The key thing to
differentiate is the reason for rejection of the claims. If the claims batch is
not following the HIPAA Syntax (meaning loops and segments) , then an automated
system may not be able to infer the correct claim data from the batch and that's
the reason for rejecting the entire batch.
However, if the batch is syntactically
correct, all claims would be processed and the bad claims would be denied and
reported on the 835 transaction.
regards
Arvinder Singh
Enterprise Solutions
Division
Client Network Services
Inc.
301-987-5021
Most Medicaid
Agencies share your view.
Please pardon me if
my thought process is to simplistic, but here is my view on EDI claim
rejections:
EDI is an attempt
to automate and streamline a paper based process. In a paper
based system, if a provider mails 1000 billing forms (claims)
to a payer, the payer is only going to return correspondence on the
forms that have problems. The payer is not going to return all 1000
paper forms (claims) because one of them is incorrect.
I see EDI the same
way, why return all 1000 claims because one of them is bad? As
a patient, I would hate to know that my claim has not been
processed because someone else's claim was coded
wrong.... From the payer's point of view, I would hate
to go to court and explain to a judge that a claim was not
processed in a reasonable amount of time because another claim in
the batch was bad....
Anyway, that's my two cents, for
what is worth...
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