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.


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