Health Information Management

Why your claims are rejected, part 2

HIPAA Weekly Advisor, March 8, 2004

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Why your claims are rejected, part 2

 

A new Medicare program transmittal contains more reasons why claims processors might send your claim back (see HWA, 3/1/04). 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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