Why claims are rejected
Case Management Weekly, March 17, 2004
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Why claims are rejected
A new Medicare program transmittal contains more reasons why claims processors might send your claim back. Claims lacking any of the following data points may be headed back your way:
--Admission date
--Admitting diagnosis
--Admission type code
--Patient status code
--Admission source code
In addition, transmittal 107, which modifies the HIPAA X12N 837 implementation guide, tells payers and processors to reject claims in the following circumstances:
--Outpatient claims containing covered days
--Claims containing a NPP000 UPIN
--Claims containing an invalid E-code
Editor's note: To download transmittal 107, click here:
http://www.cms.hhs.gov/manuals/transmittals/comm_date_dsc.asp
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