Hipaa 5010 top rejection reasons for providers - …

1 Simplifying the Business of HealthcarePay close attention toongoing CustomerService Alerts (CSAs) emdeon is working closelywith payers to close outissues Be alert of any Emdeoncommunication to be up todate on resolutionsHIPAA 5010 Top rejection reasonsMissing claimsDescription: Claim not showing up as accepted by emdeon viaEmdeon Vision for Claim Management provider action: Contact EmdeonClaim showing as sent to payer, however, no payerreporting has been sent backProvider action:Contact the payer for information, if payer statesthat they have never received the claim or have no record of thereceipt, then contact EmdeonMissing payer specific claims statusDescription:If you received a payer acknowledgment but have notreceived any further claim statusProvider action:Review emdeon s Customer Service Alerts (CSAs)as we may have an open production issue for that particular payer;contact the payer if necessary for further updates and statusPayer message is not understandableProvider action: Contact the payer to understand why the claim mayhave been rejected.

2 If you determine any issues related to potentialmapping, then contact emdeon immediatelyMissing payer report 10 and 11 provider action:Re-queue reports via emdeon Vision for ClaimManagementEmdeon Vision for Claim Management s report re-queues are unsuccessfulProvider action:Contact payer for missing reportsMissing remitsProvider action:Review open production issues via emdeon sCustomer Service Alerts (CSAs) as many payers are having delays orissues in delivering Electronic Remittance Advice (ERAs)Billing provideraddress (PO BOXedit)Error message: ACK/REJECT RELATIONAL - provider not approved for electronic claim submissions on behalf of this entity - billingproviderProvider action: Ensure provider information and National provider Identifier (NPI) are appropriately linked to the Emdeonclearinghouse and the Medicare payer.

3 The error may be due to the following billing errors: Using rendering provider s NPI instead of billing provider s NPI (rendering provider is not associated with the clearinghouse/vendor submitter) Billing Part B services under provider s individual NPI when they should be billed under provider s group NPI Using a billing provider Tax ID that is not associated with billing provider NPIC ommon 5010 error codes and how to address themProvider linkageissues (Medicare496 edit)Procedure codedescriptionError message:ACK/REJECT INVAL INFO - entity street address - billing providerDescription: If you have received this error message, this means that your billing provider address was not submitted as a complete streetaddress or physical locationProvider action:Ensure that the billing provider address is a street address or physical location.

4 PO BOX should be sent as a pay toaddress if needed Service lineinformation(Status code 247)Missing or invalidinformation (Statuscode 21)Error message: ACK/RETURNED - Line informationProvider action: No action is required on provider s behalf. This is not an erroneous response but a successful payer claim statusresponse. Contact the payer if further information is neededError message: ACK/RETURNED - Missing or invalid informationDescription: 277 Status Code 21 note states that at least one other status code is required to identify the missing or invalid informationProvider action:Contact the payer if no further payer claim status updates are provided.

5 Check subscriber information in some casesError message: ACK/REJECT RELATIONAL - detailed description of serviceDescription: Non-specific procedure codes require a description to be submitted in order for the payer to understand what serviceswere performedProvider action: Provide a detailed description of the serviceEmdeon is a leading provider of revenue and payment cycle management and clinicalinformation exchange solutions, connecting payers, providers and patients in the system. For more information, visit 2012 emdeon Business Services LLC. All rights rev Lebanon Pike, Suite 1000 Nashville, TN 37214 ( )Un-actionableerror messagingNational ProviderIdentifier (NPI)Error message: ACK/RETURNED - Missing or invalid informationError message:ACK/REJECT INVAL INFO - No status code information providedProvider action:Contact the payer if you receive these messages.

6 emdeon is working with these payers in attempt to improve payerclaim status messagingError message: ACK/RETURNED - Entity National provider Identifier (NPI) - insured or subscriberError message:ACK/RETURNED - Entity National provider Identifier (NPI) - patientProvider action: No action is required on provider s behalf. emdeon is following up with these payers to provide the correct providerentity or accurate claim status messageHospitaladmission dateError message: ACK/REJECT MISS INFO - Hospital admission dateDescription: Some plans are requiring admission date/time on institutional claims for home health services, Some 4010 payers stillrequire the rendering provider Tax ID even after the NPI s compliance date of May 23, 2008 provider action.

7 providers will need to continue to send the rendering Tax ID in the REF segment using a G2 qualifier when sending claimsto these payersService linequantity / units(Status code 697)Error message: ACK/REJECT INVAL INFO - Invalid decimal precisionError message: ACK/REJECT INVAL INFO - Days/units for procedure/revenue codeDescription: Quantity/units cannot contain a decimal point for some plans. provider action:Submit quantity or units without decimal points for these payers. For example, submit as 1 vs.