Friday, October 24, 2008

First Choice Health Network new electronic claim edits

CPID#'s 6453 and 6554 First Choice Health Network (and this edit may apply to other health insurance carriers) has been added by RelayHealth to notify medical offices of incorrect billing processes that are taking place.

This is happening when claims are being submitted from the Provider to the primary insurance carrier to the secondary insurance carrier through electronic claims transmission. Some people call this Provider-to-Payer-to-Payer or Coordination of Benefits (COB).

When Medicare Part B is the primary insurance carrier and the patient has secondary insurance they are requiring all of this information to be transmitted with the claim so Medicare can forward on to the secondary insurance carrier for you.

Fix: Confirm you have the correct secondary insurance subscriber information for Medicare can adjudicate the claim correctly and facilitate the 837COB transaction. First Choice Health Network does not accept Social Security Numbers

SBR09 = MB stands for Primary Insurance Carrier Medicare Part B
2330 A is Subscriber's secondary insurance information
REF01 CANNOT = SY and SY means Social Security Number

Update the Insurance Carriers Subscriber information with the ID# found on the insurance card and rebill the claim.

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