The newsletter lists the top five reasons for EDI claims rejections for Alabama, Georgia, Mississippi and Tennessee. Here are the top three most common reasons for all states as provided by Cahaba:
- 434 – Procedure Code Requires Referring NPI — Around 25,760 claims in the four states were rejected due to this error. The reason for the rejection is, “Procedure code billed was for a diagnostic procedure, such as an X-ray or lab, which requires the NPI of the ordering physician, or a consultation, which requires the NPI of the referring physician,” according to Cahaba.
- 421 – Diagnosis Code (XXXXX) Invalid for Date SVC — Over 18,000 claims were rejected due to this error, according to Cahaba, defined as “The diagnosis code submitted was not valid on the date-of-service billed.”
- 888 – Instream Rejection — Cahaba records 11,214 rejections due to this error, described as “There was a problem involving HIPPA required loops, segments, or values. The specific loop will be identified, for example, ‘ELEMENT N401 (D.E.19) AT COL. 4 IS MISSING, THOUGH MARKED “MUST BE USED” (LOOP:2010BA POS:3140).’ The number after ‘POS’ indicates the position in the file where the error occurred.” Cahaba provides further explanation here.
Cahaba provides its newsletters free-of-cost to healthcare providers through its website.
Read the Cahaba bulletin on common EDI claim rejections (pdf).
