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Latest Updates
Jan
20
Regence Incorrect Payer Rejections
Posted on 20 January 2014 09:36 AM

Regence has began rejecting claims with the following rejection message:

Acknowledgement/Returned as unprocessable claim | Claim submitted to incorrect payer.

This is a valid rejection.  Below is the information we have received from Regence in regards to the error:

HMA and RGA claims submitted incorrectly will be returned (11/12/13)

Currently, Healthcare Management Administrators (HMA) and Regence Group Administrators (RGA) claims that are submitted electronically to Regence in error are forwarded to HMA or RGA for proper handling.

Effective in January 2014, Regence will no longer forward these claims. HMA and RGA claims that are submitted incorrectly to Regence, on or after this date, will be returned with instructions to resubmit to the correct payer. HMA and RGA claims should be submitted with Payer Identification Code ID: HMA01.

UPDATE: This payer has been added to our system on 1/22/14. Claims can now be sent to HMA01.


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Dec
23
Erroneous Rejection
Posted on 23 December 2013 09:28 AM

Claims with the following rejections were failed in error:

ACCEPTED CLAIM HAS BEEN FORWARDED TO PAYER FOR CONTINUED PROCESSING (00247)      
ACCEPTED CLAIM HAS BEEN FORWARDED TO PAYER FOR CONTINUED PROCESSING (00247)      
REJECTED BILLING PROVIDER ADDRESS, CITY NAME, STATE/PROVINCE CODE, AND POSTAL ZONE/ZIP CODE- REQUIRED; ALL COMPONENTS OF THE BILLING PROVIDER ADDRESS MUST BE ENTERED WHEN ONE OR MORE OF THE COMPONENTS ARE ENTERED      
REJECTED SERVICE DATE- INVALID; MUST BE IN A VALID DATE FORMAT      
REJECTED BILLING PROVIDER CITY NAME- REQUIRED; MUST BE ENTERED      
REJECTED SERVICE LINE PROCEDURE CODE, LINE ITEM CHARGE AMOUNT AND SERVICE DATE- REQUIRED; MUST BE ENTERED      
REJECTED SERVICE DATE- INVALID; MUST BE IN A VALID DATE FORMAT      
REJECTED SERVICE DATE- INVALID; MUST BE IN A VALID DATE FORMAT      
REJECTED BILLING PROVIDER FIRST, LAST OR ORGANIZATION NAME- REQUIRED; MUST BE ENTERED      
REJECTED SUBSCRIBER PRIMARY IDENTIFIER- REQUIRED; MUST BE ENTERED FOR PAYER      
REJECTED BILLING PROVIDER TAX ID QUALIFIER- REQUIRED; MUST BE ENTERED      
REJECTED BILLING PROVIDER ADDRESS, CITY NAME, STATE/PROVINCE CODE, AND POSTAL ZONE/ZIP CODE- REQUIRED; ALL COMPONENTS OF THE BILLING PROVIDER ADDRESS MUST BE ENTERED WHEN ONE OR MORE OF THE COMPONENTS ARE ENTERED      
REJECTED BILLING PROVIDER FIRST, LAST OR ORGANIZATION NAME- REQUIRED; MUST BE ENTERED      
REJECTED PATIENT FIRST NAME- REQUIRED; MUST BE ENTERED      
REJECTED BILLING PROVIDER ADDRESS 1- REQUIRED; MUST BE ENTERED      
REJECTED CLAIM REJECTED BY TRADING PARTNER    

These claims can be removed from claim fix, they do not need to be correct or resent.  The payers have reprocessed the claims and new responses should be available either today (12/23/13) or tomorrow (12/24/13). 


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Dec
5
Select Payers
Posted on 05 December 2013 04:22 PM

A few payers returned the following error on claims batched on 12/3/13 (sent to Office Ally on 12/2/13):

Claim Status:
CLAIM FAILED AT PAYER (144)
REJECTED CLAIM REJECTED BY ENS UNKNOWN 12/03/2013  
REJECTED STATUS CODE: A3:21 UNKNOWN 12/03/2013  
REJECTED Acknowledgement/Returned as unprocessable claim - The claim/encounter has been rejected and not entered into the adjudication system UNKNOWN 12/03/2013  
REJECTED Missing or invalid information. Note: At least one other status code is required to identify the missing or invalid information. UNKNOWN 12/03/2013

These were all rejected in error.  New responses will be posted to the claims.  These can be removed from Claimfix.

Known payers with this issue:

Physicians Health Choice - PHCS1

Wellmed Medical - WELM2

 


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Dec
5
Homebound Indicator (Loop 2300, CRC*75)
Posted on 05 December 2013 03:27 PM

Office Ally has made an update to send out the Homebound Indicator (Loop 2300, CRC*75) when the word 'HOMEBOUND' is in box 19.

Medicare recently began requiring this segment on some claims.  They have not been able to give us all of the CPT codes that do require it, but we have seen many denials with these codes: P9603 and P9604.  Any claims that have denied on an EOB/ERA due to not having the homebound indicator can be resent in the above format.


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Nov
27

Claims sent to the following payers rejected in error on the payer's end from the dates of 10/15/13 - 11/26/13 for billing providers in the states of Kansas, Florida, and California.  All affected claims will be failed back to Claim Fix with the following message:

Error in Processing - Please Resubmit (SDS)

These claims can be simply resubmitted, no changes need to be made on the claims.

Absolute Total Care
Bridgeway Health Solutions
Buckeye Community Health
California Health and Wellness
CeltiCare Health Plan
Coordinated Care
Granite State
Home State
IllniCare Health Plan
Kentucky Spirit Health
Louisiana Healthcare Connections
Magnolia Health Plan
Managed Health Services
Managed Health Services
NovaSys Health
Peach State Health Plan
Sunflower State
Sunshine State Health Plan
Superior HealthPlan 


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