ANSI error codes are impossible to figure out

[peter@crystalpm]

I've helped dozens of CrystalPM users track down problems with billing.  The biggest challenge that I've found so far has been in interpretting the error messages that are used in ANSI billing.  They won't just tell you that you are missing a member number on your patient's insurance anymore.  The messages tend to be a "Loop XXX is broken", which doesn't mean a whole lot to anyone.  I have some helpful information if you have ever been in that same boat as me trying to figure it out.   One of the best tools I've found for trying to decipher the codes given by clearing houses and insurance companies when a claim rejects is www.billexonline.com/blxol/ov837-Q1.htm

    It helps when the error is "Loop 2310D, NM1-09 is missing", you can figure out that there is a problem with the service facility.  And further that the problem is a missing ID number, which would be a group NPI for a service facility.

I hope this helps you!

[KizerOpt]

Any experience with Blue Cross corrected billing? They have information they want in 'Loop2300' and I have no clue how that is supposed to work! What I see is Loop 2300 contains the CPT and diag codes.
Karen

[peter@crystalpm]

For the benefit of other readers I'll explain what we did about this. Blue Cross had some cryptic messages as to what they wanted to see in the file. They wanted a Reference code of "F8" and a note that included "NTE*ADD", for example. The good news is that we can fix the claim rather easily once we know what they are asking for. The "F8" refers to the "Original Reference Number", so when you add this number, crystal will correctly code it with "F8". Similarly, they wanted the note to specifically reference the line that changed. Adding the note will automatically code it correctly as a note and add the "NTE*ADD" to the file.

It would have been much easier if they had just said "Send a CORRECTED claim referencing the original claim, and include a note as to what changed."