Claims Billing Errors

Top Ten Claims Billing Errors For Highmark Healthcare Providers

Top Ten Claims Billing Errors  have been identified to help providers send and process claims correctly.

Incorrect provider number listed – Generally, the billing provider number is the assignment account, while the performing provider number is the individual practitioner. If practices are unsure which National Provider Identifier (NPI) to use (assignment account/group or individual practitioner/group member), they should contact Highmark Provider Services.

Performing provider name and number – The performing practitioner name and practitioner identification number should be reported on the claim when it is different than the billing provider identification number.

Invalid place of service codes submitted and/or the facility name and number is not listed – Ensure the correct place of service code is being used. When the place of service is different than the billing provider’s address(e.g., Hospital or SNF), ensure a service facility location and identification number are reported.

NOC (not otherwise classified) codes listed without descriptions – Descriptions of the service provided must be reported on the claim for NOC codes.

Applicable coordination of benefits/other insurance information and/or documentation is not accompanying the claim – Please make an effort to report electronically or attach coordination of benefits/other insurance information.

Member identification numbers are incomplete – List the complete member identification number including any alpha prefix.

Zero charges or adjustments are being reported – Unless the claim is an encounter, zero dollars or blank charges are not acceptable.

Claims are range dated but the number of services do not clearly correspond with the date range (e.g., indication that services were performed 01-01-16 through 01-10-16 but list only five services) – When services span over a period of days, the number of services should correspond on a one-on-one basis if you are range dating (indicating that services span from one date through another date). If they do not correspond on a one-on one basis, you should itemize the services.

Submit HCPCS codes that are not valid for the time the service was rendered (e.g., billing for a service performed in 2015 with a code that was not in place until 2016 or vice versa) – Report correct procedure codes that are valid for the date of service.

Invalid diagnosis code – Report diagnosis codes that are the highest degree of specificity and valid for the date of service.

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