What are the most common mistakes made when submitting data?
Any of the following can cause the submission to be rejected: a) Relationship code is wrong for ME012, DC011, MC011, PC011. HIPAA standards call for different code values for eligibility data and claims data. For example, Employee is coded as 18 in the eligibility data (ME012) but as 20 in the claims data (DC011, MC011 and PC011). b) Product code is wrong for ME003, DC003, MC003, PC003. HIPAA standards call for different code values for eligibility data and claims data. For example, indemnity insurance is coded as IN in the eligibility data (ME003) but as 15 in the claims data (DC003, MC003, PC003). c) Low Paid Amount to Charge Amount ratio in claims data. This generally occurs when the payer has failed to code the product as Medicare (DC003, MC003, PC003 = MA, MB) or failed to code the claim status as secondary (DC031, MC038, PC025 = 02). d) Claims unsupported by eligibility data. In general, more than 95 percent of the claims incurred for a given month should be supported by eligibil
