X12 837 QUICKLINK PROFESSIONAL FRONT-END VALIDATION ...

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Level 4 – IMPLEMENTATION GUIDE (IG) EDITSIG0103IG0104IG0106IG0107IG0110IG0111IG0114See Critical IG Edits sectionSee Critical IG Edits sectionSee Critical IG Edits sectionLOOP 2300 CR1 MISSING, REQUIRED FOR AMBULANCE SERVICE CLAIMAn ambulance service claim is defined as Loop 2400 SV101-2 procedure code = A0021 – A0999.LOOP 2000B CONTAINS 2300 CLM WITH SBR02 NOT PRESENTLOOP 2400 NTE MISSING, REQUIRED FOR NOC PROCEDURESA NOC (not otherwise classified) procedure is defined as Loop 2400 SV101-2 procedure code =99429, 99499, 01999, 15999, 17999, 19499, 20999, 21089, 21299, 21499, 21899, 22899, 22999,23929, 24999, 25999, 26989, 27299, 27599, 27899, 28899, 29799, 29909, 30999, 31299, 31599,31899, 32999, 33999, 36299, 37799, 38129, 38589, 38999, 39499, 39599, 40799, 40899, 41599,41899, 42299, 42699, 43289, 43499, 43659, 43999, 44209, 44799, 44899, 44979, 45999, 46999,47399, 47579, 47999 48999, 49329, 49659, 49999, 50549, 53899, 54699, 55559, 55899, 58578,58579, 58679, 58999, 59898, 59899, 60659, 60699, 64999, 66999, 67299, 67399, 67599, 67999,68399, 68899, 69399, 69799, 69949, 69979, 76499, 76999, 77299, 77399, 77499, 77799, 77499,77799, 78099, 78199, 78299, 78399, 78499, 78599, 78699, 78799, 78999, 79999, 80299, 81099,84999, 85999, 86586, 86849, 86999, 87999, 88099, 88199, 88299, 88399, 89399, 90399, 90749,90799, 90899, 90999, 91299, 92499, 92599, 93799, 94799, 92199, 95999, 96549, 96999, 97039,91739, 97799, 99199.LOOP 2300 CRC=07 MISSING, REQUIRED FOR AMBULANCE SERVICE CLAIMAn ambulance service claim is defined as Loop 2400 SV101-2 procedure code = A0021 – A0999.IG0115 DECIMAL DATA ELEMENT CAN NOT EXCEED 10 CHARACTERS (00000000.00)Data element 782 is limited to 10 characters including the reported or implied decimalsand places for cents (.00). This edit applies to every data element 782 defined in theimplementation guide.IG0116IG0117LOOP 2300 CRC03=NU REQUIRED FOR CRC02=NCLM11-1, -2, -3 = AA, AP OR OA, 2300 DTP01=439 REQUIREDIG0118 CR212 REQUIRED FOR SERVICE DATES PRIOR TO 1/01/2000IG0119IG0120LOOP 2400 SV501-2 MUST EQUAL SV101-2DEPENDENT HL 23 PRESENT WITH HL 22 HL04=0This is a subscriber level error. When element HL04 in Loop 2000B is equal to Hierarchical ChildCode "0" (no child/subordinate HL for this subscriber), and subordinate Loop 2000C (PatientHierarchical Level), with element HL03 equal to "23" (dependent) is present, IG edit IG0120 willreturn Loop 2000B (subscriber) and all dependent loops for the subscriber in error.EMC Front End Validation – Quicklink Commercial Professional 4010A139
LEVEL 4 - IMPLEMENTATION GUIDE (IG) EDITSIG0121 DEPENDENT HL 23 MISSING WITH HL 22 HL04 =1This is a subscriber level error. When element HL04 in Loop 2000B is equal to Hierarchical ChildCode"1" (a child/subordinate level HL is indicated for this subscriber), and subordinate Loop2000C (Patient Hierarchical Level), with element HL03 equal to "23" (dependent) is missing, IGedit IG0121 with return Loop 2000B (subscriber) and all dependent loops for the subscriber inerror.IG0122 LOOP 2300 DTP=439 PRESENT, CLM11-1,2, OR 3 MUST= AA,AP, OR OAThis is a claim level error. When a DTP segment with a Date/Time Qualifier equal to “439”(Accident) is present in Loop 2300 (Claim Information), then there must be an associated RelatedCauses Code in CLM11-1, CLM11-2 or CLM11-3 equal to AA, AP or OA or the claim will rejectwith IG edit IG0122.IG0123IG0124LOOP 2420G REF MISSING, REQUIRED WHEN LOOP 2420G NM1 PRESENTIf the value in Loop 2420G, NM101 equals “PR” (Payer), then Loop 2420G, REF01 must bepresent and equal to “9F” or “G1”.LOOP 2400 DTP01 = 472 MISSING, REQUIRED WHEN LX SEGMENT PRESENTWhen Loop 2400 LX segment is present, then Loop 2400, DTP01 equal to “472” (Service Date)must be present.Note: The following IG edits reference external code sources. Refer to Section C of the X12 837Version 4010A1 Professional (004010X098A1) Implementation Guide for availability of codesource.IGE0000001 COUNTRY CODE ENTERED IS INVALIDCode Source 5 – Countries, Currencies, and FundsCountries – ISO 3166IGE0000002 STATE OR PROVINCE CODE ENTERED IS INVALIDCode Source 22 – States and Outlying Areas of the U.S.IGE0000003 HCPCS MODIFIER ENTERED IS INVALIDCode Source 130- HCFA Common Procedural Coding SystemIGE0000004 HCPCS/CPT4 CODE ENTERED IS INVALIDCode Source 130 – HCFA Common Procedural Coding SystemIGE0000014 CLAIM FREQUENCY TYPE CODE ENTERED IS INVALIDCode Source 235 – Claim Frequency CodeIGE0000016 PLACE OF SERVICE CODE ENTERED IS INVALIDCode Source 237 – Place of Service from HCFA Claim FormIGE0000020 ICD-9-CM DIAGNOSIS CODE ENTERED IS INVALIDCode Source 131 – International Classification of Diseases Clinical Mod (ICD-9-CM)This IGE edit validates that the ICD-9-CM exists on the external code source, and that the ICD-9-CM effective and cancel dates (when applicable) from the external code source are valid for thedates submitted on the claim. To calculate a service line date range for the claim, this IGE editlooks at all of the service lines in Loop 2400 DTP03 when DTP01 = 472. It selects the earliestdate in Loop 2400 DTP03 and the latest date in Loop 2400 DTP03 to create a calculated serviceline date range. This calculated service line date range is compared to the ICD-9-CM externalcode source effective and cancel dates.When this IGE edit fails, the service date range printed on the Receipt Report is the calculatedservice line date range. It may not be an actual date range in Loop 2400 DTP03. All service linedates need to bereviewed.EMC Front End Validation Edits – Quicklink Commercial Professional 4010A140
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