X12 837 QUICKLINK PROFESSIONAL FRONT-END VALIDATION ...

Level 5 - EMPIRE BUSINESS EDITSFAIL: If a provider number FAILS with a Provider Authorization edit:All claims for this provider (HL03=20) are rejected. Claims for every subscriber and every dependentare rejected.The remaining Level 5 – Edits are not performed.The EMC Receipt Report will list all errors, including all Level 4 - IG Edits received by any part of thetransaction.The Provider (HL03=20) needs to be corrected and resubmitted, including all claims and dependentclaims for this provider.PASS: If a provider number PASSES all Provider Authorization edits:Processing continues to Claim Level Business edits.Claim Level Business EditsThese edits are applied to specific segments within the Transaction Set (ST through SE).The purpose of these Claim Level Business Edits is to identify data errors that will prevent the claim fromprocessing.FAIL: If a claim FAILS with a Claim Level Business Edit:This specific claim is rejected.The EMC Receipt Report will list all errors.The submitter must correct all errors within this Claim and resubmit it.PASS: If a claim PASSES all Claim Level Business Edits:The claim is accepted by the front-end system and passed to the WebMD commercial claimsclearinghouse.Critical Transaction Error Codes & NarrativesWP00000001CLAIM OR ENCOUNTER IDENTIFIER MUST EQUAL ‘CH’The value in BHT06 must be present and equal to ‘CH’. Return entire ST/SE. Do not continueprocessing within that ST and do not report any other Business edits.837 Locations: BHT06Level of Return: Transaction (ST-SE)Provider Authorization Error Codes & NarrativesREF01WP001 MORE THAN 1 BLUE SHIELD BILLING PROV QUAL SUBMITTED PER BATCHOnly 1 Blue Shield Qualifier ‘1B’ can be submitted for each occurrence of 2010AA REF01(HL03=20). Reject the provider HL (batch level) if there are multiple occurrences of qualifier‘1B’.837 Locations: 2010AA REF01Level of Return: Provider Batch (Provider Hierarchical Level)EMC Front End Validation – Quicklink Commercial Professional 4010A143