New transmittals address rejected, incomplete claims
HIPAA Weekly Advisor, March 1, 2004
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New transmittals address rejected, incomplete claims Two new transmittals from the Centers for Medicare and Medicaid Services (CMS) should help you understand at least two reasons why your Medicare payer might tell you to resubmit your claims. Both transmittals update the HIPAA X12N 837 implementation guide. CMS transmittal 86 directs Part B carriers and durable medical equipment regional carriers to reject inbound electronic claims with invalid diagnosis codes, regardless of whether those codes point to a specific detail line. This document further directs carriers to reject claims with spaces, dashes, special characters, or 1-byte numerics in any zip code. Finally, carriers will reject claims with spaces, dashes, special characters, or parentheses in any telephone number. CMS transmittal 99 outlines some of the changes contractors and clearinghouses will have to make to process coordination-of-benefits transactions that comply with the HIPAA X12N 837 standards. If you send your clearinghouse a claim with missing alphanumeric data, the clearinghouse will replace each missing character with an "X." The clearinghouse will also replace any missing numeric data with a "9." Missing phone numbers will appear as "8009999999." Claims processors will not fill in gaps for data such as qualifiers and data elements, or other items whose values are defined in the implementation guide. You can download these transmittals at
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