EDI Claims and UNITS Field Issue

Palmetto GBA has identified an issue with electronically submitted claims received through one of our six EDI system translators. One of the transmitters was inadvertently not updated as expected during the January 2017 release. This caused electronic claims handled through that translator to experience an issue with the UNITS field (loop 2400, SV1 segment - qualifier UN) to come in with a six digit service unit count byte instead of five. As a result of this sixth digit, when claims entered into the MCS system, the extra digit was dropped causing an incorrect quantity billed on the claim detail line. Some of the affected claims stopped in correctable locations and were updated to the correct five byte quantity billed. Claims that finalized without stopping are being underpaid. Claims affected were submitted with internal control numbers (ICN’s) Jan 2nd – Jan 5th (002-005). These claims can also be identified as showing an incorrect value in the NOS section of the remittance advice. EDI Systems stopped routing claims through this translator effective 3:00 PM Thursday, January 5. Some of the affected claims have suspended and Palmetto GBA is correcting the quantity billed field with no action necessary on the provider's part. EDI Systems and Claims have identified the affected claims. Claims that did not suspend to a correctable location will be mass adjusted.

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INDUSTRY NEWS TAGS: Palmetto GBA, MAC JM North Carolina, MAC JM South Carolina, MAC JM Virginia, MAC JM West Virginia

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