Clean Claim

We continue to receive claims that cannot be processed due to missing or invalid information. The most common errors resulting in denials for clean claim are:

• Box 10a – Should reflect ‘YES’ if services are related to a work related injury;
• Box 14 – Incorrect date of injury (or no date of injury listed), please call MSF if you do not have this date. It is also listed on the EOR.
• Box 24J – Missing rendering provider which typically coincides with the provider name listed in Box 31;
• Box 32 and/or 32a – If place of service is other than 12 (home), then Box 32 must denote the facility name and physical address where services were provided. Box 32a must include the NPI for this entity;
• Box 33a – Missing the NPI for the billing provider.

A complete list of required fields by bill type can be found by going to the right hand corner of this publication and clicking More Articles from the Archive. From there click on Provider Bulletin | Winter 2012, then “Clean Claim Defined” .

Corrected Billing Submission
When submitting a corrected billing, providers should make sure that the integrity of the original billing is maintained and the billing form clearly reflects that it a corrected billing. Corrected bills must be submitted with a copy of the denial EOR.

Rebilling new bills (or combining bills) with only codes that were denied on other bills will cause delays and errors in processing due to the amount of time it takes to research each code and date of service (DOS). If the submission of a corrected billing is due to the correction of a code, the corrected bill should contain the same codes (even if already paid) from the original bill with the exception of the corrected code. This allows easy comparison of previous processing so the bill can be processed quickly and correctly. If the previous bill is only missing a procedure code, please submit a separate bill with the appropriate documentation for processing. If you have questions regarding how to resubmit a bill, call the Medical Audit Team at the number listed in the Contacts section of this bulletin.

Reconsideration/Re-evaluation Requests – Please submit the following when requesting a reconsideration or submitting a corrected bill:

• A copy of the EOR
• Corrected CMS 1500/UB04 (if applicable) and indicate on the bill that it is a “Corrected” bill, and
• Any additional documentation or information (if applicable).