Saturday, October 6, 2007

Are you getting deleted claims from Medicare?

Most states are now starting to "delete" Medicare claims at the EDI level for invalid NPI crosswalks. It is extremely important to read your Carrier Forwarded Reports from Medicare to identify if your office is having these issues.

Medicare can delete your claims for the following reasons:

* Billing Provider level (2010AA) - M340 & M379
* Pay to Provider level (2010AB) - M341 & M380
* Rendering Provider level (2310B) - M343 & M381
* Rendering Provider level (2420A) - M347 & M382

Edits M340, M341, M343, and M347 occur when the NPI submitted with legacy number does not match the crosswalk; that is the NPI legacy is not on the crosswalk or is invalid.

Edits M379, M380, M381, and M382 will fail if you are sending NPI only and the NPI is not on the crosswalk or you are sending an EIN/SSN with the incorrect qualifier.

This is not a software vendor issue but if you need help with setting up your carrier correctly you may contact your practice management software support department for assistance. Mainly you will need to identify what fields in your practice management software relate to Loop(s) 2010AA, 2010AB, 2310B, and 2420A.

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