CLAIM REJECT SERVICE FACILITY NAME ISSUE.

[nptnhnh]

I converted to V17 in October, tested with capario and all was set to transmit in A5010. Today, I am having problem with facility physical address conflicting with the mailing address which is a P.O.Box. Please tell me what needs to be modified. Thanks.

[Gavin Walker]

Can you paste in the exact error message? X out anything that might identify a particular patient to avoid a HIPAA violation.

[nptnhnh]

THANKS FOR THE RESPONSE. THE REPORT READS AS FOLLOWS
1 CLAIM LEVEL - SERVICE FACILITY NAME / PRIMARY IDENTIFIER IS MISSING OR INVALID.-[] REJECTED

[Gavin Walker]

Edit the facility that is assigned to the case. Be sure to enter the physical address of the facility with Zip+4 without a dash. Then go to the Ids tab and make sure you have an "ALL" record and setup the group NPI on this record. Delete any extra records on the Ids tab that you don't need.

[nptnhnh]

THANKS. I DID BUT STILL, CLAIMS ARE REJECTED.

[Gavin Walker]

Well, the NPI you are entering must be invalid. You'll have to call to find out why it is invalid. Go to the NPI registry and make sure the address you are entering matches the NPI number.

[nptnhnh]

Hi again,
First to thank you for making so much effort. When I finally got hold of my "added value seller" or so she looked into my set up and said that all was okay with the set up. She accessed the pc remotely to actually perform all the billing tasks etc. Then sent an e-mail to MicriwiZe that there is a problem but it was not from the facility set up and will get back to me. This was three weeks ago!!!
Yesterday I managed to engage one of the Capario's medisoft specialist who looked through the rejected claims and itemized the problem areas.
Stating that (1)the rule for subscriber and child is such that I can list the subscriber's address for a child who's parent has different address..This is new to me.
(2) The facility address can not be repeated twice ----
She then said that I should tell the value added seller to go to Loop / Segment 2010ba segment n4. Also to remove Loop2310c facility location. My value ?? seller has not got back to me (she is not possibly because she is losing money from her errors)!!!!!
Please could you help direct me to how to fix these loops so that i can send electronically. Paper claim is impeding cash flow.
Thanks a bunch.
Npt

[Gavin Walker]

We are hearing about others rejecting for the same error regarding the facility. It sounds like now if the service facility is the same as the billing address it should not be submitted on the claim. The quick solution here is to delete the facility from the case and then from the individual transaction lines and recreate your claims.

I am not sure what you are saying on #1. Can you paste or type in the exact error message?

[nptnhnh]

Thanks a lot!!! What I meant was that according to the Capario staff, when the subscriber is a parent and has a different address the address of the subscriber should not be listed. However when I deleted the address and resubmit, the claim was rejected due to the missing address and the facility issue.
Two problems so far. one the facility listing. two the issue with Guarantor i.e. parent residing at a different address. perhaps certain rules need to be applied in the set up for such situations I do not know.
Ironically, cigna claims were not rejected!!!
Thanks for all your help.

[Gavin Walker]

What insurance is it?

[nptnhnh]

Anthem BCBS

[Gavin Walker]

I don't know. Does Anthem BCBS sell insurance where the policy holder lives at one address and the covered child lives at another address? That doesn't sound too uncommon? Are either of the addresses outside of the United States? Is the error message being generated by Capario or BCBS?

[nptnhnh]

The error is generated at Capario's end. The transmission is seen at the Caparion's end but transmitted to Anthem.

Although when sent by paper it is not a problem. My "value added seller" finally called to look into it this morning!!!. I will give you a feedback once successful at transmitting electronically.
Thanks.

[nptnhnh]

UPDATE
Well it turned out that the facility where patient is treated i.e when entering case information, the facility must not be dropped down or pulled, meaning that all transactions will be billed without the facility listed.
Also the guarantor's name or and address also need not be listed but just the patient.

I removed the facility from already populated claims, recreated them without the facility and it went. Also once the patient's guarantors info was removed it went.

It is absurd but that was the end of my problem in the last nearly a month!!! The rules does not apply to paper obviously because 5010 is not applicable to paper claims.
I must say a heartfelt thank you for not letting go in sane, by maintaining the communication which helped me feel that at least someone is listening and attempting to help.
Thanks again.
npt