COORDINATION OF BENEFITS PAYER PAID AMOUNT MUST BE GREATER THAN ZERO.
MULTIPLE BILLING PROVIDERS ARE NOT ALLOWED AT THE LINE LEVEL. IF MORE THAN ONE PROVIDER IS PRESENT, THE CLAIM NEEDS TO BE SPLIT INTO ONE CLAIM PER PROVIDER BEING FILED.
FOR UROLOGY SPECIALTY PROVIDERS, PROCEDURE CODES 50590 OR 52353 MUST BE SUBMITTED WITH MODIFIERS ‘LT’ OR “RT”. THE FIRST THREE DIGITS OF THE DIAGNOSIS CODE MUST BE NUMERIC (WITH THE EXCEPTION OF V CODES). THE PRIMARY DIAGNOSIS CODE MUST BE MORE SPECIFIC. THE NDC NUMBER SUBMITTED IS NOT A VALID NUMBER. ANY CHARACTERS WITHIN THE PARENTHESIS REFLECT WHAT WAS ACTUALLY SUBMITTED ON THE CLAIM. FOR HOME HEALTH PROVIDERS, SUBMITTED PROCEDURE CODE REQUIRES A PRESCRIPTION NUMBER. AN ACCIDENT DATE IS REQUIRED FOR THE DIAGNOSIS THAT WAS FILED.
SERVICE FACILITY LOCATION IS REQUIRED FOR ALL CLAIMS EXCEPT CLAIMS WITH PLACE OF SERVICE (11) OR (12).
CR1 SEGMENT REQUIRED FOR AMBULANCE AMBULANCE CLAIMS REQUIRE COMPLETION OF THE 2400 LOOP CR1 CLAIMS SEGMENT.
AMBULANCE MODIFIER MISSING OR INVALID
LastupdatedJuly2010
AMBULANCE MODIFIER SUBMITTED IS EITHER INVALID OR MISSING.
Page10of12
ERROR NUMBER
442
443
444
445
451
452
455
459
460
461
PROFESSIONAL EDIT EXPLANATION DOCUMENT AUDIT REPORT MESSAGE EXPLANATION
MODIFIER AA, AD, QK OR QY REQUIRED FOR ANESTHESIA INVALID MODIFIER FOR PORTABLE XRAY
MODIFIER LC, LD, OR RC REQUIRED FOR CORONARY PROCEDURE MODIFIER QX OR QZ REQUIRED FOR CRNA/ANESTHESIA ASSISTANT PROVIDER TAX ID REQUIRED WITH LINE RENDERING NPI (XXXXXXXXXXX)
MODIFIER AA, AD, QK OR QY IS REQUIRED WHEN THE PROVIDER SPECIALTY IS ANESTHESIA. MODIFIER SUBMITTED IS NOT A VALID MODIFIER FOR PORTABLE X RAY. CORONARY PROCEDURES REQUIRE USE OF THE FOLLOWING MODIFIERS: LC, LD, OR, RC. CLAIMS FILED FOR CRNA OR ANESTHESIA ASSISTANT REQUIRES THE FOLLOWING MODIFIERS: QX, OR, QZ. THE TAX ID IS REQUIRED WITH NPI.
ADDRESS/STREET ADDRESS/ZIP CODE DOES THE PHYSICAL ADDRESS OF THE PROVIDER DOES NOT MATCH NOT MATCH BCBS FILE FOR LINE WHAT IS ON FILE WITH BLUE CROSS. RENDERING NPI (XXXXXXXXXXX)
LINE LEVEL NPI NOT ON FILE AT BLUE CROSS. PLEASE CONTACT PROVIDER DATA WITH NPI INFORMATION.
THE NPI FILED AT THE LINE LEVEL IS NOT ON FILE WITH BLUE CROSS. CONTACT CREDENTIALING TO HAVE THIS UPDATED AT 205 2206765.
FILE WITH THE NDC OF THE MAJOR COMPOUND DRUGS SHOULD BE FILED USING THE NDC OF THE COMPONENT IN THE COMPOUND DRUG MAJOR COMPONENT. DOSAGE INFORMATION IS REQUIRED IN CERTAIN DRUGS REQUIRE DOSAGE INFORMATION. THIS SHOULD BE THE NOTE SEGMENT FOR THIS PROCEDURE SUBMITTED IN THE 2400 LOOP NTE SEGMENT. CODE LINE LEVEL OF LOCATION OF SERVICES A PHYSICAL ADDRESS MUST BE SUBMITTED. RENDERED MUST BE A PHYSICAL ADDRESS
LastupdatedJuly2010
Page11of12
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