This is the first in a series of articles that cover in detail the formats of each record that is sent electronically when doing medical billing. It should be noted that the following stats are for NSF 3.01 format. We'll be covering other formats in future articles. We're going to start with the AA0 record, which is the first record that is sent electronically with any claim.
The AA0 record is called the submitter record. In other words, this record provides information to tell the insurance carrier who is actually submitting this claim. Many times the person submitting the claim is not the provider of services, if they have an outside agency submitting for them.
Each field in this record is designated with field number, position, field name and data entry screen description.
Field one is the field description in positions 1-3. This tells the receiver what record is coming so they know what to look out for as far as data. Field two, which is in positions 4-19 is the submitter ID. This tells the receiver the ID of the person submitting the claim. Field three is not used so we'll skip that. Field four in positions 29-34 is the submission type. This tells the receiver just what type of claim is being submitted such as medical, dental, etc. Field five is the submission number, filling positions 35-40. It is important that this number is updated by 1 with each submission or your claim will be rejected.
We now move into the submitter info fields as far as name, address, city, state and zip. These are in fields 6-12. Each of these fields are required and must be filled in. The only optional field is the address line 2 field, which is field number 8 and in positions 104-133. Not everybody has data for this field, such as an additional PO Box or route number.
Field 14 is the submitter phone number and this must also be filled in. This is in case the submitter has to be contacted to discuss a problem. Insurance carriers don't like to have to send mail to get through to you if there is a problem with your claim. They much prefer phone calls.
Fields 15 and 16 are the creation date and time of the claim and are to be automatically filled in by the software. If the date is not filled in correctly, the claim will be denied. Trust me on this.
Fields 17 and 18 are the receiver ID and type. You would think that the person receiving this claim knows who they are, but this is to make sure that the claim itself was actually sent to the right place. If you meant to send the claim to Michigan Blue Cross and instead it went to New York Medicaid, well, you're in big trouble.
In the second part of our AA0 record, we're going to finish with fields 19 through 33. This is where things get a little complicated, as some of the fields need some detailed explanation as they are not cut and dried.
Michael Russell Your Independent guide to Medical Billing |
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