Keep your eyes open for these errors
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Kepa Zubeldia, chief executive of Claredi, a
transactions testing and certification business, has pulled together a list of
the top 12 most frequent errors his company finds during claims testing. The
errors are listed in descending order of frequency. Zubeldia is preparing a
similar list of vendor errors. "If we can get these common errors corrected,
the compliance rate will jump from zero percent to 99 percent," said Zubeldia.
The list:
- Missing or incomplete service facility name, address and ID (for
services rendered outside of the office or home) and/or invalid service
facility ZIP code or state abbreviation
- Missing Medicare assignment indicator and/or benefits assignment
indicator
- Invalid provider (rendering provider, referring provider,
etc.)
- Missing referring provider ID or complete name of referring
provider
- Missing or invalid subscriber's birth date
- Missing insurance type code for secondary coverage (The secondary
coverage information, such as the spouse's payer, is important in order to file
not only secondary claims but also primary claims.)
- Missing payer name and/or payer ID (This information is required
for both primary and secondary payers in all claims.)
- Missing or invalid admission date for inpatient services
- Missing or incomplete ordering provider name, address and
identifier
- Missing attachment transmission code on claims with attachments
Incomplete "other payer" information (This is required in all secondary claims
and in all primary claims that will involve a secondary payer. This is one of
the most disruptive missing data clusters. It does not appear higher on the
list because not all claims involve a secondary payer.)
- Invalid procedure code (Watch out for "made up" codes.)
This list is provided by Claredi to assist the industry
in its HIPAA compliance efforts. This generic list reflects common provider
errors. It does not reflect any one provider, vendor or clearinghouse. Your
particular experience may vary. Claredi makes no representation or warranty of
any kind. An error list like this is only a general guidance and should not be
used in lieu of testing your own transactions. For more information on HIPAA
transactions testing, visit http://www.claredi.com.
(©) 2003 Claredi. All rights reserved. Reprinted with
permission.
FP Report is published by the
AAFP News Department.
Copyright © 2003 by
American Academy of Family Physicians.
