• member eligibility errors
• provider enrollment / NPI errors
These items changed significantly with the transition to 5010.
To reduce your risk of rejected claims related to these issues, we recommend the following:
To reduce Member Eligibility Errors:
1. Recheck member eligibility cards to confirm information is current for the 2012 calendar year.
2. Confirm member eligibility before filing any claims on that member.
3. Verify each member ID number for a patient uniquely identified on a membership card, and report that member ID number on the claim. If the patient can be uniquely identified, you must file the claim using Patient Relationship as Self.
To reduce Provider Enrollment/NPI Issues:
1. Check your provider enrollment and NPI information for correct reporting of Billing and Servicing provider information with each of your payers. New requirements may be in place for 5010 reporting.
2. Verify your Provider/NPI information on the National Plan and Provider Enumeration System (NPPES) to make sure enumeration is correct for reporting.
Please review the information above and take steps to reduce your risk of rejected claims due to member eligibility errors or provider enrollment/NPI issues.
If you have any questions or concerns, please feel free to contact Client Services at (888) 348-8457 option 2.
Your Med Advent Team