Medicare Part B Newsline March 2012 - Cahaba GBA

Alabama Medicare Part BTop Five Reasons for EDI Claim Rejections for January 2012Audit trails show which of your claims were accepted by the Cahaba GBA Part A processing system, alongwith claims that were rejected and the reason for the rejection. Referring to this report will allow you tocorrect and resubmit claims quickly, resulting in a dramatically reduced turnaround time. You will alsobecome aware of any major problems with your claims so they can be corrected before they create aninterruption in your cash flow. Audit trail reports are available the next business day for files that arereceived before 3:30 p.m. Central Time. If you are not receiving your audit trails contact your softwarevendor, billing service, or clearing house.See Audit Trail Explanations for a more complete list of edits, along with descriptions of loops that mightbe referenced in an edit.In order to increase the number of claims that successfully pass through audit trails and into processingCahaba GBA Part A EDI Services is providing you with the top five reasons for claim rejections. For themonth of January 2012, these are:Claim DescriptionRejection213 INVALID PAYER ID OR QUAL IN 2010BBA payer ID or qualifier was submitted in the 2010BB loop(Payer Name) that is not valid for Medicare Part B.434 PROC CODE REQUIRES REFERRING NPIProcedure code billed was for a diagnostic procedure such as anx-ray or lab work which requires the NPI of the orderingphysician, or a consultation, which requires the NPI of thereferring physician, and this was not submitted on the claim.421 DIAG CODE (XXXXX) INVALID FOR DATE SVCThe date of service was outside of the effective date range ofthe diagnosis code used. The invalid diagnosis code will appearinside the parenthesis.888 INSTREAM REJECTIONThere was a problem involving HIPAA required loops,segments, or values. The specific loop will be identified, forexample, 'ELEMENT N401 (D.E. 19) AT COL. 4 ISMISSING, THOUGH MARKED "MUST BE USED"(LOOP:2010BA POS:3140)'. The number after 'POS' indicatesthe position in the file where the error occurred377 PAID & ADJUSTMENT AMOUNTS DO NOT EQUALCLAIM CHARGThe claim was submitted as Medicare Secondary Payer but theprimary paid amount plus the primary adjustment amounts donot equal the total claim charge.Number ofClaims701689595447439Medicare B Newsline March 2012 10