ACPM Claim Validation: Errors and How to Fix Them

Transcription

1 ACPM Claim Validation: Errors and How to Fix Them All claim files, both electronic and paper, are accessed from the Manage Claim Batches pane of Billing. This is where claim batches are handled. How to run claim validation 1. In the Billing area of ACPM, in the Manage Claim Batches pane, select For electronic claim batches: Electronic - Not transmitted in the By field and click Search OR For paper claim batches: Paper Unprinted in the By field and click Search. Note: Paper claims are batched by billing provider and by the paper claim strategy that was selected in the Plan table (e.g.,bcbs Paper, Commercial Paper, CMS 1500). Other state or plan specific paper claim strategies may also be listed. 2. Two links will display for each batch that hasn't yet been validated: Delete and Validate. Claim batches must be validated successfully before the link to transmit will be available. Delete: This deletes the entire batch. The claim will not show a submit status on the patient claim history and will be included in a future batch. Validate: This action checks for errors that will impact that claim. If errors are found in the batch, it will have to be deleted; the errors will have to be fixed and it will have to be batched again. 3. Click on the Validate link. 4. Wait until a Claim Validation Report appears on the screen. Page 1 of 6

2 The information appears in sections by plans. The total number of claims and total charges for each plan are displayed below that plan s section of charges. A grand total of all claims and total charges will appear at the end of the report. Rejection reasons appear in italicized print below the patient information. 5. If errors are found in the batch, print the report and click Delete to delete the batch. The errors will have to be fixed and it will have to be batched again. The following list of errors and how to fix them should help you to work through the validation report. the table below outlines some common validation errors and how to fix them. Note: If there are no errors in the claim validation report (or you've fixed all errors and recreated the batch), you can move on to transmitting the electronic claims to the clearinghouse via Claim Remedi. See the Amazing Charts Practice Management User Guide at this website for more information. Page 2 of 6

3 Missing plan street address Missing city name Missing state code Missing postal code Missing other plan street address Missing other city name Missing other state code Missing other postal code. The primary insurance plan address is missing from plan table. Go into Administration and Select the Plan Table Management link. Search for the plan and add the insurance address for plan. You must include the 4-digit zip code extender. The secondary or additional insurance plan address is missing from plan table. Go into Administration and Select the Plan Table Management link. Search for the plan and add the insurance address for plan. You must include the 4-digit zip code extender. Missing subscriber street address Missing subscriber city name Missing subscriber state code Missing subscriber postal code The subscriber address for the insurance is missing or incomplete. Open the patient's chart who is identified in the Claim Validation report. Click on the patient's insurance plan in the Account pane. In the Manage Insurances screen, Select Insurance. nsurance set up and add address. Missing patient street address Missing patient city name Missing patient state name Missing patient postal code The patient's address is missing or incomplete. Go into patients chart and in the Patient Demographics pane, select More... Add or edit the address Page 3 of 6

4 Missing MSP insurance type The patient has Medicare as a secondary insurance and the policy type field under the insurance set up is set at Medicare Part B. In ACPM, go into patients chart and under the Account pane, select the insurance plan. Change the Policy Type for the Medicare plan to Medicare Secondary Working Aged Beneficiary Or Spouse With Employer Group Plan. Missing release of authorization code One if not all three authorization fields on the patient insurance set up is missing and required. Release Info Authorization must be set to Y Assignment Authorization must be set to Y Patient Sig Source must be set to B Invalid service location postal code This error is only common for home visit charges. Any service location that is set to Home for Place of Service, does not require an address in the Service Location table. The patient will need the last 4 digits of their zip code added in the demographics screen Missing submitter contact method This error occurs because either the Billing Office or Billing Agent tables do not have the contact method and/or contact phone number filled in. Add the contact method/phone number in to both those tables and save changes. Missing accident type Missing accident date This occurs when you use the Case Type of "Accident" and did not fill in the additional fields in the Visit. Return to the visit via the Visit History pane (click View/Edit) in the patient's chart, and fill in the Accident-related fields. Page 4 of 6

5 Invalid referring provider name This occurs when the referring provider is not filled in at the visit level, or when the clinician you've selected in the visit is one of your Practice Providers, but is marked in the Provider Table as a Referring Provider. To fix this,you should check two things: 1. Return to the visit via the Visit History pane (click View/Edit) in the patient's chart and verify the referring provider selecte dis the correct provider for this instance. If they are Verify that in the Provider Table, the Practice field is empty for the clinician's record, and that the Name field was not checked off as a business or entity. Missing adjudication for charge This occurs because a secondary claim has been created and when validating it, the system is noting the primary claim has not yet been committed but the EOB for the primary payment has not yet entered the system. You will want to verify you've received payment for the primary insurance in the Manage EOB pane of the Bookkeeping section. You will need to enter the EOB and commit the payment into the system before you will be allowed to create the secondary claim. Incomplete adjudication for charge This occurs because a secondary claim has been created and when validating it, the system is noting the primary claim has not yet been committed but the EOB is available. You will want to locate the visit in question in the Manage EOB pane section in the Bookkeeping area and commit the primary EOB before continuing with the secondary claim. Page 5 of 6

6 Missing or invalid charge amount for This occurs because there is not an amount or there is an invalid amount associated with this in the Usual Charge Table or the charge entered manually in the visit is somehow invalid. To deal with this, you can do one of the following: 1. Return to the visit via the Visit History pane (click View/Edit) in the patient's chart and verify the charge amount for the procedure has been entered and is $0 or above.. 2. Open the Usual Charge Table and review the charge for the procedure, ensuring it is entered, and that it is $0 or above. Missing units or minutes for procedure code Missing diagnosis code pointer(s) for Missing diagnosis pointer for charge Invalid diagnosis code pointer {1} for Invalid diagnosis code pointer {2} for This occurs because the procedure is not associated with the correct unit. Return to the visit via the Visit History pane (click View/Edit) in the patient's chart, and add the correct unit for the procedure(s). This occurs because the procedure is not associated with a diagnosis or the correct diagnosis. Return to the visit via the Visit History pane (click View/Edit) in the patient's chart, and add/edit diagnosis pointers in the Diagnosis field. Note: There can be no more than four diagnosis pointers for each CPT code. Invalid diagnosis code pointer {3} for Invalid diagnosis code pointer {4} for Page 6 of 6