EDI BIlling Notes (Claims Submission)

EDI Billing Notes: Do’s And Dont’s For Health Partners Plans Vendor Billing Operations

EDI Billing guidelines given briefly in today’s post refer to general EDI billing rules set for Health Partners Plans partners. Health Partners Plans has identified the most common electronic errors that occur during EDI billing process and compiled a list of helpful hints that are given further.

Incorrect Billing Procedures

• DO NOT submit claims with the Member’s 10 digit access number or their Social Security number.
• DO NOT submit Kidz Partners (CHIP) claims with the member’s Social Security number only.
• DO NOT submit claims for dependent children under the Mother’s 9 digit Health Partners Plans ID number once the child has been assigned their own permanent member ID number.
• DO NOT submit claims without verifying that the member ID number indicated is correct.
• DO NOT submit claims with the incorrect sex indicator for the patient.
• DO NOT submit physician claims with the site location number, medical license number, Medicaid or UPIN or Tax ID number.
• DO NOT submit facility and ancillary claims with the Medicaid, UPIN, and tax ID number.
• DO NOT submit claims with NPI number in the Federal Tax Id number field on the CMS claim form.

Correct Billing Procedures

• All Health Partners Plans (Medicaid) claims must be submitted with the Member’s 9 digit Health Partners Plans ID number.
• All Kidz Partners (CHIP) claims must be submitted with the 10 digit member ID number that starts with a three (3).
• Claims for children should be billed with the child’s 9 digit Health Partners Plans member ID number.
• Verify that the member ID number submitted on the claim is the patient’s Health Partners Plans /Kidz Partners ID number.
• The sex indicator for the patient should be verified before claims are submitted.
• All physician claims must be submitted with the individual rendering provider’s 10 digit National Provider Identifier (NPI) number.
• All facility and ancillary claims must be submitted with the group or organizational 10 digit NPI number.
• For CMS- 1500 claims, individual physician’s number should be entered in the “RENDERING PROVIDER ID. #” field (box 24J), The billing provider’s NPI number should be entered in the “BILLING PROVIDER INFO &PH #” field (box 33A).

All providers are responsible for monitoring and updating any claim errors that appear on the daily R022 / RPT – 05/05A and R059/ RPT – 10 EDI claim rejection reports. Corrected claim data should be immediately retransmitted electronically to Health Partners.