This type isn't used to ask for routine maintenance (revisions) to X12 solutions or to submit remarks related to an inner or community evaluate interval.
X12 defines and maintains transaction sets that establish the data articles exchanged for precise business enterprise functions. Each and every transaction set is taken care of by a subcommittee working in X12’s Accredited Criteria Committee.
The member's Shopper Expending Account doesn't have enough cash to address the member's liability for this claim/provider.
Start to report the Universal Product Selection on statements for things of this sort. We are going to soon start to deny payment for things of this sort if billed with no right UPN.
Lacking/incomplete/invalid service provider identifier for the substituting medical doctor who furnished the assistance(s) under a reciprocal billing or locum tenens arrangement.
Alert: This reaction includes only expert services that might be believed in true-time. No estimate will likely be provided for that solutions that would not be estimated in authentic-time.
More information and facts has long been asked for within the member. x12 The fees are going to be reconsidered on receipt of that facts.
Lacking/incomplete/invalid date the client was final seen or perhaps the provider identifier on the attending doctor.
Warn: You may not appeal this final decision but can resubmit this claim/assistance with corrected data if warranted.
Notify: This is certainly an estimate with the member's legal responsibility based upon the knowledge offered at enough time the estimate was processed. True coverage and member liability amounts will be determined in the event the assert is processed. This is simply not a pre-authorization or maybe a warranty of payment.
Our data indicate that a Principal payer exists (in addition to ourselves); nonetheless, you didn't total or enter correctly the insurance policy approach/group/software identify or identification amount. Enter the PlanID when productive.
The attachment/other documentation that was obtained was incomplete or deficient. The necessary information and facts is still required to system the claim.
It's been determined that A further payer paid out the services as Most important whenever they were not the key payer. Consequently, we've been refunding for the payer that compensated as Principal in your behalf.
Mismatch among the submitted ordering/referring provider identify plus the purchasing/referring supplier name saved within our information.