Emdeon Office HIPAA 5010 Rejection reasons

1 Simplifying the Business of Healthcare HIPAA 5010. Top Rejection reasons Missing claims Pay close attention to Description: Claim not showing up as accepted by Emdeon in Emdeon Reporting and Analytics ongoing Customer Provider action: Create an Emdeon ON24/7 service request. Note that the most efficient way of opening an Emdeon ON24/7 service request is Service Alerts (CSAs) via Claim Detail page in Emdeon Office Reporting and Analytics. Just click Emdeon is working closely with on the Get Help with this claim link and all the information pertaining to that claim will be automatically exported to Emdeon ON24/7. payers to close out issues Be alert of any Emdeon Claim showing as sent to the payer, however, no payer communication to be up to reporting has been received back date on resolutions Description: Claim has been sent to the payer but the payer has not sent an acknowledgment back Provider action: Contact the payer; if the payer states that they never received the claim or do not have a record of receipt, then create an Emdeon ON24/7 service request Missing payer specific claims status Description: You received a payer acknowledgment but no further claim status has been received Provider action: Review Emdeon 's Customer Service Alerts (CSAs) to verify whether a production issue has already been opened for that particular payer.

2 If you don't find an open production issue for that payer, you may contact the payer for a status or open a service request via Emdeon ON24/7. Payer message is not understandable Description: You have received an unknown error message Provider action: Contact the payer to get clarification of the error message; if you determine any issues related to potential mapping, create an Emdeon ON24/7 service request Missing remits Description: All the reports have been received except the remittance advice Provider action: Review open production issues as reported in Emdeon 's Customer Service Alerts (CSAs) as many payers are having delays or issues in delivering Electronic Remittance Advice (ERAs). If you do not find any open production issues for that payer, open a service request via Emdeon ON24/7. Common 5010 error codes and how to address them Provider Error message: ACK/REJECT RELATIONAL - Provider not approved for electronic claim submissions on behalf of this entity - billing provider linkage issues Provider action: Ensure your information and National Provider Identifier (NPI) are appropriately linked to the Emdeon clearinghouse and the Medicare payer.

3 The error may be due to the following billing errors: Using your rendering provider's NPI instead of your billing provider's NPI. Billing Part B services under your individual NPI when they should be billed under your group NPI. Using a billing provider Tax ID that is not associated with your billing provider NPI. Billing provider Error message: ACK/REJECT INVAL INFO - entity street address - billing provider Description: If you have received this error message, this means that your billing provider address was not submitted as a complete street address (PO BOX address or physical location edit) Provider action: Ensure that the billing provider address is a street address or physical location. PO BOX should be sent as a pay to address if needed. Refer to the instructions that are available to you in the flash message section of the Emdeon Office homepage Procedure code Error message: ACK/REJECT RELATIONAL - detailed description of service Description: Non-specific procedure codes require a description to be submitted in order for the payer to understand what services were description performed Provider action: Provide a detailed description of the service.

4 Consult the Emdeon Office user manual for further information or open an Emdeon ON24/7 service request Missing or invalid Error message: ACK/RETURNED - Missing or invalid information Provider action: Contact the payer if no further payer claim status updates are provided information Service line Error message: ACK/RETURNED - Line information Provider action: No action is required on your behalf. This is not an erroneous response but a successful payer claim status response. information Contact the payer if further information is needed National Provider Error message: ACK/RETURNED - Entity National Provider Identifier (NPI) - insured or subscriber Error message: ACK/RETURNED - Entity National Provider Identifier (NPI) - patient Identifier (NPI) Provider action: No action is required on your behalf. Emdeon is following up with these payers to provide the correct provider entity or accurate claim status message Un-actionable Error message: ACK/RETURNED - Missing or invalid information Error message: ACK/REJECT INVAL INFO - No status code information provided error messaging Provider action: Contact the payer if you receive these messages.

5 Emdeon is working with these payers in attempt to improve payer claim status messaging Service line Error message: ACK/REJECT INVAL INFO - Invalid decimal precision Error message: ACK/REJECT INVAL INFO - Days/units for procedure/revenue code quantity / units Description: Quantity/units cannot contain a decimal point for some plans (Status code 697) Provider action: Submit quantity or units without decimal points for these payers. For example, submit as 1 vs. Emdeon is a leading provider of revenue and payment cycle management and clinical information exchange solutions, connecting payers, providers and patients in the healthcare system. For more information, visit 3055 Lebanon Pike, Suite 1000. 2012 Emdeon Business Services LLC. All rights reserved Nashville, TN 37214 USA. EMDA1040194 rev ( ).