EDI Claimings Filing Tips

  1. Use current coding manuals and appropriate claims filing guidelines when filing claims. This would apply to the SCHA Manual, ICD-10 codebooks, current CPT codebook, etc. 
  2. If you change your provider number and receive electronic remittance advice files (ERAs), make sure you have requested ERAs under the new provider number. 
  3. Please make sure you have the correct provider number for the correct payer.  
  4. If you add a new physician to your practice, please make sure that his or her provider information reflects that change. If this information is not current, claims may error in transmission unnecessarily. 
  5. If there is a change in your provider number, please verify that your software has the correct provider number.  
  6. Please verify that you are using the correct payer information (carrier code) when filing claims. Claims filed to the wrong payer may reject or not process correctly. Your clearinghouse or vendor can assist with this. 
  7. Please use the entire member ID, as indicated on the insurance card, when filing claims. Use the prefix (if applicable) on member IDs every time you file a claim. Claims can receive unusual or inappropriate errors if the prefix is not on the claim. 
  8. If a transmission error is received for any date on a claim, make sure all dates entered on the claim make sense. For example, make sure there was not a keying error on a date, such as 05/34/2020. 
  9. Check each of your transmission reports every time you transmit to verify what claims were accepted for processing and which claims were edited back. If a claim errors in transmission, please correct and retransmit that claim. Claims that error in transmission will not be processed. 
  10. Institutional providers – Please make sure you keep us updated on your room rates. If this information is not current, claims may error in transmission unnecessarily. 

 If you need assistance with a transmission error, please call the Technology Support Center at 800-868-2505 as quickly as possible.
  
Note: This list is intended as general information to help you in filing electronic claims. You should follow all current coding practices, documentation requirements and guidelines for each and every claim you submit for processing. 
 

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