Report: Invalid Billing Export Data
(Topic Last Updated On: 08/10/2015)
This report was designed to provide users with the ability to find and correct known invalid third party billing export data prior to the generation of claims and/or exporting 837P EDI files. Currently this report includes 4 of the most common reasons why 837P EDI files, or specific claims within them are rejected, because this data is mandatory in order for files to be valid and claims to be adjudicated: 1.) Missing Subscriber ID - This means one or more Billing Episodes for a patient do not have a Subscriber ID Code entered. 2.) Missing Patient Address - This means a patient's Patient Address has not been fully completed on the Patient Addresses window accessible from the Profile screen. Specifically Address Line 1 and/or City and/or State and/or Postal Code (Zip Code) data is missing for the patient. 3.) Missing Procedure Code: This means no Procedure Code has been entered for a Billable Service. 4.) Missing Diagnosis Code: This means that no ICD-9 or ICD-10 Diagnosis Code has been selected for a Billable Service. This report can be filtered by Billing Episode effective date ranges, Payer/Category, and Billable Service Type. All sections of this report are grouped by Payer/Rate Group, and totals are provided for each type of problem. Correcting these issues prior to claims generation and/or 837P EDI file export can save a facility time and expedite the adjudication of claims submitted to third party Payers.
Patient ID
This column appears in the 'Missing Subscriber ID' and 'Missing Patient Address' sections of this report, and displays the Patient ID of each patient missing Subscriber ID Code or Patient Address information.
Patient Name
This column appears in the 'Missing Subscriber ID' and 'Missing Patient Address' sections of this report, and displays the first and last name, in <Last Name, First Name> format, of each patient missing Subscriber ID Code or Patient Address information.
Effective Date
This column appears in the 'Missing Subscriber ID' section of this report, and displays the Effective Date of the Billing Episode missing Subscriber ID Code data. This data can be corrected on the Billing Episodes screen for a retrieved patient.
Expiration Date
This column appears in the 'Missing Subscriber ID' section of this report, and displays the Expiration Date of the Billing Episode missing Subscriber ID Code data. This data can be corrected on the Billing Episodes screen for a retrieved patient.
Street Address 1
This column appears in the 'Missing Patient Address' section of this report, and displays the address data entered in the Street Address Line 1 field for the displayed patient's Patient address type, as entered on the Patient Addresses window.
Street Address 2
This column appears in the 'Missing Patient Address' section of this report, and displays the address data entered in the Street Address Line 2 field for the displayed patient's Patient address type, as entered on the Patient Addresses window.
City
This column appears in the 'Missing Patient Address' section of this report, and displays the City entered for the displayed patient's Patient address type, as entered on the Patient Addresses window.
State
This column appears in the 'Missing Patient Address' section of this report, and displays the State selected for the displayed patient's Patient address type, as selected on the Patient Addresses window.
Zip
This column appears in the 'Missing Patient Address' section of this report, and displays the Postal (Zip) Code entered in the Zip field for the displayed patient's Patient address type, as entered on the Patient Addresses window.
Service
This column appears in the 'Missing Procedure Code' and 'Missing Diagnosis Code' sections of this report, and displays each specific Billable Service missing a Procedure Code and/or Diagnosis Code. This data can be corrected on the Billable Services screen.
(Problem Type)
This grouping header field displays the type of invalid data problem being presented, beneath which all specific instances of the problem are listed and grouped by the Payer/Rate Group associated with the Billing Episode in the patient-specific sections of this report.
Payer/Rate Group
This grouping header field appears within each (Problem Type) section, beneath which all specific instances of the problem are listed. For patient-specific problems, the list beneath this header field is based on the Payer/Rate Group associated with each patient's Billing Episode. For billable service-specific problems, the list beneath this header field is based on the Payer/Rate Group associated with each Billable Service.
Total
This field displays the total number of problems for each (Problem Type) section.
Episode From Date
This parameter allows users to limit the report's data by only displaying invalid patient-specific data for patients with Billing Episodes effective on or after the date selected here.
Episode To Date
This parameter allows users to limit the report's data by only displaying invalid patient-specific data for patients with Billing Episodes effective on or before the date selected here.
Payer/Category
This parameter allows users to limit the report's data by only displaying invalid data based on the Payer/Rate Group or Payer Category selected here. For patient-specific invalid data, this filtering is based on the Payer/Rate Group(s) associated with each patient's Billing Episode. For service-specific invalid data, this filtering is based on the Payer/Rate Group associated with each Billable Service. If a Payer Category is selected, then data will be returned for all Payer/Rate Groups assigned to the selected Payer Category as defined on the Payer/Rate Groups screen.
Service Type
This parameter allows users to limit the report's data by only displaying invalid Billable Service data for the specific type of service selected here.