Relay Health: New wrinkle sending 5010 claims

prosete · Post by **prosete** » Sat Jan 21, 2012 4:45 pm

I've been sending claims under the new 5010 format since Jan 1 and have found that on nearly all of them, I have received a report/message back from the clearing house several days after submitting the claim, informing me that the Payer has rejected their claim batch due to an undetermined cause but that the "defective' claims were removed and remaining claims re-submitted automatically by RH.

I managed to get thru to their EDI support desk and was told that, yes, they've been having these problems wherein several claims within a given batch they submit are being rejected by payers, causing all claims by any provider included in that particular batch to also be rejected. This appears to be happening repeatedly so that I am now seeing claims I submitted as far back as Jan 5 and 6 are being kicked out due to their being included in a batch that contains at least 1, if not more, "faulty" claims.

It looks like I'm now caught in the proverbial "one bad apple" situation ruining it for the rest of us. Doesn't matter that my particular claims are error-free. So long as some other provider's claims contain errors, the entire batch RH submits will be rejected on account of those 1 or more submitted that contain errors. This is causing at least a 3 week delay in submitting some of my earliest 2012 claims under 5010, since I still get notices that my Jan 5 submits are not being accepted.

Is this happening to anyone else?

Post by **Gavin Walker** » Mon Jan 23, 2012 10:19 am

Yes it is a common problem. I am hearing RelayHealth is having problems with OK Medicare. I am sure there are others. So far, the only remedy I have heard is to resubmit your claims. You can call and wait on hold for hours if you want to hear a repeat of basically what you heard.