Avoid Error Code H40142 for Crossover Claims
There reportedly has been a high incidence of crossover claims being rejected. According to Palmetto GBA, many physician offices and durable medical equipment (DME) suppliers are receiving provider notification letters from their servicing Medicare administrative contractor (MAC) or carrier that includes an H40142 error code and the description “Discharge date (DTP-01=096) was not expected because this claim is not for inpatient services.”Palmetto offers physicians and practitioners a simple solution: Only include a discharge date if you are billing Part B claims for services with place of service (POS) codes 21, 31, 51, and 61. These POS codes all contain “inpatient” in the description.
A discharge date is only required for 5010A1 837 inpatient claims when the patient was discharged from the facility and the discharge date is known. The same is true for entities that bill Medicare via hardcopy claims.
DME suppliers are instructed to include a discharge date on incoming claims when billing HCPCS Level II E0935 Continuous passive motion [CPM] device. For such claims, the POS is most often 12 (home). To ensure DME claims for a CPM device will properly cross over, DME suppliers should include discharge date reporting within the 2400 NTE (notes segment), not in 2300 DTP03 on incoming version 5010A1 837 professional claims, when billing their DME MAC electronically.
The crux of the matter is that Medicare does not maintain an edit for inbound 837 professional claims to check that a discharge date is only billed with inpatient POS codes, but the Coordination of Benefits Contractor (COBC) does.
In recent weeks, three additional issues have arisen that were caused by defects in the COBC compliance validation process. According to a Palmetto news article, the error codes are:
- “H51108: ‘237’ is not a valid ‘Line Level Adjustment Reason Code’
- Issue: COBC was incorrectly rejecting claims that contained a claim adjustment reason code (CARC) 237. The rejection occurred because COBC’s vendor inadvertently did not have reason code 237 loaded to its CARC table.
- Fix date: January 16
- H20203: Element CLM16 is present though marked ‘Not Used’
- Issue: COBC’s vendor’s translation routine was copying the value from 2300 CLM20 and incorrectly creating that value within 2300 CLM16 (‘Not Used’)
- Fix date: February 27
- Steps taken: As of the week of February 13, the Centers for Medicare & Medicaid Services (CMS) asked its A/B MACs, DME MACs, FIs and carriers to hold the letters they would normally generate that contain error code H20203. Effective February 27, our Medicare contractors will be able to resend the affected claims to the COBC so that they may be successfully crossed over.
- H45255: The Other Subscriber Primary Identifier (2330A NM109) cannot be the same as the group or policy number (2320 SBR03)
- Resolution: COBC scrubs the duplication that is present in 2320 SBR03
- Project fix date: TBD, but hopefully not later than early April 2012
- NOTE: Currently, error H45255 is prohibiting the sending of Medicare crossover claims to North Dakota Medicaid in certain instances
- Steps taken: CMS is requesting that Medicare contractors hold the letters that would normally be generated for error code H45255. Once a fix date is identified for this issue, CMS will notify the Medicare contractors to resend the affected claims to the COBC so that they may be successfully crossed over.”
Providers now have until June 1, 2012 to implement version 5010. Regulations and guidance for implementing version 5010 are available on the CMS website. You can also file a complaint with CMS if you’re experiencing unfounded claims payment delays or other claims processing issues.
This just in: CMS released this month an important update regarding Health Insurance Portability and Accountability Act (HIPAA) Version 5010/D.0 implementation. This document includes descriptions used for interpreting the 277CA responses.
Sources: Palmetto GBA news, March 5, 2012:
“Crossover Claims Rejecting Due to Unnecessary Billing of Discharge Date”
“HIPAA 5010 Claims Translation Issues Affecting Medicare Crossover Claims: Error Codes H51108, H20203 and H45255”