We are struggling with creating a process that will be compliant with the 837 X12 standards and still allow us to take in newborn claims without denying them back to providers on the initial submission. Our current process is that our providers are educated to submit with a "dummy" newborn member number (if a unique number is unknown) that will allow the claim into our core system to pend. A process then takes place to assign or locate the correct / unique member number which is then modified on the claim and remits back to the provider. We have found this process more efficient and accurate for several reasons related to our Medicaid line of business, but primarily because the newborns may not yet have a unique ID of their own and this allows us to process the claims in one submission versus a denial and reprocess.
Our concern is that if we continue this practice going forward we will not be compliant because providers will submit with a "dummy" member number and we will remit back with the correct ID which is assigned after we receive the claim. If we leave the claims on our system with a "dummy" member number, it will be difficult for servicing to locate claims for specific member numbers and edit for duplicate submissions. Is anyone else struggling with the handling of newborn claims? Any suggestions on a compliant process that will also be efficient? CONFIDENTIALITY NOTICE. This e-mail and attachments, if any, may contain confidential information which is privileged and protected from disclosure by Federal and State confidentiality laws, rules or regulations. This e-mail and attachments, if any, are intended for the designated addressee only . If you are not the designated addressee, you are hereby notified that any disclosure, copying, or distribution of this e-mail and its attachments, if any, may be unlawful and may subject you to legal consequences. If you have received this e-mail and attachments in error, please contact Independent Health immediately at (716) 631-3001 and delete the e-mail and its attachments from your computer. Thank you for your attention. To be removed from this list, go to: http://snip.wedi.org/unsubscribe.cfm?list=business and enter your email address. The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited.
