Common Claims Filing Errors

The following filing errors cause the majority of delays in claims processing:

• Provider number is not appropriate for the type of service rendered and/or place of service.
• Type of bill is invalid or incorrect for the provider number.
• Services and/or charges are omitted.
• Units do not accurately reflect the quantity of supplies dispensed or services rendered.
• Additional information is needed, such as a referral, other carrier report or accident/injury form.

When HMSA's claims processing system detects an error, the claim automatically suspends and the provider is notified of the problem. HMSA's system tries to detect multiple errors simultaneously; however, this is not always possible because each component of the UB-04 depends on other data in different form locators. For example, if a revenue code is invalid, the provider must first make the correction and return the claim before HMSA can ascertain whether the procedure codes and units for a particular service were billed correctly.

Claims Filing Reminders

Provider Number

Please ensure that the HMSA-assigned provider number listed on the UB-04 is correct for the type of service rendered and the place of service. Many facilities have multiple provider numbers. Entering the appropriate provider number on the claim will expedite processing.

This guideline applies to initial claims as well as resubmissions. For example, if a patient was admitted and the initial claim was billed using the provider number for inpatient services, a replacement claim with an ambulatory surgery center (ASC) provider number will be denied.

Resubmissions and Corrections to Previously Processed Claims

• For UB-04 claims, go to Verifying Claims Status and Resubmission of Processed Claims (UB-04).
• For CMS-1500 claims, go to Verifying Claim Status and Resubmission of Processed Claims (CMS-1500).

Revision History