837 Health Care Claim Challenge

After completing HIPAA EDI 210 Webinar consider the following claim we analyzed. Email your answer to info@ediacademy.com

Agile Billing Solutions was responsible for creating this claim on behalf of Dr. Watson’s office and The Best Lab Company. They were able to include the LAB CPT codes from service line number two LX*2.

BCBS Disney Issue: BCBS Disney informed Agile Billing Solutions that they can no longer bill on behalf of Doctor Watson and The Best Lab Company on the same Claim.

Solution: Using the RAW data below provide the solution for this challenge. Copy and paste the raw data below into a file and mock-up the data on how to solve this problem. Email the answer (raw data) to info@ediacademy.com

ST*837*3701*005010X222A1
BHT*0019*00*004545*20160124*135420*CH
NM1*41*2*AGILE BILLING SOLUTIONS*****46*47198 Loop 1000A Submitter Name
PER*IC*ANN GILLIS*TE*8185601000*EM*edisupport@agilebilling.com
NM1*40*2*BCBS DISNEY*****46*47198 Loop 1000B Receiver Name
HL*1**20*1 – Loop 2000A Info Source (really billing provider name)
PRV*BI*PXC*207Q00000X
NM1*85*1*WATSON*JOHN*H***XX*1134125736 2010AA Billing Provider Name
N3*221 Baker Street
N4*ANAHEIM*CA*928020900
REF*EI*123456789
HL*2*1*22*1 2000B Subscriber Hierarchal
SBR*P********16
NM1*IL*1*MOUSE*MICKEY****MI*60345914A 2010BA Subscriber Name
NM1*PR*2*BCBS DISNEY*****PI*8584537845 2010BB Payer Name
HL*3*2*23*0 2000C Patient Loop
PAT*01
NM1*QC*1*MOUSE*MINNIE Loop ID 2010CA
N3*1565 DISNEYLAND DRIVE
N4*ANAHEIM*CA*92802
DMG*D8*19281118*F
CLM*ABC7001*65***11:B:1*Y*A*Y*Y**AA:CA -> Loop 2300
HI*ABK:K522*ABF:A09*ABF:K591*ABF:R197
LX*1 -> Line items Loop 2400
SV1*HC:99213:52:52:96*50*UN*1***1
DTP*472*D8*20160124
REF*6R*1
LX*2
SV1*HC:87046*15*UN*1***1:2:3:4 -> Line items Loop 2400
DTP*472*D8*20160124
REF*6R*2
NM1*77*2*BEST LAB COMPANY*****XX*1124157821 -> Loop 2420C
N3*505 Main Street
N4*ANAHEIM*CA*92802
SE*35*3701