Wednesday, July 30, 2008

Custom Training Videos specific to your internal Policies

Outsource your internal office policies to be captured in a office manual and or videos for training internal staff.

Examples:
Medical Office has a new front office employee starting Monday. The employee shows up and you hand her a form that shows a check list of things she needs to complete including:
- Manual of daily steps, how to use the practice management software, how to answer phone calls, inter-office policies.
- 2 hour training video that they can either watch in the medical office or at home after work. The training video goes through use of practice management software, and other basic tasks they will be required to perform on a daily basis.

In about 4 hours of reading the training manual and watching the training video your new hire will actually understand what is expected of her/him and can begin working immediately.

Medical Billing Service hires on a new employee

- Training Manual which includes steps:

  • implementing a new medical office
  • how to use the practice management software
  • which reports commonly to run
  • Medical billing service internal policies of what the employee can and can not do like casual fridays, how to process refunds etc.
- Training Videos

  • Steps of how to use each screen including when to use the practice management software
  • End of Month / End of Year Steps
  • How to complete patient statements
  • how to answer the phone
  • How to call Health Insurance companies

Also medical billing services would need supporting documentation to give to new medical offices that sign on with them:

- Training Videos

  • How to use the practice management software
  • How to use the appointment scheduler software
  • How to check patient eligiblity
  • How to complete SOAP notes, medical records
  • How to scan and upload EOB's, documentation, Medical records to the billing service
  • Answer basic support questions

- Training Manuals

  • Steps on using the practice management software
  • internal policies for the front office to follow to support the billing service
  • Support questions
To save time, money and employee frustration check out Online Practice Management Software and scroll down and click on Medical Billing Training Videos on the left Navigational Bar.

Practice Management Software training videos are already completed specific to
AdvancedMD Practice Management Training Videos setup and use of. This company can also create training videos and manuals specific to your practice work flow and Practice Management Software.

For more information how this can improve your office new hire, cross-training, and internal policies visit videotrainingpro.com and use the contact form.


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Web Based Training Videos a Must

In this day and age it's imperative that your medical staff know how to use Microsoft Word, Excel and based on your medical billing software and internal data possibly even Access.

Most medical offices purchase Microsoft however; they end up not even using it because of lack of knowledge of how to use it.

Microsoft is extremely important for Medical offices so that doctors can have -
Word Templates of SOAP notes
Word Templates of Medical Reports
Word Labels for mailers (patients addresses, birthday cards, appointment reminders, change of location, open houses)
Outlook to email doctors and possibly patients
Excel spreadsheets to create graphs, identify $$ trends etc

I seriously would die if I didn't have these tools handy for me! So, that being said you now need to look for alternative inexpensive solutions that works around your office time schedule. Look no further! Go to
http://www.videotrainingpro.com/ and get started for under $10.00 purchasing Microsoft Word Level 1. You can also purchase the full packages or just individual levels keeping it completley in your budget. As you get new staff or train your existing staff on Microsoft and watch as your employees being "creating" documents that work for your office flow.

You will not be disappointed in these training videos. They are trained by a professional who is not only a Certified Microsoft Office Specialist but he has been training for over 8 years. If you would like a more personalized web-based or onsite training just give him Kirt a call.

Do not wait - learning these tools can be extremely valuable for medical offices to improve their office work flow!

Another idea:
Let's say your office purcahses medical documents each month/year and you decide you would like to no longer purchase them but have them converted into Word and include your logo, address information etc. Contact
http://www.videotrainingpro.com/ and in the contact us page indicate the # of documents you have, time frame needed and Kirt or his staff will most likely be able to do this work for a fee.


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Capital Blue Cross of Pennsylvania requiring new EDI Agreements

If you are transmitting electronic claims through RelayHealth they are asking that all medical practices who submit claims to CPID#2858 Capital Blue Cross of Pennsylvania/Capital Advantage Insurance (CAIC) to complete a new EDI Agreement.

Learn more about Electronic
Medical Billing and Coding at this site medical billings and health insurance claims

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Florida Medicaid new Exclusion edits for electronic claims

For clients submitting claims electronically to Florida Medicaid you may receive the following exclusions:

Edit 06 0001C:INVALID EPSDT (early and periodic screening, diagnosis and treatment) REFERRAL COND CODE - IN LOOP 2300, IF CRC01 = ZZ AND CRC02 = Y; CRC03 MUST BE AV, S2, OR ST
Fix: Add the correct Condition Code

  • AV: Patient refused referral (Available, Not Used)
  • NU: Patient Not Referred (Not Used)
  • S2: Under Treatment (for referred diagnostic or corrective health problem)
  • ST: New Services requested (patient referred to another provider for diagnostic or corrective treatments or scheduled for another appointment with check up provider for diagnostic or corrective treatment for at least one health problem identified during a Child Health Check-up, not including dental referrals
Edit 14 0007D:DTL PAID/ADJUST OUT OF BALANCE - THE SUM OF ALL 2430-SVD02 (DTL PRIMARY PAYOR PAID AMT) + (PLUS) CAS03 + CAS06 + CAS09 + CAS12 + CAS15 + CAS18 (ALL ADJUSTMENT AMTS) MUST EQUAL 2400-SV102 (CHARGE AMOUNT) (PROFESSIONAL)
Fix: on HCFA 1500 or CMS-1500 claims the Charge amount must equal the Paid Amount + Adjustment Amounts.

Edit 14 0008C:CLM PAID/ADJUST OUT OF BALANCE - IF LOOP 2320-AMT01 = D (PRIMARY PAID AMT) IS PRESENT, THE SUM OF AMT02 (WHEN AMT01 = D) (PRIMARY PAID AMT) + (PLUS) LOOP 2320 CAS03 + CAS06 + CAS09 + CAS12 + CAS15 + CAS18 (CLM ADJUSTMENT AMTS) + LOOP 2430 CAS03 + CAS06 + CAS09 + CAS12 + CAS15 + CAS18 (DTL ADJUSTMENT AMTS) MUST EQUAL 2300 CLM02 (TOTAL CHARGES)
Fix: on HCFA 1500 or CMS-1500 claims the Charge amount must equal the Paid Amount + Adjustment Amounts.

Edit 14 0015C:MISSING INFO FOR OTHER INSURANCE - IF LOOP 2330B IS SENT, THEN EITHER LOOP 2430 OR 2330B-DTP SEGMENT MUST BE SENT
Fix: Make sure the "other" insurance carriers information is being submitted on the claim.

Edit 35 0001C:MISSING REFERRING PROVIDER NBR - IN LOOP 2310A REFERRING PROVIDER, EITHER NM109 OR REF SEGMENT MUST BE SENT
Fix: Add the referring provider number


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

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Payor Batch Totals Reports and Payor Batch Totals Data Files

On August 11th 2008 RelayHealth will be releasing two new reports called the Payor Batch Totals Report (SB) and the Payor Batch Totals Data File (SD). After August 11th 2008 medical practices using RelayHealth will have the option to view claims transmitted in the Batch File along with status messages for each batch. This report will not be available for all payors. Messages will only reflect in the SB report as the SD report does not reflect messages.
Payor Batch Total Data File crosswalk:


Sample of the SD Data File:Sample of Payor Batch Totals Report (CSPR37.01)


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New Jersey Insurance Claim Electronic Exclusion Edits

If your medical office is submitting electronic claims to New Jersey Medicaid, New Jersey Charity Care Inpatient, New Jersey Charity Care Outpatient, New Jersey Medicaid Inpatient or New Jersey Medicaid Outpatient you will want to be made aware to common claim rejections and how to fix them.

If you receive a denial for the following:
edit: 1217 Description: Taxonomy Code is missing for the billing provider
Fix: Add the correct Taxonomy Code for the specific billing provider

edit: 0271 Description: Submitter not approved for provider
Fix: Your medical provider is not authorized to submit claims electronically for the claims date of service. Contact your clearinghouse or one of the insurance carriers to get the provider setup to submit claims electroncially.

edit: 1218 Description: Taxonomy Code is invalid for the billing provider
Fix: If you are using a invalid or incorrect Taxonomy Code you will receive this edit. To
Register NPI for Medical Providers, or edit an existing NPI number. Take a minute and watch the training tutorial to navigate through the NPI website.

edit: 1240 Description: Provider not Mapped-Billing
Fix: If you are missing the NPI number or it's not put in the correct field in your medical billing software you will receive this edit. Add the correct NPI number in the correct fields and resubmit these claims.

All error codes are located New Jersey's website:
http://www.njmmis.com/editCodeSearch.aspx

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Florida Medicaid transitions to EDS with minor bumps

Florida Medicaid made a fiscal agent transition from ACS to EDS (Electronic Data Systems) on July 1st 2008. With this change came a few minor bumps which seems normal with any type of conversion of this scale but it's good for all medical practices that bill electronically to be aware of.

First issue is that reports are reflecting claims accepted but in reality if they are missing NPI numbers they are getting kicked out and are not being processed. For more information on this please reference
Florida Medicaid Claim Rejections

Second issue is that ERA (electronic remittance advice) are not getting transmitted through clearinghouses effectively. If you are not receiving your ERA 835 files please log in to Florida Medicaids website and indicate an agent to receive 835 files (ERA). Florida Medicaid has indicated that medical providers have either not registered for the 835 file or they setup the roles incorrectly causing the ERA no files issue.

1. Go to Florida Medicaid website
http://mymedicaid-florida.com/
2. In provider section tab; select
Secure Information for Providers
3. Sign in to Florida Medicaid using login information
4. Under Applications select: Account Manager

  • Select Add Agent
  • Enter the email address of your clearinghouse
  • Click Search
  • Select available options
  • Terms of Service: Yes, I Agree

5. Under Applications select: Manage Agent Roles

  • Select Provider or Billing Agent (clearinghouse)
  • Select Florida Web Portal
  • Modify the permissions for FLPortalProd
  • Check 835
  • Check Trade Files
  • Save Changes

Electronic Remittance Advice is a electronic explanation of benefits.

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Florida Medicaid rejection claims missing NPI numbers

As of July 1st 2008 Florida Medicaid has been accepting all electronic claims submitted to them through the Electronic Data Systems (EDS) and your medical office may also receive "997" report notification that claims were accepted. However; what you may not be aware of is that claims missing the provider NPI number are in actuality being rejected or kicked out of their EDS system and are not getting processed for payment.

If you have identified problems with receiving insurance payments on electronic claims from Florida Medicaid after July 1st 2008 please contact the enrollment department to verify your NPI and associated Tax ID numbers are setup correctly in the Florida Medicaid system.

Call Florida Medicaid Provider Enrollment Department at 800-289-7799 option 4 and verify NPI setup. Once everything is setup correctly please rebill all unpaid claims electronically.

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Wellcare Health Plan new exclusion edits

For offices billing electronic claims to Wellcare Health plan new edits were put in place in July of 2008:

Professional claims (CMS-1500) have 6 new edits in place:

35 0001C:MISSING REFERRING PROVIDER NBR - (PROF) IN LOOP 2310A REFERRING PROVIDER, EITHER NM109 OR REF SEGMENT MUST BE SENT

HU 0019C:INVALID BILLING PROVIDER ID QUAL - IN LOOP 2010AA, NM108 MUST BE SENT AND MUST BE EQUAL TO XX

HU 0020C:INVALID PAY-TO PROVIDER ID QUAL - WHENI LOOP 2010AB IS SENT, NM108 MUST BE SENT AND MUST BE EQUAL TO XX

HU 0022C:INVALID CLAIM REND PRV ID QUAL - IN LOOP 2310B(PROF)/2310C(INST), NM108 MUST BE SENT AND MUST BE EQUAL TO XX

HZ 0001C:INVALID CLIA NUMBER - IN LOOP 2300, IF REF01 = X4 THEN REF02 MUST BE 2 NUMERICS FOLLOWED BY D FOLLOWED BY 7 NUMERICS

HZ 0002D:INVALID CLIA NUMBER - IN LOOP 2400, IF REF01 = X4 THEN REF02 MUST BE 2 NUMERICS FOLLOWED BY D FOLLOWED BY 7 NUMERICS

HZ 0003D:DUPLICATE CLIA NUMBERS - IN LOOP 2400, CANNOT HAVE MORE THAN 1 REF~X4 WITH THE SAME REF02 VALUE

Institutional claims (UB-04 or UB-92) have 4 new edits:

HU 0019C:INVALID BILLING PROVIDER ID QUAL - IN LOOP 2010AA, NM108 MUST BE SENT AND MUST BE EQUAL TO XX

HU 0020C:INVALID PAY-TO PROVIDER ID QUAL - WHENI LOOP 2010AB IS SENT, NM108 MUST BE SENT AND MUST BE EQUAL TO XX

HU 0022C:INVALID CLAIM REND PRV ID QUAL - IN LOOP 2310B(PROF)/2310C(INST), NM108 MUST BE SENT AND MUST BE EQUAL TO XX

HU 0026C:INVALID CLAIM ATTEND PHY ID QUAL - IN LOOP 2310A(INST), NM108 MUST BE EQUAL TO XX

These edits will take place through RelayHealth for:
CPID 1844 Wellcare Health Plan / Staywell - Professional
CPID 8551 Wellcare Health Plan / Staywell - Institutional
CPID 3211 Wellcare Health Plans Encounters - Professional
CPID 4949 Wellcare Health Plans Encounters - Institutional

Let me know if you need help identifying how to fix these edits.

Learn more about Electronic
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Monday, July 21, 2008

Re-enrollment required for Nevada and Hawaii Medicare by August 4th 2008

If you have been billing electronic claims to Nevada or Hawaii of Medicare through RelayHealth it is extremely important that you re-enroll your providers.

CPID# 1446 Nevada Medicare & CPID# 2467 Hawaii Medicare is converting on August 4th to a new intermediary Palmetto GBA. Palmetto GBA is requiring re-enrollments for all providers including those that are already approved to submit claims electronically.

Other insurance carriers to follow suit-
CPID 1446 Nevada Medicare currently contracted with Noridian, converting on August 4, 2008 CPID 2467 Hawaii Medicare currently contracted with Noridian, converting on August 4, 2008 CPID 3508 California Medicare currently contracted with NGS, converting on August 18, 2008 CPID 5567 Hawaii Medicare currently contracted with NGS, converting on August 18, 2008 CPID 1436 Northern California Medicare currently contracted with NHIC, converting on September 2, 2008 CPID 1444 Southern California Medicare currently contracted with NHIC, converting on September 2, 2008

Recommendation: Time is not on your side. If you are concerned about your money flow and what is coming in it's imperative you complete these EDI Agreements with RelayHealth ASAP. Think of EDI Agreements as going to Disneyland. You arrive early to find that all of LA must be sleeping in today because the Park is empty. You have free reign to rides, assistance, friendly employees. A couple of hours later you notice that you are now standing in lines (no more running through them) but it's still not bad. By mid-day you feel that everyone from LA is at Disneyland it's taking you a hour to stand in line to ride a 3 minute ride.

**Moral of the story is it pays to be first in line and get this out of the way before you try and do it when everyone else is trying to complete EDI Agreements. Also the later you take in completing them the possibility of processing issues, missing documents or worse they are so inundated with EDI Agreements they prevent doctors from registering until they complete the ones they have on file.

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Tricare South Region Invalid Character exclusion

CPID#6594 Tricare - South Region has requested that due to the high volume of claim denials they would like RelayHealth to scrub claims for invalid characters in Loop 2430 SVD01.

If you use RelayHealth as your clearinghouse and bill to Tricare South Region CPID#6594 you may come across this new edit:
0002D:INVALID IDENTIFICATION CODE - WHEN LOOP 2330B OTHER PAYOR NAME IS SENT, LOOP 2430 SVD01 MUST MATCH ONE OF LOOP 2330B NM109 PAYOR IDENTIFICATION VALUES

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Missouri Medicaid Requiring NPI

As of May 10th 2008 Missouri Medicaid (CPID#1471 & 5571) will only accept NPI as the provider identifier for both CMS-1500 and UB-04 claims. For any additional information please visit Missouri Medicaids website at http://www.emomed.com/

For more articles about
Medical Billing and Coding read this Over 250 Medical Billing and Coding Articles


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Louisiana Medicaid NPI registration updates

As of Friday July 18th 2008 Louisiana Medicaid will no longer accept claims containing a legacy Medicaid ID number with a reference 1D qualifier. Insurance carriers that this will affect are:

CPID 1475 Louisiana Medicaid
CPID 2236 Louisiana Medicaid - Ambulance
CPID 4249 Louisiana Medicaid KidMed
CPID 3578 Louisiana Medicaid

On a good note Medicaid of Louisiana will no longer reject an entire claim file when a single NPI is invalid. They will begin rejecting at a provider/claim level.

If the provider has a NPI tie breaker on file at the payer claims submitted will require the approriate tie breaker information:
Loop 2000A PRV Taxonomy Code
Loop 2010AA Billing Provider 9 numeric zip code

For more articles about
Medical Billing and Coding read this Over 250 Medical Billing and Coding Articles

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Electronic claim rejections for missing NPI

If you have been fighting your clearinghouse on claim denials for NPI issues is to identify you have the NPI number setup in all areas of your medical billing software. Depending on your PM (practice management) software and your clearinghouse (and how well both parties work with each other) you may think you have the NPI setup in all areas when in fact it's possible you are missing 1-2 areas.

1st Recommendation - Identify the exact claim denial and contact your PM software to identify you have that "loop" filled in correctly.
2nd Recommendation - If you are not on speaking terms with your PM software try contacting the clearinghouse to identify what "fields or loops" are missing on the claim. Try and identify where these areas would be in your PM software so you can add them correctly.
Third Recommendation - Take deep breathes if none of these recommendations will help you.

It is still coming down from insurance carriers that doctors are not attaching NPI numbers to claims when submitting electronically. For some clients it sounds like a reasonable fix but for those who don't understand their medical billing software (or those that find the medical billing software is not setup to submit NPI's in all fields) this may be a time consuming fix.

RelayHealth has been notified that these 9 insurance carriers are getting a high volume of claim rejections due to missing NPI information. For this reason they are setting up new edits to alert users to attach the NPI.

CPID 2400 MED3000 MD Medicare Choice
CPID 4718 MED3000 HFN Health Options
CPID 4719 MED3000 HFN Vista
CPID 4720 MED3000 HFN Healthy Kids
CPID 4721 MED3000 HFN Wellcare Choice
CPID 4722 MED3000 HFN Healthease
CPID 4723 MED3000 Pedicare
CPID 4724 MED3000 Health Select IPABCBS
CPID 4725 MED3000 South West IPABCBS


EDIT HU 0019C:INVALID BILLING PROVIDER NPI IN LOOP 2010AA, NM108 MUST BE SENT AND MUST BE EQUAL TO XX

EDIT HU 0020C:INVALID PAY-TO PROVIDER NPI IN LOOP 2010AB, NM108 MUST BE SENT AND MUST BE EQUAL TO XX

EDIT HU 0022C:INVALID CLAIM RENDERING PROVIDER NPI IN LOOP 2010B(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0028D:INVALID SRV LINE RENDERING PROVIDER NPI - IN LOOP 2420A(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

EDIT HU 0044C:INVALID CLAIM PURCHASED SERVICE NPI IN LOOP 2310C(PROF), NM108 MUST BE SENT AND MUST BE EQUAL TO XX

EDIT HU 0046C:INVALID CLAIM SERVICING PROVIDER NPI IN LOOP 2310E(PROF), NM108 MUST BE SENT AND MUST BE EQUAL TO XX

EDIT HU 0047D:INVALID CLAIM SRV LINE PURCHASED SERVICE NPI IN LOOP 2420B(PROF), NM108 MUST BE SENT AND MUST BE EQUAL TO XX

EDIT HU 0048D:INVALID SRV LINE SERVICE FACILITY NPI: IN LOOP 2420C(PROF), NM108 MUST BE SENT AND MUST BE EQUAL TO XX

EDIT HU 0049D:INVALID SRV LINE SUPERVISING PROVIDER NPI IN LOOP 2420D(PROF), NM108 MUST BE SENT AND MUST BE EQUAL TO XX

EDIT HU 0050D:INVALID ORDERING PROVIDER NPI IN LOOP 2420E(PROF), NM108 MUST BE SENT AND MUST BE EQUAL TO XX

EDIT HU 0051D:INVALID SVR LINE REFERRING PROVIDER NPI IN LOOP 2420FE(PROF), NM108 MUST BE SENT AND MUST BE EQUAL TO XX

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

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Maryland Medicaid requiring NPI registration

If you are a medical provider, treat patients for Maryland Medicaid and submit claims electronically please be aware that they are requiring all doctors to register NPI numbers. If you do not register the NPI you will get claim rejections and a instant stop in insurance payments from Maryland Medicaid.

To complete the NPI registration form please visit:
https://portal.transactions.mckhboc.com/documents/payor_guides/MD_CAID_NPI_Reg_Form.pdf and fax the completed document to Maryland Medicaid at 410-333-5341 Questions on this form call 410-767-5370. Maryland Medicaid electronic CPID's through RelayHealth is 1488 (Professional CMS-1500) and 5552 (Institutional UB-04).

Happy claim submission


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Tuesday, July 1, 2008

Oklahoma Blue Cross and Blue Shield claim exclusions

If your medical office is billing electronic claims to Oklahoma Blue Cross and Blue Shield you may have identified denials for invalid rendering ID given and billing provider must have NPI.

To fix MSG-220 rendering ID given as billing not valid confirm you are sending the correct NPI in the billing provider ID field when NPI is required.

MSG-GQA Billing Provider must have NPI (Qual-XX) - again confirm you are sending the correct NPI (or added the NPI) in the billing provider ID field.

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RelayHealth Batching Options

If your medical office is receiving Electronic Remittance Advice (ERA) files from RelayHealth (McKesson) you may notice you have the following batch options available.

ANSI 835 Version 4010A1 (HIPAA- Enabled):

Batching Option 1: Typically, this option will produce one file per payor but may vary based upon processing options and multiple checks may be contained within each file. A new interchange (ISAIEA) file will be created when the value in one of the following fields change: system ID, submitter ID, CPID, or test indicator.
Batching Option 2: Typically, this option will produce multiple files per payor but may vary based upon processing options and multiple checks may be contained within each file. In addition to the fields defined in Batching Option 1, a new interchange (ISA-IEA) file will also be created when the value of the receive date, receive time, or interchange control number change within the payor’s file.

Batching Option 3: This option will produce a single file (ISA-IEA interchange) for each check produced. These files will be combined into one mailbox file.

Batching Option 4: This option will produce a single file (ISA-IEA interchange) for each check produced. These files will be placed into separate mailbox files.

Batching Option 5: This option is not available

Batching Option 6: This option is not available.

Batching Option 7: This option will produce a single file (ISA-IEA interchange) for each Check Date only. These files will be put into separate mailbox files.

If you had ERA's agreements setup prior to March 19th 2008 you can request to have Batch #7 available for those agreements. You can email
DBQTSHEnrollments@relayhealth.com with the six digit submitter number and your Selected Batching Option.

Batching Option 7 has been added to give you the ability to split ERA checks by Check Date alone into separate files within your RelayHealth Electronic Mailbox Facility (EMF).

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Health Alliance Medical Plans of Illinois requiring NPI

In order to submit claims electronically to Health Alliance Medical Plans of Illinois it is required to submit the NPI # in one of the following loops:

Loop 2010A Billing Provider
Loop 2310B Rendering Provider
Loop 2420A Rendering Provider

If you are getting electronic claim denials for missing NPI numbers please make sure to add the NPI to one of these fields.

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