Medical Billing Troubleshooting Electronic Billing

By: Michael Russell

Absolutely one of the hardest things to troubleshoot when it comes to medical billing is electronic transmission of claims. There are so many things that can go wrong with this process that there is just no way to cover them all in one article. So we're going to cover the problems that are most common and most annoying. Hopefully, this will help you in getting your electronically submitted claims through to the carrier.

One common problem is that the claim file itself won't go through. Either you will get a timeout error or some other kind of error when transmitting the file. The end result is that the claim file doesn't make its way to the carrier. While this is just one common problem, there are a number of things that can cause this to happen.

For starters, the protocol being used by the electronic billing package is not compatible with the carrier. For example. The package may be transmitting via Xmodem protocol. In the case of New York Medicaid, as of this writing, they only accept Ymodem protocol. So if you're transmitting to them and using Xmodem, your file won't go through. The simple solution is to change the protocol in your billing package. There are usually instructions to do this.

If the protocol is okay, then another common problem is the baud rate. Unfortunately, most medical carriers still live in the stone ages and won't accept transmissions at anything greater than 19,200 baud. So if your program is transmitting at a high speed then most likely the file is going over to fast for the carrier to read it clearly and many errors will occur. The simple solution to this is to change the baud rate in your billing package. Changing it in your modem won't do a thing. It's the package that determines the transmission speed.

If the protocol and speed are okay, then another common problem is noise on the phone line. Unfortunately, to get a clean transmission to a carrier, the phone line has to be absolutely static free. Any noise at all on the line and most likely the file will not go through. In order to test this, simply make a call to the carrier using that line with a regular phone attached. After you connect, monitor the amount of noise on the line. Sometimes you can hear the line noise even before you dial.

If all of the above are not the problem, then the next most common problem is that the claim file itself was not created properly. If you remember our review of NSF 3.01 record specifications, a file has to be exactly right or the claims will be denied. Sometimes, if a critical record, like the ZA0 record, is missing, the carrier will reject the file before it even gets into the area where it is reviewed. This will show up as a transmission error. The fix for this is to examine the claim file. Most software programs come with special viewers to do this.

The above problems only scratch the surface, but they will give you a good head start on making sure that your medical billing of claims via electronic media goes smoothly.

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