Medisoft v14 Secondary Claims Loop 2430 issue

[Eric White]

I am having an issue with my secondary claims processing. The claims are being rejected and I have found that the problem lies within loop 2430 SVD 03. The error message reads: "HCPCS Procedure Code is invalid in Line Adjudication Information. Invalid data: N09, N20, M06". I was told that this was a known issue, and I wanted to check to see if anyone else has heard of this.

[Gavin Walker]

Are those intervention codes and is this a hospital claim? I am not exactly an expert on hospital billing, but it appears the procedure code does not match the intervention codes or possibly the diagnosis code. What procedure code are you trying to bill exactly?

[Eric White]

I'm sorry I did leave out some info there. The N04 etc are our cheat codes, or internal codes that we use, but when we send the secondary claims, it is sending our cheat codes and not the procedure codes. This is only for the secondary claims though, the primary is fine.

[Gavin Walker]

OK, I think I see. Edit the procedure code and make sure the correct procedure code for the secondary payer is in either Alternate Codes 2 or Alternate Codes 3. Now edit your secondary insurance carrier record on the Options and Codes tab and make sure you have either 2 or 3 in the Procedure Codes Set field depending on which alternate code you want to use on your procedure.

Since Medidare and Medicaid are usually the insurance that require different codes, we usually recommend code set 2 for Medicare and code set 3 for Medicaid.

[Eric White]

I double checked all of that. Medicare is set up to use Procedure code #2. I checked the Procedure code N09 and in the boxes 2 and 3 the same code "A042" are in each, but when I prep the file for transfer and I check in the .tch file this is what is coming up...

LOOP2430 00003244 SVD*CC:*559*HC:N09:HH**1

The "N09" I am being told, is supposed to be the "A042" on this report. I can see where the loop 2400 has another code i know to be mapped to an alternate code and is translated correctly.

This problem ONLY arises with the secondary claims. It seems that the primary claims are all translated correctly.

Thanks

[Gavin Walker]

It could be a bug. Are you using a direct module? Which one?

[Eric White]

We are using AVAP.

[Gavin Walker]

OK, check to see if you are using AVAP v14.05 or higher. If not, then you need to install Medisoft v14 sp2 and then you will need the AVAP update. All of this can be downloaded from our services packs download page here: http://www.medtechsys.net/service-pack- ... php#m14sp2

Here is the bug fix that I think you might need:

Version 14.05 6/27/2008

All Modules

13080 – The application was modified to correct an issue in Loop2430 SVD in which the
application was transmitting the NDC code instead of the procedure code.

[Eric White]

Thank you. That seemed to have fixed the problem we were having.

[Eric White]

I spoke too soon. I looks like now the exact same thing is happening just for loop 2400. I have searched but I cannot find anything on this one.

[Gavin Walker]

If you call our office we can work directly with you on this with a paid support agreement. Since it sounds like you are already using the most up-to-date AVAP module for Medisoft v14, we may not be able to bring you a satisfactory resolution to your problem without an upgrade.