Friday, June 13, 2008

How to format out of country addresses for Medicare


The Electronic Media Claims (EMC) system reviews every claim for a number of pre-pass edits to ensure that claim data is valid. If a claim contains missing or incorrect information, one of two things will happen because of a pre-pass edit.

1. If an informational edit is in effect, the claim, batch, or file will process normally. The informational edit identifies the error and alerts the submitter in order to correct future claims.
2. If a delete edit is in effect, the claim, batch, or file will NOT process normally; it deletes from the claims processing system and alerts the submitter to the error.

Addresses are present in various loops in an electronic claim. For electronic claims, the state code is required and must be present and valid unless the country code is used. The state code edits set if N402 is present and is an invalid code OR if N402 = spaces AND N404 (Country Code) = spaces or a valid country code. Spaces or CAN are acceptable values. Alpha numeric zip codes are also acceptable.

Element Description
N401 City
N402 State
N403 Postal Code (Zip Code)
N404 County Code

Claims with a foreign address are subject to the mandatory electronic claims submission requirements for Medicare and are NOT an Administrative Simplification Compliance Act (ASCA) exception.

For a complete list of valid country codes, go to:

Confused by Electronic Medical Claim billing then read these articles on Billing Health Insurance medical claims

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