Availity rejects whole batch with >4 diagnoses.

ed_g · Post by **ed_g** » Sat Feb 25, 2012 3:04 am

I added 5th Dx in transactions, but Availity rejected the whole batch. The very first file .999 shows rejection. Can't reach availty - they keep callers on hold for 40 minutes and then disconnect. Would appreciate any help. Thank you.

Post by **Gavin Walker** » Sun Feb 26, 2012 5:14 pm

We have seen cases where there are NULL values in the MWTRN table in columns "Diagnosis_5" through "Diagnosis_8". If you go into Medisoft and check diagnosis pointer 5-8, click save, and then uncheck them it places a False value in the column and does not send the pointers in the transmission file.

Aside from the method above, there are a couple of ways to go about fixing this. 1) Update the IGuide in Revenue Management to not to send these pointers unless the fields have True in the columns. 2) Write a SQL script to update MWTRN Diagnosis Pointer columns to False where they are NULL.

ed_g · Post by **ed_g** » Mon Feb 27, 2012 11:18 am

Thank you for the answer.
I use Simple 837 instead of Revenue Management.
As far as I understand, there is no point to use 5-8th Dx at all (if they do not go to the transmission file)? Right?

Gavin Walker wrote:We have seen cases where there are NULL values in the MWTRN table in columns "Diagnosis_5" through "Diagnosis_8". If you go into Medisoft and check diagnosis pointer 5-8, click save, and then uncheck them it places a False value in the column and does not send the pointers in the transmission file.

Aside from the method above, there are a couple of ways to go about fixing this. 1) Update the IGuide in Revenue Management to not to send these pointers unless the fields have True in the columns. 2) Write a SQL script to update MWTRN Diagnosis Pointer columns to False where they are NULL.

Post by **Gavin Walker** » Mon Feb 27, 2012 12:18 pm

Actually, they can go on the claim. With ANSI 5010 there is still a limit of 4 diagnosis pointers on a transaction line, but there is no reason why one of those pointers couldn't point to the eighth diagnosis code for example. So, just make sure you don't have more than 4 diagnosis pointers selected on any given transaction.

ed_g · Post by **ed_g** » Mon Feb 27, 2012 9:26 pm

Oh, I see. I will try to use maximum 4 pointers per transaction. Thank you for your help!!

Gavin Walker wrote:Actually, they can go on the claim. With ANSI 5010 there is still a limit of 4 diagnosis pointers on a transaction line, but there is no reason why one of those pointers couldn't point to the eighth diagnosis code for example. So, just make sure you don't have more than 4 diagnosis pointers selected on any given transaction.