Medical Billing - Electronic Billing Formats

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					Medical Billing - Electronic Billing Formats
This is the first in a series of articles that is going to be primarily
for the tech head or somebody who is actually in the medical billing
industry and sends claims electronically. This is information that you
mostly get from experience, so hopefully it will be of use to those of
you who fit the above description. This particular article will provide
an overview of the electronic billing records in the format. Future
articles will go into more detail as far as each individual record itself
so you understand the major requirements of each record and field within
the record. This way, if you're confronted with rejected claims, you'll
have a decent idea of where to look and what to look for.
Whenever a medical record is sent electronically when doing electronic
medical billing, the records have to be sent in a particular sequence,
they must have all required field filled out and each required record
itself must be transmitted. There are some records that are only
submitted under certain conditions and they will be covered as well, but
without the main records being transmitted, the entire claim will be
denied.
Unlike paper claims, electronic billing formats are not easily read by
the human eye unless you are really used to working with them. The only
data being transmitted is the field data itself. In other words, when
doing medical billing on a paper HCFA, where you would see the actual
header "Patient First Name" printed on the form itself with the actual
name typed in after, with an electronic billing record, the only thing
that gets transmitted is the actual patient name, such as "John Doe". The
header is implied. So the question most people ask is, "How does the
receiver know that the name being transmitted is the patient's name if
there is no header?" The answer is simple. Each piece of data is
transmitted in a certain position in that particular record. This is a
standard format that the receiver has been programmed to recognize. So if
the patient's name is supposed to appear in the first record in positions
30 through 60 and instead is transmitted in positions 61 though 90, the
claim will be denied because the name was not transmitted in the right
positions.
If this sounds nit picky, it's not. There is a ton of medical information
that is transmitted in each claim. If the information is not sent
correctly or in the expected positions, then the receiver, or the
insurance carrier, won't know what to do with the claim as there are no
"human eyes" to see that the name was meant to be placed in the box or
area to the left of where it was. And even then, they'll probably still
reject your claim as paper billing doesn't give you much wiggle room
either.
The main records for transmission of medical claims are the AA0, BA0,
CA0, DA0, EA0, FA0, XA0, YA0 and ZA0 records. Each of these records
transmits different pieces of information that are all related. For
example, the CA0 record transmits patient information such as name and
address.
In future articles, we'll cover each of these records plus the
conditional records in more detail. Medical billing in electronic format
is an exact science. One wrong character and your whole claim can be
toast.
Michael Russell
Your Independent guide to Medical Billing