Who is responsible for claim edits?
A. THIN establishes edits based on HIPAA compliance requirements and payer claim processing requirements. This process allows you to correct and re-transmit rejected claims immediately, to avoid unnecessary delays. Software vendors may have edits in their software programs to ensure some level of completeness prior to transmission of claims to the clearinghouse/payer. It is very important for you to review your response files for warning and reject messages. If the message is a “Warning,” the claim has been forwarded to the payer; however you should attempt to correct the error prior to your next submission. If the message is a “Reject,” the claim WAS NOT forwarded to the payer; you should correct the error and resubmit that claim in your next transmission.
