1 / 33

ADL DATA SYSTEMS, INC Electronic Billing Rejections and Denials 999, 277ca, 270/271, 276/277

ADL DATA SYSTEMS, INC Electronic Billing Rejections and Denials 999, 277ca, 270/271, 276/277 Presented by Sara Montoro October 15, 2012. What we will cover Billing EDI Responses and Intermediary Inquiries : 999 Implementation Acknowledgment 270 Eligibility/ Benefit Inquiry

jethro
Download Presentation

ADL DATA SYSTEMS, INC Electronic Billing Rejections and Denials 999, 277ca, 270/271, 276/277

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. ADL DATA SYSTEMS, INC Electronic Billing Rejections and Denials 999, 277ca, 270/271, 276/277 Presented by Sara Montoro October 15, 2012

  2. What we will cover • Billing EDI Responses and Intermediary Inquiries : • 999 Implementation Acknowledgment • 270 Eligibility/ Benefit Inquiry • 270 Table Setup • 271 Eligibility/ Benefit Response • 276 Claim Status Inquiry • 277 Claim Status Response • 277ca Automatic Status Report • Compare Acknowledgement file 999 with Submitted file 837

  3. Acknowledgement files 997 Acknowledgment file for 4010 format 999 Acknowledgment file for 5010 format Program Acknowledgment or PT997 handles both formats

  4. Raw data File will display the IK5 and AK9 in the 999 A= Accepted, E = Accepted with errors, R= Rejected

  5. Segments indicate if your file was accepted or rejected Example of a 999 Accepted File

  6. Example of a 999 Rejected File

  7. Example of a 999 Accepted with errors File

  8. Download Acknowledgement/Response - File 999 Acknowledgment Report From State 999 User - Download file to USER DIR and run process

  9. Acknowledgement file – Accepted 999 File

  10. Acknowledgement file – Rejected 999 File EI: Bad Data Element Error NPI Level Table Setup incorrectly

  11. Acknowledgement file – Rejected 999 File File Rejected due to NPI Level Table Setup incorrectly

  12. 270 Eligibility Benefit Inquiry How to request Eligibility Benefit Report • 270 table setup: • HIPAA Exchange Parms Folder: Eligibility (270) • Pt270 Source Table • PT270 Receiver Table • Create a 270 request: • Open HIPAA Folder located under Resident Module • Click Eligibility Benefit Inquiry (270) • System Creates a file:PT270.DAT in the USERS DIRECTORY

  13. Example of an Eligibility Benfit Inquiry - File 270

  14. Download Acknowledgement/Response file – Eligibility Report 271 Acknowledgment Report From State - 271 User - Download file to USER DIR and run process

  15. How to identify a 271 File

  16. Example of a 271 file - Report

  17. Request Billing Status 276 How to request Claim Status Report • 276 table setup: • HIPAA Exchange Parms Folder: Bill Status (276) • Pt276 Payers Table • PT276 Receivers Table • Create a 276 request: • Open HIPAA Folder located under Resident Module • Click Claim Status Inq (276) • System Creates a file:PT276.DAT in the USERS DIRECTORY

  18. Example of a Claim Status Request -File 276

  19. Download Acknowledgement/ Response file – 277 Acknowledgment Report From State - 277 User - Download file to USER DIR and run process

  20. Acknowledgement file 277 - How to identify a 277 file from Medicaid

  21. Download Acknowledgement file – Automatic Status Report 277ca Acknowledgment Report From State - 277ca User - Download file to USER DIR and run process

  22. Acknowledgement file 277ca - How to identify a 277ca file from Medicare

  23. Example of a 277 file - Report

  24. Example of a 277 Insurance Report

  25. Batch Naming Convention Change – For Medicaid Files – NY Clients New York State Medicaid EMedNY News and Issues_11-09-2011_v4: Response Files – Batch Naming Convention Change: UPDATE- A change in the naming convention was necessary to accommodate large numbers of outbound response files. Extra digits have been added to make this node a 6 digit field. The first two digits denote the file type. The next 4 digits represent the Sequence number of the file. 010001 – TA1 (TA1 is only sent when requested (ISA14=1) and/or when Interchange-level errors exist) 020001 – F-File (which will only be sent if the input file was structurally wrong and had to be rejected) 030001 – 999 050001 – 277CA 060001 – U277 070001 – 278 100001 – 271 For example – R110725123456.030023 depicts a 999 Response with a sequence number of 0023

  26. Batch Naming Convention Change – For Medicaid Files – NY Clients - Example First file R120717134540.050001.X12 is a 277 file Second File R120717134540.030001.X12 is the 999 Acknowledgment file

  27. Acknowledgement file 999 against submitted file 837 Example: UBTAB setup error 999 against submitted 837 file User - Download file to USER DIR and run process

  28. Acknowledgement file 999 against submitted file 837: Example 999.NS 837.NS Output:

  29. Data reported 866 . ARD not belong here. UBTAB Setup error Occurrence code 50 should be an F

  30. Acknowledgement file 276.999 against submitted file pt276.dat 276.999 against submitted pt276.dat file User - Download file to USER DIR and run process Example: Invalid data sent

  31. Acknowledgement file 276.999 against submitted file pt276.dat Example 276.999 Pt276.dat Output:

  32. Requesting Medicaid claim status for a Non - Medicaid Resident

  33. ADL DATA SYSTEMS, INC Electronic Billing Rejections and Denials999, 277, 270/271, 276 Presented by Sara Montoro October 15, 2012

More Related