Tuesday, December 23, 2008

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,


  1. how do you bill a neb treatment w/xopenex or other meds. which codes do you use?


  2. what cpt codes do you use to bill a neb treatment w/xopenex or other meds?

  3. Hi J,

    Codes 94010-94799 include laboratory procedure(s) and interpretation of test results. If a seperate identifiable Evaluation and Management service is performed, the appropriate E/M service code should be reported in addition to 94010-94799.

    94640 - Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device.)

    If more than one inhalation treatment performed on the same date, append with modifier 76

    Modifier 76 - Repeat Procedure by same physician: When a procedure or service is repeated by the same physician subsequent to the original service, use modifier 76

    If you are instructing the patient on how to use the nebulizer you want to code using 94664 Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device.

    Now add your J codes for the supply of the nebulizer drug. You mentioned Xopenex above:
    Xopenex (levalbuterol HCI)
    0.5 mg, concentrated form INHALER J7612
    0.5 mg, unit dose form INHALER J7614
    **As of July 1, 2007 Medicare will no longer accept J7611, J7612, J7613 or J7614. In it's place they want:
    Q4093 Albuterol inh non-comp non (Albuterol, all formulations including separated isomers, inhalation solution, FDA-approved final product, non-compounded, administered through DME, concentrated form, per 1 mg (Albuterol) or per 0.5 mg (Levalbuterol))

    Q4094 Albuterol inh non-comp u d Albuterol, all formulations including separated isomers, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose, per 1 mg (Albuterol) or per 0.5 mg (Levalbuterol))

    Q4095 Reclast injection Injection, zoledronic acid (Reclast), 1 mg

    *****HCPCS code J3487 (short description: Zoledronic acid; long description: Injection, zoledronic acid, 1 mg) is used to bill for products under the FDA’s approval for Zometa® or such therapeutically equivalent products that may become available as identified in the FDA’s Orange Book.

    Add modifier 25 to the E/M code to indicate that it was a significant, seperately identifiable service from the other services described.

    For more steps on Medical billing and collections