Wednesday, July 30, 2008

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:

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