Medicare Part B Newsline March 2012 - Cahaba GBA

Mississippi 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 DescriptionRejection888 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 IS MISSING,THOUGH MARKED "MUST BE USED" (LOOP:2010BAPOS:3140)'. The number after 'POS' indicates the position in thefile where the error occurred. If you need help locating specificpositions in your 4010A1 file here is an article explaining oneway you can do this:http://www.cahabagba.com/part_b/edi/hipaa_identifying_your_errors.htm.307 DIAG CODE (XXXXX) INVALID OR INACTIVEThe diagnosis code indicated is invalid, or was inactive on thedate of service billed.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 claim421 DIAG CODE (XXXXX) INVALID FOR DATE SVCThe date of service was outside of the effective date range of thediagnosis code used. The invalid diagnosis code will appearinside the parenthesis.302 INVALID BILLING (NO CHARGES BILLED)Claim must contain at least one item with an associated billedamount.Number ofClaims3,0571,564609539226Medicare B Newsline March 2012 12