Claim Rejections For Invalid Diagnosis Codes When Sending ICD-10 Codes

[Robert Gabriel]

Problem or Issue

Claims can be rejected at RelayHealth for Invalid Diagnosis Codes even though the diagnosis codes on the claims are valid ICD-10 diagnosis codes. The reason for the rejection is NOT the diagnosis codes but the diagnosis code qualifiers. Instead of the ABK or ABF qualifiers being sent on the claims the ICD-9 qualifiers are being sent (BK and BF).

Cause

There can be two causes. One is that the Iguide field for the receiver that is being used to send claims has a 4010 Iguide entered. The other cause is that for the receiver that is being used to send claims the Iguide field is blank.

Solution

In Revenue Management click on Configure then Receivers. Highlight the receiver that is being used to send claims with and scroll to the right. Click on the TX Sets field to open. Then check what Iguide is showing in the Iguide field. If the Iguide field is blank, the Revenue Management program will select a 4010 Iguide by default to send claims with. Or if the Iguide field is populated with a 4010 Iguide then the Revenue Management program will not use the ICD-10 qualifiers (ABK and ABF) in the claim file.

For Lytec the Iguide selected should be “Outbound Claims (837P Ly2014 5010 Claims – Standard)” for professional claims.

For Medisoft the Iguide selected should be “Outbound Claims (837P MS19 5010 Claims – Standard)” for professional claims.

If that does not resolve the claim rejections then a call into support will be required for further troubleshooting.

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