Prevent Claims Rejections Related to Member ID and Eligibility

We have noted a high volume of initial claim submissions by providers with incorrect member eligibility data and an invalid member identification number. Two major causes of these “unclean claims” which are being rejected, are:

• incorrect formatting of the member identification number
• incorrect submission of AmeriHealth Administrator claims using the AmeriHealth HMO/PPO payer codes or claims address.

To ensure your electronic and paper claims are accepted and processed on your initial submission, please note the following:

• Do not include the lab indicator (e.g., “A,” “H,” “L,” “M,” “N,” “T,” or “Q”) located to the right of the ID number for HMO and POS members. This will cause your claim to reject.
• When billing ID numbers containing the prefix “Q1B” (Q “one” B), please be sure to use the number “1” (one), not the letter “I.”
• Be sure to obtain the member’s current member ID number.

Read more in the October 2006 edition of Partners in Health Update.