Providers are not required to submit claims electronically, and paper claims do not contain all the required information.
For example, if a
chiropractor does a spinal manipulation, we would expect him to submit his bill
on a HCFA 1500 claim form as he has always done.
For spinal
manipulation, there are several required fields within the 837.
Within the 2300 loop
CR2 detail (Spinal Manipulation Service Information), the following information
is required and can not be found on a paper claim:
Treatment Series Number
Treatment Count
Subluxation Level Code
Treatment Period Count
Monthly Treatment Count
Patient
Condition Code
Complication Indicator
For ambulance
transports, loop 2300 detail CR1 (Ambulance Certification), required and not
found on a paper claim are
Ambulance Transport Code
Ambulance Transport Reason Code.
For obstetrical
claims, the paper claim provides the last menstrual cycle date but not the
estimated date of birth.
It would be easy to
say that the provider has to supply the information, however we really
don't expect that to happen in practice. We are
required to include this information when we submit the 837 to
our state agency.
Has anyone addressed and or resolved an issue similar to this?
Art
Schenkman
Senior HIPAA
Systems Analyst
Schaller
Anderson
4645 E.
Cotton Center Blvd, Bldg 1, Suite 200
Phoenix, AZ
85040
(602)
659-1241 (office)
(602) 659-1379 (fax)
[EMAIL PROTECTED]
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