Pre-billing Data Missing – These are things the computer needs before it even thinks about billing an order.
Date of Birth – Missing from consumer
– Billers should speak with a CSR about adding a gender (M or F). Every consumer needs a gender except for countries, JACC, PCA, Options, etc.
Physician, Physician Med License number, Physician NPI & Physician ID – Missing from consumer
– Billers should speak with a CSR about the physician, physician med licence number, physician NPI & physician ID.
Recipient ID – Missing from consumer
– Billers should speak with a CSR about adding a recipient ID number to a consumer account its need so we can bill.
ICD 10 Diagnosis Category – ICD 10 code may not be a valid code in our system.
– Billers should check the consumer account to make sure we have a valid ICD 10 code in our system.
– If the ICD 10 code is not valid, the billers should talk with a CSR about getting a valid diagnose code.
– Once the diagnose code is fixed, billers should mark the order as RB-NW if the order does not have a ICN number yet.
– Billers should be aware that this issue may come up when the has been billed and paid, use your judgement on the order, every order may not need to be marked as RB-GO.
No Diagnosis – No diagnosis was found for this order.
– Billers should speak with a CSR about adding a valid diagnosis code.
No ICD-10 Found – The ICD-10 code is not found in our system.
– Billers should speak with a CSR about adding a valid ICD-10 code.
No ICD-9 Found – The ICD-9 code is not founf in our system.
– Billers should speak with a CSR about adding a valid ICD-9 code.
ICD-10 No Replacement – No conversion code
– For very ICD-9 code there should be a ICD-10 code that matches inside our system.