Monday, September 8, 2008

How to fix a RelayHealth Edit

We received this exclusion code for CPID# 4417 through RelayHealth because somehow the medical biller received a different denial and after fixing during the re-billing phase through our Practice Management software selected to rebill the Secondary Insurance Carrier. The secondary insurance carrier was submitted and was denied with this exclusion because we had not posted the primary insurance carriers payment which of course is because they have never received the claim. Our scenario is probably way different as to why most medical offices are receiving this denial reason.

Edit: PA The Claim Adjudication Date (Loop 2330B, DTP)
What it means: Medicare Secondary Payer (MSP) information is missing
Fix: Add the MSP code to the claim and rebill

Loop 2330B DTP segment - Line Adjudication Date
The ANSI X12 Implementation Guide indicates the claim adjudication date by using a DTP segment in loop 2330B. The DTP01 element will contain qualifier 572, Date Claim Paid, to indicate the type of date that follows. DTP02 will contain qualifier D8 to indicate the format of the date. The DTP03 element will contain the claim adjudication date. The Claim Adjudication Date is required on all MSP claims and is used to report the date a claim was adjudicated or paid by the primary payer.

2330B/DTP segment syntax: DTP*573*D8*20080908~

DTP01 = 573 which indicates date claim paid
DTP02 = D8 indicating date format
DTP03 = Actual Primary Payer Adjudication Date

Claims that do not balance at the claim and line level will not be accepted into the processing system. The total primary payer paid amount (AMT*C4) plus the adjustment amounts in both the claim and line level CAS segments must equal the Total Submitted Charge (AMT*T3)

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

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