Wiki CPB course- Electronic Claims-ASCX12 transmissions.

[Karinking]

Been medical biller 17ys. Working my CPB course/certification. Chapter 8 Claims-electronically, and READ this in Section 8.2 page 158; "The medical biller must understand completing the claim form with accurate information, but not the technical data elements required for the ASCX12 transmissions."
So is that saying we as billers are not required to know how the data/format changes from our claim when transmitted to ASCX12?
And if so, why then when a biller receives claim rejections from payer (edi dept) and clearinghouses that references errors of "looping data errors" are we expected to resolve that issue? These are the kinda errors related to the ASCX12 transmissions, right? (correct me if im confused)??
Because in my experience when contacting clearing house or edi depts of payers...they are most of the time very unhelpful with these rejections.
These kinda rejections have always been my biggest frustration trying to get claims adjudicated/paid!

 

[Rajinder_Dhammi]

Dear friend,

As a medical biller, you should have a good working knowledge of RARCs and CARCs codes written on ERA/EOBs and not on EDI (Electronic Data Interchange). Technical team handles the nuisances related to electronic data interchange (EDI) interconnecting clearing houses and practice management softwares, so it is something that they should be well versed with.

Being a medical biller, to get better at your work, get your hands dirty on medical coding stuff (along with modifiers) to enhance your skills.

I hope I have helped.

Thank you,
Rajinder Singh Dhammi, CPC, CPB

 

[SharonCollachi]

And if so, why then when a biller receives claim rejections from payer (edi dept) and clearinghouses that references errors of "looping data errors" are we expected to resolve that issue? These are the kinda errors related to the ASCX12 transmissions, right? (correct me if im confused)??

I agree with you. The more you know, the easier your denials are to work. I had an issue with my NDC codes on injections not transmitting electronically to some payers. The software people were trying to tell me I wasn't putting them on the claim. I told them the box they were in on the paper, and the loop they were supposed to be in on the electronic claim. Then I told them that was where they should concentrate their problem-solving; it's going to box Y but not loop Z.