In continuing with our review of the CA0 record for medical billing claims through electronic means, we're going to cover fields 20 through 30. Some of these get a little tricky so we'll cover those in a little more detail, starting off with the first one.
Field 20, position 173, may seem a little strange to those who aren't in the business. This is the patient death indicator field. Many people think why would you bill a claim for a patient who has died? Well, whether the patient lived or died, the provider of services still needs to be paid for the work done. So why the indicator? This is to let the carrier know that the patient has died and by date of death, the provider can't bill for any other services after that date. That's why the indicator.
Field 21, positions 174 - 181, is that patient's date of death. This is recorded by the carrier so they know the patient can no longer be billed for services. This is another way of cutting down on fraud.
Field 22, position 182, is the other insurance indicator. This tells the carrier that the patient has other insurance in addition to the carrier's insurance. This is important in cases where a carrier only pays a partial payment.
Field 23, position 183, is the claim editing indicator. This is a field that just about nobody uses so don't concern yourself with it. If it is needed, consult the manual.
Field 24, position 184 - 185, is the claim type indicator. This is a two character code that tells the carrier what type of claim this is, such as DME, dental, etc.
Field 25, position 186, is the legal representation indicator. This is one of those very complex fields but we'll try to simplify it here. In some cases, a patient has a guardian or somebody with a power of attorney. Basically, this means that there are legal issues involved with the care of the patient and therefore the submission of the claim. This has to be indicated here. These are usually very messy claims as far as who is paid, how much and when.
Field 26, positions 187 - 195, is the origin indicator. This indicates the care facility that the patient was admitted to and where care was given. There are a number of codes for this that can usually be found in the software's lookup table when doing medical billing.
Field 27, positions 196 - 212, is the payer claim control number. This is currently not supported by any carriers using NSF 3.01, so there is no point even trying to explain what this number is for.
Field 28, positions 213 - 227, is the provider number. This MUST match the provider number that is transmitted in the provider record or the claim will be denied.
Field 29, positions 228 - 233, is the claim ID number. Every claim has one of these and it must be transmitted. All references to this claim will be made through this number.
Field 30, positions 234 - 320, is filler national and must be left blank or the claim will be denied.
This concludes our review of CA0 record fields 20 through 30 for medical billing of claims through electronic means.
Michael Russell Your Independent guide to Medical Billing |
No comments:
Post a Comment