Monday, March 24, 2008

Clearinghouses are still Stripping information from Medicare Claims

Medicare has made an announcement to let customers know that they have identified that medical clearinghouses are still stripping information from Medicare claims which could be resulting in claim denials for customers.

Medicare would like to let customers know that if they have identified any clearinghouse that is stripping the NPI number from the claim to notify your Medicare Contractor immediately so CMS can work with your clearinghouse to resolve this issue.

To verify if this is happening follow these steps:

  1. identify that you are sending your NPI # in the correct fields and bill Medicare claims electronically.

  2. Call your medical billing software vendor to verify the NPI # is being forwarded on to your clearinghouse (they should be able to track how your eClaims are being submitted)

  3. Place a call with your clearinghouse and have them pull your claim file. Have them verify the NPI#'s are on the claim and they are receiving it

  4. Call Medicare a few days later and identify if Medicare received the NPI #

If not you can then tell them where the issue is lying - i.e. you verified that your medical billing software vendor forwarded the NPI # to your clearinghouse and that your clearinghouse verified receiving the NPI #. The issue would be at this point that your clearinghouse is not forwarding that information on to Medicare.

Medicare has also identified that some clearinghouse are stripping the SY qualifer and the Social security number (SSN) from claims that contain NPI. Clearinghouses are required to send this information as a result of business requirement 4320.17 (outlined in transmittal number 204, dated Feb 1 2006).

Interested in Medical Billing and Coding read more articles on Medical Coding and Billing Courses

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