Referral > Demographics | Make sure patient Gender is marked |
Referral > Demographics | Patient date of birth should NOT be 1/1/1900 |
Referral > Dr + Pharmacy | Make sure Primary Physician is noted and has a valid NPI number |
Referral > Start | Make sure the County is indicated (CBSA denial is always county) |
Referral > Payers | Make sure the HIC# is valid for the payer |
Codes > Other Basic Codes > Doctors | Check the NPI for the doctor, and the CA as needed. |
Correct the Doctor NPI | This article tells how: https://www.barnestorm.biz/kb/KnowledgebaseArticle50694 |
Cross Reference NPI to CA | This article tells how: https://www.barnestorm.biz/kb/KnowledgebaseArticle50172 |
Codes > Rates > Job Codes | Check the job code used on the visits for the correct HCPCS code |
Billing > PPS Billing > Edit PPS Episodes | Check all of the information on your RAP: - Has it been cancelled or put on hold? - Is the from date correct? - Is the admission date correct? - Does the HIPPS code match? |
To correct a HIPPS code, you follow the instructions in our KB article, OASIS Correction, for correcting a KEY FIELD. https://www.barnestorm.biz/kb/KnowledgebaseArticle50435 | |
OASIS Correction | The from and thru dates and admission date on the initial RAP are the same. Therefore, the 0023 line item service date must also match. https://www.barnestorm.biz/kb/KnowledgebaseArticle50435 |
Check the from and thru dates and total cert period days. https://www.barnestorm.biz/kb/KnowledgebaseArticle50435 | |
Therapy need--correct as needed and resubmit. https://www.barnestorm.biz/kb/KnowledgebaseArticle50435 | |
Referral > Payers > Extra Billing Info | If the error code indicates that you need a condition code, include the appropriate condition code and make sure that there are no other codes listed for that claim set date. D0 - changes to service dates D1 - changes in charges D2 - changes in revenue code/HCPC D3 - second or subsequent interim PPS bill D4 - change in grouper input (DRG) D5 - cancel only to correct a hic or provider number D6 - cancel only - duplicate payment, outpatient to inpatient overlap, OIG overpayment D7 - change to make Medicare secondary payer D8 - change to make Medicare primary payer D9 - any other changes. EO- change in patient status note: if you are having trouble getting E0 change in patient status. Note: if you are having trouble getting E0 to process and it is correctly applied to the claim please contact call center. If D9 code is missing: - Look up the patient in Referral and go to Payers > Extra Billing Info. - Remove any old billing dates and any other condition codes, such as D7. - Add a new date set to cover the current claims and make sure D9 is the only condition code listed. |