Claim Filing Indicator Code Values

Claim Filing Indicator Code . At A Glance. Name: Claim Filing Indicator Code

: Type: Data Element: Definition: Code identifying type of claim or expected adjudication process. Version: ... 1032: Permissible Values: Code / Value Meaning Meaning Definition Text 09 Self-pay Not Provided: 11 Other Non-Federal Programs Not Provided: 12

What this means: Claims may reject when the secondary insurance does not con

tain a valid payer ID, or if the Claim Filing Indicator is MB, MA, OF or 16 when it should be CI or another common code. Provider action: Ensure that valid Payer Id’s are coming over on the claim, and Ensure that an accurate Claim Filing Indicator as MB, MA, OF, and 16

If all of the lines on a claim transaction are denied, then the CLAIM-DENIED

-INDICATOR should be set to “0”, rather than setting each line’s CLAIM-LINE-STATUS to one of the denied code values (“542”, “585”, or “654”).

Claim Filing Indicator Code The Claim Filing Indicator Code identifies the t

ype of claim being filed. BCBSNC requires that the first instance of this code (2000B, SBR09) within the 2000B looping structure be either a value of BL (Blue Cross/Blue Shield) or ZZ (Mutually Defined – for subscribers covered under the State Employee Health Plan).

Claim Filing Indicator (Loop: 2320, SBR09) From the drop down menu, select t

he code identifying the type of insurance. Once the claim filing indicator is selected, additional fields will display for reporting Medicare payments. Payer Responsibility (Loop: 2320, SBR01)

HIPPS Code: CDXE1. Default Billing. There may be instances in which provider

s may bill the "default" rate on the SNF claim (when an MDS assessment is late). The default code under PDPM is ZZZZZ, instead of the default RUG-IV of AAA00. Resource. CMS SNF PPS Patient Driven Payment Model

The tables below indicate the additional data items that are required, depen

ding on the value in the Claim Filing Indicator Code and whether the claim is Inpatient or Outpatient. Ambulatory Surgery and Emergency Department Only: Claim of Filing Indicator Code: Payer ID: Provider ID: 09, WC, OF, CH, VA--11, 14, 15, MA, MB, MC-

For any submission after August 2, 2011, you will need a corresponding Payer

ID when submitting a "Claim Filing Indicator" when you have a value of MA (Medicare Part A), MB (Medicare Part B) and MC (Medicaid). Specifically, if your Claim Filing Indicator value is 12, 16, BL, CI, HM, MA, MB, or MC, then you will need to report the appropriate ...

Service Location: Entity's Postal/Zip Code. The claim has been rejected as a

n invalid service location zip code was sent on the claim. Please verify that the 9-digit zip code submitted on the claim is valid. Please note that some payers will not accept "0000" as the last four digits of the zip code.

Entity code errors on claim denials are unfortunately not among the easier m

ysteries to solve. Entities in Medical Billing Generally, the definition of an entity is a person or thing with an independent existence—so an individual, a corporation, or a small business would be an entity.

How to fix the claim filing indicator? Edited January 15, 2021 18:53 . If yo

u have a patient who has multiple insurances, one of those payers could deny your claim asking for the claim filing indicator. This indicator will identify the payer as the primary or secondary.

Insurance Type Code (for MSP claims only) Indicator’s must equal one of th

e following values: 12,13,14,15,16,41,42,43 or 47 if 2000B SBR01 = “T” or “S” 2000B. or. 2320. SBR09. Claim filing indicator code. 2000B must be MB. 2320 must be anything other than MB. 2300. CLM01. Claim submitter’s identifier. CLM02. Total Claim Charge ...

Comment : Code identifying the insurance carrier's level of responsibility f

or payment of a claim. If claim is being sent to Medicare Part B the code would be "P" to identify primary information. Usage : Required Element : SBR02 Value : 01 = Spouse 04 = Grandfather or Grandmother 05 = Grandson or Granddaughter 07 = Nephew or Niece 10 = Foster Child

Other Insured Claim Filing Indicator Code must be valid. 2320.SBR*09. Reject

ion Details. This rejection indicates the claim was submitted with an Insurance Program code of “09 -Self-Pay.” Certain payers will not accept claims without the appropriate insurance program code tied to the insurance company being billed. Resolution

After keying all the Claim Page 01 information, press the key to access Cla

im Page 02.. Note: If the / key is pressed while entering data from the claim (before the claim has been submitted by pressing /), all the information you just keyed will be lost. Use Claim Page 02 to report line item details. To insert a revenue code line, key in the claim line details and ...

The original claim is displayed. Scroll down the claim window to the Adjustm

ents for Service Line: 1 group. In the Adjustment 1 row, select a value from the Adjustment Group Code drop-down box. Select a value from the Reason Code drop-down box.

005010X222A1 Health Care Claim: Professional (837). 3.

Comment : Code identifying the insurance carrier's level of responsibility f

or payment of a claim. (To identify whether Medicare is primary, secondary or tertiary) For Medicare Secondary Payer (MSP) claims being sent to Medicare Part B the code would be "S". Usage: Situational Element : SBR02 Value : 18

2300 DTP 01 through 03 (Qualifier 439, D8) and 2300 CLM 11-1 through 11-3 wi

th value AA or OA. Worker's Compensation. 2320 SBR05 = Insurance type code. 15 - Worker's Compensation. 2320 SBR09 = Claim filing indicator. WC - Workers’ Compensation.

The first 'Other Insurance must be Medicare Part B, using Carrier Code 100 a

nd Claim Filing Indicator MB. Click on 'Add' and enter the second (2) other insurance segment. Use on of the applicable 500 series Medicare HMO Carrier Codes to denote the recipient's Medicare HMO with Claim Filing Code 16 (Health Maintenance Organization – HMO).

Code / Value Meaning Meaning Definition Text ... signed and dated by the phy

sician, is on file at the supplier's office. The supplier's guarantee that a copy of the paper certification, signed and dated by the physician, is on file at the supplier's office. 12 Indicator that this certification is for a DME item replacing a previously purchased ...

Federal Register January 16, 2009. This document …. SBR09. Claim Filing In

dicator Code. Institutional Claims Submission with MassHealth – Mass.Gov. Sep 25, 2014 … 16. Select the appropriate value in the Provider Accepts Assignment drop-down. 17. Select the Claim Filing Indicator from the drop-down. 18. Standard Companion Guide – eohhs ...

• 2320 SBR09 (primary payer claim filing indicator) cannot contain ‘MB�

�, Medicare Part B. • The equations for the balancing routines are as follows: • Claim payer paid amount [2320 AMT02 (AMT01=D)] = line level paid amounts [ (all) 2430 SVD02] – claim level adjustment [2320 CAS monetary amounts (CAS03, 06, 09, 12, 15 and 18)].

Other Payer Claim Filing Indicator Code is Invalid. Cannot = Medicare. Rejec

tion Details. This rejection indicates that the Insurance Program Type for both insurances billed on the claim was “Medicare.” When Medicare is listed as one of the payers on a claim, the other payer(s) listed cannot also have an Insurance Program of "MB- Medicare ...

Diagnosis Code Not Billable; Referring prov first and last name must be in s

eparate fields and both are required; Element CAS02 (Claim Adjustment Reason Code) is missing. This Elements standard option is Mandatory. Segment CAS is defined in the guideline at position 5450; A3 143 P406 BILLING NPI REQUIRES RENDERING NPI