Incorrect EDI Billing Procedures

The most common electronic errors

Health Partners Plans has identified the most common electronic errors that occur. Find below the 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.

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. Please review all electronic claims data before transmission to verify all pertinent information is accurate.

Leave a Reply

Your email address will not be published.

Post Navigation