How will you correct a rejected CMS-1450

Health & Medical
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How to correct a rejected CMS-1450.

Jul 15th, 2015

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HELLO, THE ATTACHED FILE MAY HELP YOU IN SOLVING THE PROBLEM.

  1. When a claim meets all necessary specifications and passes all predetermined data edits, it is known as a clean claim. The patient account specialist aims to achieve clean-claim billing on all UB-04s. A claim that does not meet all the specifications of a clean claim is either denied or rejected by the payer. A provider cannot resubmit a denied claim but can appeal it. The reverse is true of a rejected claim: the provider can correct a rejected claim and resubmit it but cannot appeal it.


  2. The UB-04 has eighty-one data elements contained in eighty-one different fields called form locators (FLs). The form locators on the UB-04 can be sequentially grouped into ten different sections based on similar types of data. The data included in each form locator are determined by Medicare's billing rules. In most cases, other payers have the same or similar rules. Most of the form locators are required fields for Medicare billing, and other payers' requirements may differ somewhat. The billing rules for each form locator specify (a) the type of data that must be entered in the field, (b) the format of the data, and (c) the number of characters-letters, numbers, symbols, or spaces-allowed. Specific formats for each form locator can be numeric, alphabetic, alphanumeric, or text-based.


  3. Eleven form locators on the UB-04 are unlabeled. Seven of these fields (FLs 7, 30, 37, 49, 68, 73, and 75) are reserved for assignment by the NUBC and are not intended for provider use. The remaining four (FLs 1, 2, 38, and 67) are not labeled on the UB-04 but do have names in the documentation and are intended for provider use.


  4. Each of the nine chapters that follow in Part 2 of this text provides a detailed walk-through of a group of form locators on the UB-04. Form locators are described and listed in numeric order, and guidelines, formatting examples, and billing and coding tips are provided. The detailed instructions apply mainly to Medicare claims. The billing entities are primarily acute care facilities, as the main focus of this text is the correct processing of inpatient and outpatient hospital claims.

 

http://www.valueoptions.com/providers/Forms/Administrative/Tips_for_Completing_the_UB04.pdf


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Jul 15th, 2015

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