2010
Feb 
16

Common electronic claims rejections

Filed under: Uncategorized — admin @ 9:48 pm  

Billing electronically can be frustrating at times. Here are some common error rejections:

-Missing or invalid CPT codes

-Patient date of birth missing

-Invalid Rendering NPI number

-Patient not Eligible

-Invalid Diagnosis Code

2010
Feb 
9

Key differences between Print Image format vs ANSI

Filed under: Uncategorized — admin @ 6:37 pm  

The ANSI format has many different data fields that are not included in the Print Image format.

Some of these include:

Taxonomy Codes

NDC Drug Codes

Contact Information

The ANSI format is the standard for Electronic Claims Submission and must be used to be considered “HIPAA” compliant.

2010
Feb 
6

What are Print Image Files?

Filed under: Uncategorized — admin @ 6:25 pm  

Print Image files are generated by many different Practice Management Systems (Medical Billing Programs).  A Practice Management System also known P.M.S. software generates the medical claims in one of 3 formats: Print Image Format, NSF format, and ANSI format.

The Print Image file is the same thing as if you were printing a claim out to paper but without the lines.  It is a text file that can be opened with a program such as Notepad or any other text editor.

Most of the time but not always, Print Image files are generated by older billing systems or simple ones.  Print image files are converted by the Clearinghouse to the standard ANSI format.

Instead of sending your Print Image files to the Clearinghouses, you can process your files through the Wave-Translator program by Wave-EDI.

Insurance Companies cannot process the Print Image files and rely on Clearinghouses for this task.  Some Insurance Companies allow you to send claims directly without going through a Clearinghouse, but you must send in the ANSI format and pass testing first.  The Wave-Translator has already passed several of these tests and is ready for direct submission to either Clearinghouses or Insurance Companies.

Example of what a CMS 1500 form looks like:

http://wave-edi.com/wp-content/uploads/2010/02/CMS-1500-FORM-EXAMPLE1.png

Screenshot of what the 1 claim in a Print Image claims file looks like:

http://wave-edi.com/wp-content/uploads/2010/02/1-claim-screenshot.png

Why is it important to convert Print Image format files to ANSI files?

Filed under: Uncategorized — admin @ 12:05 am  

Since so many different Insurance Companies as well as individual claims requirements vary, it is important that the Healthcare Industry adapt and promote a standardized format.

This format is so that all information technology systems across the board can process your files.  The ANSI 837p format is the standard format, and can get quite complicated.   The ANSI format alone requires additional information that is not generated in the Print Image files.

Creating a “clean” ANSI 837p file that contains multiple claims can get a little bit messy.  It is not an easy job to be sure that the ANSI file will be consistently clean and process correctly.

Throughout the process of medical claims processing, your original claims data that started with a Print Image file that you exported from your Billing System will be converted several times (while being transmitted electronically)  before making it to the final step which is the Insurance Company.  Errors can occur and do occur frequently.  Sometimes this happens without your knowledge until it is too late and you have a delay in payment.

The Wave-Translator has been rigorously tested in both our labs and in real world environments.  Countless number of Print Image Files have been imported into the Wave-Translator program and verified for accuracy when converted to the ANSI 837p format.  It is extremely important that claims are correct when converted into ANSI.