Electronic cliam validation process tips

1000A NM109 Submitter ID

Contractor will reject an interchange (transmission) that is submitted with a submitter identification number that is not authorized for electronic claim submission.

1000B NM103 Receiver Name

Contractor will reject an interchange (transmission) that is not submitted with a valid carrier name (NM1).

2000B HL04 Hierarchical Child Code 0

The value accepted is “0”. Submission of “1” will cause your file to reject.

2000B SBR01 Payer Responsibility Sequence Number Code P, S

The values accepted are “P” and “S”. Submission of other values will cause your claim to reject.

2000B SBR02, SBR09 Subscriber Information

For Medicare, the subscriber is always the same as the patient (SBR02=18, SBR09=MB). The Patient Hierarchical Level (2000C loop) is not used.

2000B PAT08 Patient Weight

The maximum number of characters to be submitted in the patient weight field is four characters to the left of the decimal and two characters to the right. Claims with patient weight in excess of 9,999.99 pounds will be rejected

2000C HL – Segment Rule PATIENT HIERARCHICAL LEVEL

Must not be present. Submission of this segment will cause your claim to reject.

2000C PAT – Segment Rule PATIENT INFORMATION

Must not be present. Submission of this segment will cause your claim to reject.