Tuesday, December 23, 2008

Utah Health Information Network (UHIN) to raise electronic fees

If you are a medical billing service or are a medical provider in the state of Utah and you are credentialed with UHIN (Utah Health Information Network) please be advised that they are raising their per transaction surcharge from $0.12 to $0.168 effective January 1, 2009.

If you submit claims using RelayHealth please be aware that they will pass this fee onto the providers as it is currently in place at this time.

The health insurance carriers that this affects:

CPID 1536 Altius Health Plan
CPID 4726 Altius Health Plan
CPID 4728 Deseret Mutual Benefits Association
CPID 4410 Educators's Mutual Insurance Association
CPID 4480 SelectHealth
CPID 4727 Public Employee Health Program (PEHP)
CPID 1529 Utah Blue Cross
CPID 1530 Utah Blue Cross FEP
CPID 2412 Utah Blue Shield
CPID 2788 Utah Blue Shield FEP
CPID 1486 Utah Medicaid

Please be aware of these changes when you are looking at your 2009 invoices.

Medical Billing Tags: medical billing claims, claim coding, health insurance carriers, medical claims processing, medical claims clearinghouse, medical claim billing and coding, medical billing and coding, new updates, Electronic modifications, new changes to electronic claims submission, aware of New Years updates

Aetna Health Insurance Electronic Remittance Advice Updates

For all medical offices that bill to Aetna Health Insurance please be aware of their new announcement regarding electronic remittance advice.

Starting March 30, 2009 Aetna will not send Electronic Remittance Advice (ERA's) to providers subject to the National Provider Identifier regulations when

1. A billing provider NPI is not sent on the claim and

2. we have not been notified of a specific override NPI to use on ERA's and

3. the payee does not have a default NPI recorded in Aetna's health insurance providers records

If Aetna Health Insurance does not have a NPI or they adjudicate or reprocess a claim that was submitted without a Billing Provider NPI you will receive the explanation of benefits by paper.

At this time your medical office or billing service maybe submitting medical claims without submitting the NPI number. Right now Aetna health insurance will send your Explanation of Benefits using the Electronic Remittance Advice if it is currently enabled. But on March 30, 2009 those same medical claims will no longer be eligible for electronic remittance advice until you submit the Billing Provider NPI.

If you would like to ask Aetna Health Insurance to continue to receive the payee NPI loaded in to the Aetna Health Insurance system you may send Aetna a email request to their dedicated mailbox aetnanpiera@aetna.com.

Aetna health insurance will be looking for NPI's at the Payee ID source, Group ID source and/or the Rendering Provider ID Source.

The TIN and provider business group (PBG) will always be sent to identify the taxpayer ID that will be used for IRS reporting and the provider business area handling remittances for the claim.

If you have access to Aetna Health Insurance's Secure Provider Website you can access the NPI's assigned to your provider if you have registered for the ERA/EFT feature.

Please be aware of these new updates and confirm that you are submitting the NPI numbers now so you will not see a issue with your Explanation of Benefits. Waiting on paper EOB's can become extra work for any billing department when identifying paid/unpaid claims and the status of such.


For those who bill using RelayHealth: Aetna Health Insurance CPID#'s are 4500 and 6400. If you are new to billing or are interested in learning more about medical claims reports please visit: Medical Claims Clearinghouse Reports

Medical Billing Tags: medical claims clearinghouse, electronic medical claims clearinghouse, medical billing and coding, new ERA updates, new changes, reviews, reporting, Health Insurances, medical billing, medical billing, claims coding and billing, medical claims, claim submission, claim billing, healthy medical claims, clean claims submission, faster payments on insurance claims, health insurance billing and coding

Oregon Medicaid MMIS Updates

On December 11, 2008 RelayHealth, a medical claims clearinghouse, began submitting electronic claims to Oregon Medicaid Health Insurance Carrier (CPID#1481 and 5517).

RelayHealth, a medical claims clearinghouse, is adding new claim edits that you should be aware of if you bill to Oregon Medicaid Health Insurance.

The following apply for Professional CPID 1481:

Professional claims are CMS-1500 formatted claims to indicate the providers services:
HU 0019C:INVALID BILLING PROVIDER ID QUAL - IN LOOP 2010AA, 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 0028D:INVALID SRV LINE REND PRV ID QUAL - IN LOOP 2420A(PROF)/2420C(INST), NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU 0031D:INVALID SRV LINE SUP PROV ID QUAL - IN LOOP 2420D(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX
HU 0043C:INVALID CLAIM REF PROV ID QUAL - IN LOOP 2310A(PROF) NM108 MUST BE SENT & MUST BE EQUAL TO XX

The following apply for Institutional CPID 5517:

Institutional Claims are UB-04 and indicate facility charges
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 - WHEN LOOP 2010AB IS SENT, NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU 0022C:INVALID CLAIM REND PRV ID QUAL - INVALID CLAIM REND PRV ID QUAL: IN LOOP 2310B(PROF)/2310C(INST), NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU 0024C:INVALID CLAIM SRV FAC ID QUAL - IN LOOP 2310D(PROF)/2310E(INST), WHEN NM108 IS SENT IT MUST BE EQUAL TO XX
HU 0026C:INVALID CLAIM ATTEND PHY ID QUAL - IN LOOP 2310A(INST), NM108 MUST BE EQUAL TO XX
HU 0027C:INVALID CLAIM OPERATE PHY ID QUAL - IN LOOP 2310B(INST), NM108 MUST BE EQUAL TO XX
HU 0034C:INVALID SRV LINE ATTND PHY ID QUAL - IN LOOP 2420A(INST), NM108 MUST BE EQUAL TO XX

Please be aware of the NPI updates when billing electronic medical claims.

Want to read additional information on Medical Claims Clearinghouse?

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Harrington Benefit Services of OK new claims processing center

the Medical Claims Processing for Health Choice, Department of Rehab Services (DRS) and the Department of Corrections (DOC) providers are being transitioned over to a new medical claims processor effective January 1, 2009.

If you are a medical provider and you are currently submitting electronic claims to your medical claims clearinghouse please be aware of the new payor ID 22521.


Payor ID# 59142 has been deleted as of December 23, 2008 which correlates to RelayHealth's medical claims clearinghouse CPID#'s:
CPID# 1751 Harrington Benefit Services of Oklahoma Professional CMS-1500 Claims CPID# 2554 Harrington Benefit Services of Oklahoma Institutional UB-04 claims

If you use RelayHealth as your medical claims clearinghouse has not identified the new CPID# that they will use to accept electronic medical claims. They are asking that medical providers hold their medical health insurance claims until the new payor ID is created.

Another reminder is that Health Choice providers will need to send their medical practice location in loop 2010AA REF01 with the LU qualifier. The practice location code is a 6 digit code which is assigned by the HealthChoice Provider Relations Division and they can be called at 800-543-6044.

Read more articles on Medical billing and Coding

Medical Billing Tags: Harrington Benefit Services of OK, medical claims clearinghouse, medical claims processing, medical billing, medical health insurance claims, claim billing, medical coding and billing, asking, ask, choosing, selecting, using, billing, health care, health insurance, processing, producing, electronic claims billing, electronic health,

RelayHealth Medical Claims Clearinghouse has Report Update

RelayHealth a Medical Claims Clearinghouse has announced that on January 8 2008 they will be modifying the way you look at their medical claims clearinghouse reports.

Health Insurance Carriers return two reports to RelayHealth, medical claims clearinghouse. One report is the Print Image File also known as Availity Electronic Batch Report and the second report is the Data File or Availity Data File. Both of these reports contain duplicate data but the report formats are different.

RelayHealth is trying to streamline the data the their clients get so on January 8th 2008 they will no longer be parsing the Data File (Availity Data File) to clients.

You will still have access to the Payor Claim Data Report (SR), Payor Claim Rejections Report (SE), and Payor Report Data File (SF).

These changes will affect health insurance carriers like:
CPID 1403 Oklahoma Blue Shield
CPID 1405 Illinois Blue Shield
CPID 1406 Texas Blue Shield
CPID 1414 Florida Blue Shield
CPID 1514 Oklahoma Blue Cross
CPID 1563 Illinois Medicaid
CPID 1997 Washington Regence Blue Cross
CPID 2404 Oregon Blue Shield
CPID 2440 Ohio Choicecare HMO
CPID 2449 Humana
CPID 2488 Illinois Medicaid
CPID 3417 Florida Healthy Options HMO
CPID 3517 Florida Blue Cross
CPID 3540 Idaho Blue Shield Regence
CPID 3561 Florida Health Options
CPID 3890 Humana Encounters
CPID 4544 Humana
CPID 5501 Texas Blue Cross
CPID 5508 Illinois Blue Cross
CPID 5516 Oregon Blue Cross
CPID 5565 New Mexico Blue Cross
CPID 7403 New Mexico Blue Shield
CPID 7426 Idaho Blue Shield Regence
CPID 7451 Washington Regence Blue Shield

and more...

If you use RelayHealth as your electronic medical claims clearinghouse please be aware of these new changes. Tell the medical billers in your office that on January 8 2008 the Data File report will no longer be available for the majority of health insurance carriers but since this report contained duplicate content you should just notice less reports to have to sort through.

Happy Billing!

Read here for additional medical claims exclusion articles Medical Claims Clearinghouse


Medical Billing Tags: Medical claims clearinghouse processing center, medical claims processing, electronic medical claims, medical billing and claims, billing and coding, medical claims clearinghouse updates, reports, news, features, help, what's new, what to expect, changes in the industry, features, health insurance carriers, medical claims,

CDPHP Health Insurance Carrier offers new claim exclusion reasons

As of December 19th 2008 RelayHealth a medical claims clearinghouse facility will be implementing new claim exclusion edits for CPID#'s 3786 and 2987 because the NPI is now required from the health insurance carrier.

CAPITAL DISTRICT PHYSICIANS HEALTH PLAN (CDPHP)

The following payor edits are for institutional or UB-92 / UB04 facility billing

CPID 2987 - CDPHP:
HU:0019C:


INVALID BILLING PROVIDER ID QUAL - IN LOOP 2010AA, NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU0020C:


INVALID PAY-TO PROVIDER NPI - IN LOOP 2010AB, NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU0026C:


INVALID CLAIM ATTENDING PHY NPI - IN LOOP 2310A(INST), NM108 MUST BE SENT AND MUST BE EQUAL TO XX


The following payor edits are for professional CPID 3786 or CMS-1500 provider services CDPHP:
HU:0019C:


INVALID BILLING PROVIDER ID QUAL - IN LOOP 2010AA, NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU0020C:


INVALID PAY-TO PROVIDER NPI - IN LOOP 2010AB, NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU0022C:


INVALID CLAIM RENDERING PROVIDER NPI - IN LOOP 2310B(PROF), NM108 MUST BE SENT AND MUST BE EQUAL TO XX
HU0021C:


IN LOOP 2310A(PROF), WHEN NM108 IS SENT IT MUST BE EQUAL TO 'XX'


To fix if you get any of these medical claim exclusions is to add the correct NPI number in the appropriate field before submitting medical claims electronically.


To read additional posts on medical billing please see: Asking a Medical Biller

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Saturday, December 13, 2008

How to use Medicare Part B Electronic Data Interchange (EDI) Hotline

A few years ago Medicare Health Insurance began requesting medical offices to submit all Medicare Health Insurance claims electronically to save processing costs. In order to handle the connection of software products to Medicare they created a department called the Electronic Data Interchange or EDI.

The EDI department has the right to kick out a claim before it comes through their claim processing system. If a medical claim is kicked out at the EDI level it is like the insurance carrier never received the medical claim in the first place.

If you have issues where you are sending Medicare Health Insurance claims and they are not appearing in the IVR or in the support line it means one of two things:

1. Your clearinghouse kicked out the claim for issues
2. The Medicare EDI department kicked out the claim for issues

I would first recommend viewing your EDI reports for the patient that Medicare Support was not able to find on file. Now that you have the report read the exclusion reason...

If you don't understand the denial reason you have 3 different options depending on how you are submitting the claim:

1. If you use a Practice Management software that is integrated with the medical claims clearinghouse you might want to contact them first to see how to resolve the issue.
2. If you use a Practice Management Software that is not integrated with the medical claims clearinghouse and you can contact your medical claims clearinghouse do so now. Ask them to pull the file and see why they can identify the claim is getting kicked out.
3. If you have a direct connection with Medicare Health Insurance follow the EDI Hotline Rules

To make a phone call to the EDI Hotline please have this information handy:
1. Submitter ID number. It can also be called Sender ID, User ID and/or Billing Location Code for providers sending to Medicare Health Insurance through Blue Cross of Michigan.

2. NPI number (National Provider Identifier) and can be found in the NPPES directory

3. Date you submitted the claim

4. Processed Date if report states "deleted"

Do not call Medicare's EDI Hotline until you have prepared all of this information. They are usually very nice in the EDI department but they are in a hurry so they need this information quickly.

EDI Hotline for Medicare Part Health Insurance Carriers: 877-567-7261


To read more about Medicare updates including Billing Health Insurance Information check out Medicare Medical Coding and Billing Courses

Medical Billing Insurance Tags: Medicare Health Insurance, Health Insurance Claims processing, Medical Claims Billing, Medical Health Insurance Claims, Electronic Claim Submission, EDI Hotline for Medicare Part B, How to fix denials for Medicare, Deleted Files on EDI Reports, How to work EDI Denial Reports, EDI Denial options, Medical Billing, Medical Billing and Coding, Medical Coding,

Sagamore Health Network moves to new location

RelayHealth was updated with a new physical address for Sagamore Health Network.

The new location is:
Sagamore Health Network
11595 North Meridian Street
Ste #600
Carmel, IN 46032
800-933-3466

Sagamore Health Network will have the servers down during this transition and will not be able to process electronic claims during Friday December 12th 2008 - Monday December 15th 2008. RelayHealth will submit files to Sagamore Health Network up to December 11th 2008 and resubmit to Sagamore on December 15th 2008 after 8:00 am ET.

Clients do not need to stop submitting claims to RelayHealth as RelayHealth will just hold the Sagamore claims and process them the next week to Sagamore. Please be aware of the delay for claims submission and claims reporting.

Also please update your records with the new physical location.

Medical Billing Tags: Indiana, Sagamore Health Network, Medical Billing, Medical Billing and Collections, Medical billings, Medical Health Insurance claim filling,

Present on Admission (POA) for Institutional Medical Claims (UB-04)

Starting December 30, 2008 RelayHealth medical claims clearinghouse will print the Present on Admission (POA) indicator for institutional paper claims that are submitted through RelayHealth (electronic file sent to RelayHealth and RelayHealth drops claim to paper).

CMS was the first to require the POA but RelayHealth wants to open this up and make it available for institutional medical claims to submit these to other insurance carriers as needed.

When dropping Institutional Claims to Paper through RelayHealth please use these CPID#'s:
4350 ~ Commercial
4352 ~ Medicaid
4353 ~ Blue Shield
4354 ~ Commercial Carrier Direct

Reporting Options to indicate POA (Present on Admission)
Y = Yes, was present at the time of inpatient admission
N = No, was not present at the time of inpatient admission
U = Unknown, documentation is insufficient to determine if condition is present on admission
W = Clinically undetermined provider is unable to clinically determine whether condition was present on admission or not
Unreported/Not used (exempt from POA reporting)


Medical Billing Tag Words: Medical Billing Health Insurance Claims, Medical Billing Hospital Facilities, Medical billing and Coding, Medical Billing and Collections, Coding, Reporting, Present on Admission, POA, ICD-9 codes, when to use POA, updates to POA


Monday, December 8, 2008

Ask a Medical Biller Index

Sometimes accessing blog articles can be difficult for the user. I am creating a Master Page or SiteMap for ease of navigating to over 258 articles in specific categories.

You are visiting this Website URL: http://www.askamedicalbiller.blogspot.com/

These are additional blog posts that you can read while on Ask A Medical Biller.

Medical Billing and Coding Courses Information

Telehealth Online Medical Billing and Coding Courses
Present on Admission for medical claims clearinghouse
Medical Billing and Coding for Evaluation and Management
Ophthalmology medical billing
Modifier Billing
Anesthesia Medical Billing and Coding
Electronic Medical Claims Secondary
Medical Billing Coding for Allergies and Sinuses
Medical Billing Taxonomy Code text
Wisconsin Physician Service Website update
Medical Billing Place of Service
Electronic Medical Billing for Claim Adjustment Reason Codes
Medical Claim Billing with Patient Information
Electronic Claim Clearinghouse RelayHealth
Billing for Group Practices
CMS 1500 Medical Billing Claims
Medical Providers NPI Validation
Referring Providers NPI validation test
Claim Billing for Providers without a NPI
Medical Billing for CLIA waived Tests
Flu Shots
2008 deleted Procedure Codes for Medical Coding
Medical Coding updates of 2008 deleted Procedure Codes
Medical Billing and Coding Tips
Billing Medical Claims with Procedure Code 99354
Pediatrician Medical Billing
Aetna Health Care Insurance Medical Claims Billing
Aetna Health Care Insurance Dermabrasion Medical Billing
Think Green when Medical Billing and Coding
Medicaid Requires NPI
Health Alliance Medicaid and NPI updates
Electronic Claim Billing Oklahoma BCBS claim Exclusions
Maryland Medicaid and NPI updates for Medical Billing
Electronic Claim Billing Exclusions for missing NPI issues
Louisiana Medicaid NPI updates for Medical Billing
Missouri Medicaid NPI updates for Medical Billing
Electronic Certificate of Medical Necessity Forms for Medical Billing
Certified Medical Coding Trainer
Billing Medical Claims J0725 to Aetna Health Insurance
MediCal Modifier Update for Medical Billing Claims
Health and Human Services releases info on ICD-10
How to send a patient to outside collection agency
Billing 90669 and 90471 including screenshots of claim coding software
Aetna Health Insurance Medical Billing Claims Update on Attachments
Information on SCCIPA


Medicare Billing and Coding Course Information
Medicare Electronic Data Interchange Hotline
Proper Billing Steps when Medicare is the Secondary Insurance Carrier
How to resolve Overpayment issues with Medicare correctly
Waived CLIA Tests for Medicare
Resolve Podiatry Medical Billing Claim Issues
When Medicare can withhold the doctor’s insurance payment
Payment fees for Laboratory Travel Codes
2009 Medical Billing and Coding books available for purchase
Doctors can’t appeal Medicare Allowable Fee Schedules
Crossover Explanation of Benefits sent with incorrect rejections
Proper steps for emailing Medicare Health Insurance
How to Refund Medicare Health Insurance
Medicare Payments may look small
Electronic Claims Medicare Secondary Billing
Medical Billing and Coding using GA Modifiers
Medicare Secondary Payer MSP billing and coding situations
Electronic Claim Remittance Advice Remark Codes
Medicare Electronic Claims Crossover
MSP for Billing Medical CMS-1500 Claims
Medicare Remittance Advice Remark Codes Crosswalk
Submitting Electronic Claims as Secondary
Medicare Provider Bonus
Medicare Bonus Registration
Physician Quality Reporting Initiative PQRI
Medicare Billing for Smoking Cessation
Medical Billing Insurance Phone Calls with Medicare - IVR
Understanding the PTAN number
What Medicare IVR is
Checking Claim Status through IVR
IVR phone numbers by State
IVR Medicare Tip

Top 10 Medical Billing Calls to Medicare
Medicare Provider Enrollment Telephone Numbers
Electronic Medicare Claims for Secondary Payers
Electronic Claim Payment Reason Codes
NPI Medicare Website
Medical Billing NPI Registry
NPI Registration Questions
National Plan and Provider Enumeration System
Medicare Billing and Clearinghouses
Medicare PTAN
Medicare Billing and Coding Training Software
Medicare Training Courses
Medicare Claim Billing Rules for No Shows or Missed Visits
Deleted Electronic Claims Billing Issues
Medicare Electronic Claim Denial M codes
Medicare Electronic Claims Billing using CR modifier
Cardiovascular screen Blood Tests text
Medicare Electronic Claims require NPI
NPI required when Billing Medicare Electronic Claims
Register or Update NPI for Medical Billing Providers
Medicare Medical Claim exclusion H21084
Durable Medical Equipment Billing
Medicare Illinois Locality Fees
Q4097 Injection Code
Medicare ABN form updated
How to Call Medicare steps
Medical Billing Claims use of Modifier 59
Medical Billing for Active Duty in Armed Forces
National Drug Codes Claim Billing
Billing Medical Claims for Nursing Facility Service
Supporting Documentation for Medical Billing Claims
Diagnostic Laboratory Medical Billing
Medical Billing and Coding for Prolonged services
How to bill Paper Medical Claims to Medicare
Medical Billing Secondary Insurance Claim Denials
Medicare Holidays
Medicare NPI
Medicare Refund Forms Updated
Inpatient Hospital Medical Billing for Payment
Out of Country Address on Medical Claims
Medicare Medical Claim Billing for HCT or HGB values
Medicare NPI Exclusion Edits for Medical Billing and Coding
Phone Call Preparation
Highmark Medicare Services Website


Medical Billing Software
Microsoft Computer Training
Microsoft Office Online Training Videos
Medical Billing Software
Medical Billing Scanners
Medisoft Billing Software Data Export
Medical Claims Billing Software CollaborateMD
Medical Billing Software with NPI issues
Microsoft Office Training Videos
Customized Training Videos for your internal staff
Patient Eligibility Searches for Medical Billing Software
Online Eligibility for Medical Billing software


Electronic Medical Billing Clearinghouses
How to track what a Billing Service is doing through the Clearinghouse
How to identify what Clearinghouse to use Example
How to read RelayHealth Clearinghouse Payor Claim Data Reports
Save money by sending medical billing claims electronically
Claim Denials because of Medical Billing Clearinghouses
Medical Billing Clearinghouse Claim Status Reports
Electronic Billing Clearinghouse Reports Simplified


RelayHealth Clearinghouse Claim Billing, Edits, Exclusions, and Updates
Mississippi Medicaid to stop accepting Secondary Medical Billing Claims
Medical Billing Claim Edits for NDC
anchor text
New Medical Claim Exclusions for CDPHP
Medical Claims Clearinghouse Reports
Managed Care of Memphis Medical Billing Claims alert
Medicare Electronic Claim of 4 states reporting issues
RelayHealth Electronic Claims to Paper using Wrong CPID format
Medical Health Insurance Carriers Address Information
Direct connection with Gateway Health Insurance
Blue Medicare PPO how to fix Exclusions
New Jersey Medicare using Highmark Medicare Services for Electronic Claims Billing
Kaiser of Georgia has new Report updates
Electronic Claim Billing Exclusion Edit: F1 0001C and how to fix
Mcare Medical Health Insurance can be billed through Blue Care Network HMO
Medical Claim Exclusions for invalid zip code
Another Insurance Carrier can’t accept electronic secondary claims
Aetna Health Insurance requesting Secondary Claims to come electronically
Electronic Claim Exclusion PA the Claim Adjudication Date
RelayHealth Terminated Insurance Carriers Update
Medicaid Electronic Claims Update
Medicare DME new claim edit
Medicare Montana claim exclusion edit
Fixing Edit Exclusion CH 64
835 files deadline for BCBS of Florida
Wisconsin ForwardHealth update
Insurance Carriers dropping Claim Status Reports from Clearinghouse
EDI updates for Michigan Medicaid
Kaiser Permanente Electronic Claims filing
Care Choice Electronic Claims CPID update
Iowa and South Dakota BCBS medical billing updates on NPI
RelayHealth Additional Processing time for Electronic Claims Billing
Cigna Health Insurance Exclusion Report
First Choice Health Network Electronic Claim Edit updates
Direct Connection with Humana Veterans Healthcare Services
RelayHealth EDI Reports Update
Kansas, Nebraska and Western Missouri Medicare Electronic Claim Billing Updates
EDI report changes for DME MAC Dubuque and Chicago
DME MAC CPID for electronic claim billing updates
Billing Claims to Wisconsin Medicaid look for these changes
Priority Health of Michigan adding new EDI reports for electronic claim billing
SAMBA will be consolidated under Cigna Health Insurance
Insurance Carrier EDI Reports issues
Indiana University Medical Group and Electronic Claims Billing
HealthComp Electronic Claims Medical Billing updates
New York Empire Medicare system issues
New Jersey Medicare transferring to Highmark updates
Texas First Health Plan through RelayHealth updates
Oregon Medicaid Electronic Claims Billing updates
Direct connection with Kaiser Mid Atlantic
Insurance Carriers are requesting no more hand written EDI Agreements
EDI error BO13 and how to fix
Illinois BCBS Insurance Claim NPI updates
Electronic Claim Edits for New York Preferred Care HMO Billing Insurance
RelayHealth Clearinghouse
Ohio Medicare Electronic Remittance Advice Issues
Blue Shield NPI Medical Claim Exclusion Edits
RelayHealth connected to Office Ally
Palmetto GBA EDI Conversions
Illinois Medicaid Exclusion Codes when Medical billing
EDISS NPI Updates for Electronic Medical Billing
Amerigroup exclusion on Electronic Medical Billing Claims
LA Medicaid has new Payer Edits for Electronic Claims Billing
Oklahoma Medicaid Requires Taxonomy Code on Electronic Medical Claims
Direct Connection with Magellan for Electronic Claims Billing
Health Administrative Services changes Name to Trisurant
Avmed Inc Electroni Claim Exclusions
Electronic Claims Medical Billing updates for Golden Rule Health Insurance
Benefit Plan Management Inc Electronic Claims Billing update
DME electronic claims medical billing updates
Medicare Claim Exclusion 90496 on electronic claim submission
Electronic claims for National Association of Letter Carriers update
Electronic Claim Billing PHP Tenncare updates
Electronic Claim Billing IHC is now SelectHealth
Electronic Medical Billing for Oklahoma Medicaid has new EDI exclusions
New Mexico and Oklahoma Medicare Electronic Claim Submission updates
Electronic Remittance Advice Batching Options
Electronic Medical Billing Claim Exclusions for Tricare South Region
Nevada and Hawaii require new EDI agreements
Medicare and Nevada electronic claims denied for no EDI agreement on file
Wellcare new Electronic Claim Exclusion edits for Medical Billing
Florida Medicaid Rejection Electronic Medical Billing Claims missing NPI numbers
Florida Medicaid Updates for Electronic Medical Billing
New Jersey Insurance Claim Exclusions for Medical Billing
New Payor Batch Reports
Electronic Claims Exclusions for Florida Medicaid updates
Capital Blue Cross of Pennsylvania requires new EDI agreements with RelayHealth
RelayHealth enhancing Medical Billing Clearinghouse software
Amerigroup Electronic Claims Billing Exclusions
New Mexico Medicaid Electronic Claims Billing Exclusion Edits
Memorial Hermann Insurance Electronic Claim Denials
Northern and Southern California updating to Palmetto for Electronic Claim Billing
Community Health Plan of Washington Electronic Claim Billing Edits
Blue Medicare PPO Electronic Claim Edits for Medical Billing Services
Humana Electronic Claim Billing Exclusions
Indiana Medicaid Electronic Claim denials
Electronic Claim Billing to North American Medical Management of Illinois
Athens Area Health Plan edit updates for Electronic Medical Billing Claims

Dental Billing
Electronic Dental Medical Claims
Orthodontist in Utah

Medical Services Website
Doctors and Dentist Websites

Medical Billing Schools and Online Courses
Ease of Medical Billing and coding

Chiropractic Medical Billing
Chiropractic Medical Billing Office Software
98940 Electronic Claims Medicare update

Health Insurance Quotes, Online Auto Insurance Quotes, Property Insurance Quotes
Health Insurance Quotes
Life Insurance Quotes
Online Auto Insurance Quotes

Medical Billing and Coding Colleges
When to attend Medical Coding Colleges

Medical Business Suggestions
Marketing Campaign
Viewing your Medical Office through the eyes of your patients


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Friday, December 5, 2008

New Claim Edits for New York Preferred Care HMO

New York Preferred Care HMO CPID# 7434 has new NPI requirements. Because of these changes RelayHealth will be implmenting a new electronic claim exclusion on December 5th 2008 for all claims submitted to CPID# 7434.

EDIT: HU 0021 INVALID CLAIM REF PROV ID QUAL? IN LOOP 2310A(PROF), WHEN NM108 IS SENT MUST BE EQUAL TO XX

Please understand that the NPI is now required when submitting claims through RelayHealth for New York Preferred Care HMO health insurance.


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

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Illinois Blue Cross Blue Shield Insurance Claims

Blue Cross Blue Shield of Illinois has required medical offices to bill using a Rendering NPI number. If you use RelayHealth as your electronic insurance claim filing clearinghouse you will get specific denials relating to this issue.

BA7: NPI is not valid as rendering

If you receive this exclusion it means that "The NPI submitted on the claim to identify who provided the services is identified in our files as a billing entity, not a rendering provider." To rectify the above error message, the NPI of the provider who rendered the services should be populated in Loop 2310B - Data Element NM109, which is equivalent to Box 24J on the CMS-1500 claim form.

NOTE: You must continue to include the Billing NPI in Loop 2010AA - Data Element NM109. This Data Element is equivalent to Box 33A in the CMS-1500 Form.

If receiving Warning message: BAJ - Rendering Provider Loop (2310B) is Missing
Please be advised that this Warning message alerts you that "If the NPI billing provider record is NOT established as 'valid as rendering,' then the claim rendering provider loop (2310B) is required." In this situation, you must include the rendering provider's NPI in Loop 2310B - Data Element NM109. This Data Element is equivalent to Box 24J on the CMS-1500 claim form.


When filing claims, it is imperative, to include the rendering NPI (Type 1) in the rendering field (2310B Loop) and the billing NPI (Type 2) in the billing field (2010AA). The appropriate billing and rendering NPI must be entered properly to avoid claim rejection(s) and ensure proper payment.

Questions on Electronic Medical Billing and Claims then view medical claims electronic billing


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Monday, December 1, 2008

Electronic Claims EDI error BO13 Prov Phone 1

For those medical offices billing through RelayHealth to insurance carriers CPID#1405 Illinois Blue Shield, CPID# 1406 Texas Blue Shield, CPID# 7403 New Mexico Blue Shield and/or CPID# 1403 Oklahoma Blue Shield you may have noticed a EDI Denial: B013 PROV PHONE 1 on November 14th 2008.

The invalid rejections have all been corrected and forwarded on to the correct payors. Please be aware of this fix.



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