Payor Billing Errors

All of these billing warnings can be viewed in Enterprise Edition by proceeding to Master Files | Payors / Plans | Payor Billing Errors.

Error ID

Field Name

Error Message

Remedy

Hidden

Editable

01AGFEDTAX

Agency Fed Tax ID

Required element missing

Enter an agency tax ID in 'Master Files'

1

0

01AGNAME

Agency Name

Required element missing

Enter an agency name in 'Master Files'

1

0

01AGADDR

Agency Address

Required element(s) missing

Enter an agency address in 'Master Files'

1

0

01AGPHONE

Agency Telephone Number

Required element missing

Enter an agency telephone number in 'Master Files'

0

1

10MCRPRV

Medicare and/or National Provider

Required element missing

Enter a Medicare and/or National Provider Number in 'Agency Master'

1

0

20PRHOLD

Prior Hold

Cannot bill this patient due to prior holds

Remove holds in prior batches & bill those items first.

1

0

20LNAME

Last Name

Required element missing

Enter last name in 'Patient/Referral'

1

0

20LNAME

First Name

Required element missing

Enter first name in 'Patient/Referral'

1

0

20INSSEX

Insured's Sex

Invalid gender

Enter valid sex code in 'Demographics'.

1

0

20DOBGR

Patient Date of Birth

WARNING: %1 is greater than the admit date of %2

Verify birthdate in 'Demographics'.

1

0

20DOBFTR

Patient Date of Birth

WARNING: Future date

Modify birthdate in 'Demographics'.

1

0

20DOBINV

Patient Date of Birth

WARNING: Is %1 correct?

Verify birthdate in 'Demographics'.

1

0

20DOBMIS

Patient Date of Birth

Required element missing

Enter birthdate in 'Demographics'.

1

0

20PTADDR

Patient Address

Required element missing

Enter address in 'Address/Phones'.

0

1

20PTCITY

Patient City

Required element missing

Enter address in 'Address/Phones'.

0

1

20PTST

Patient State

Required element missing

Enter address in 'Address/Phones'.

0

1

20PTZIP

Patient Zipcode

Required element missing

Enter address in 'Address/Phones'.

0

1

20ADMDATE

Admission Date

Required element missing

Enter admission date in 'Admission'.

1

0

20PTSTNUM

Patient Status

Non-numeric entry.  Must be a valid numeric value.

Non-numeric entry.  Must be a valid numeric value.

1

0

20PTSTINV

Patient Status

Invalid code value.

Update code values in 'Admit/Dschg'.

0

1

20PTSTMIS

Patient Status

Required element missing.

Update code values in 'Admit/Dschg'.

1

0

20PTSTLAMD

Patient Status

Invalid code value for Louisiana MCDR&B.

Update code values in 'Admit/Dschg' using secondary LAMCDRB status dropcombo.

0

1

30INSPAYOR

Payor Identification Number

Required element missing

Add a payor for patient in 'Insurance'.

0

1

30MCDNUM

Medicaid#

Required element missing

Update Medicaid Billing # in 'Patient Insurance'.

0

1

30HICNUM

HIC#

Required element missing

Update HIC# in 'Patient Insurance'.

1

0

30INSCVST

Patient Insurance Coverage

Ins. coverage start date greater than batch start date

Update coverage start date in 'Patient Insurance'.

0

1

30INSCVEND

Patient Insurance Coverage

Ins. coverage end date less than batch end date

Update coverage end date in 'Patient Insurance'.

0

1

30PYRNM

Payor Name

Required element missing

Update Name in 'Payors'.

0

1

30PROVNUM

Provider Number

Required element missing

Enter an agency NPI in 'Master Files'

0

1

701PRIMDIA

Primary Diagnosis

Required element missing

Designate a diagnosis as primary in 'Patient Prognosis/Diagnosis.'

1

0

80PHYS

Attending Physician

Required element missing

Enter an attending physician in 'Patient/Referral'

1

0

80PHYSNPI

Attending Physician NPI

Required element missing

Record attending physician NPI # in 'Master Files'

0

1

80PHYSID

Attending Physician Identifier

Required element missing

Record attending physician UPIN, License, or Registration # in 'Master Files'

0

1

80PHYSNM

Attending Physician Name

Required element(s) missing

Record attending physician first & last name in 'Master Files'

0

1

MPOUNSGN

Unsigned Med Orders

There are Medication Physician Orders not signed by a physician for this episode. Order Ids: (%1)

Use Document Tracking/Orders or firstCPO to log your orders as received/signed.

0

1

PHYSORDERS

Physician Orders

There are physician orders not signed by a physician and/or medical director.  Order Ids: (%1)

Use Document Tracking/Orders or firstCPO to log your orders as received/signed.

0

1

40OCDATE

OccurrenceCode / Date

No or partial election coverage for this date range which may impact the calculation for Routine Home Care.

Update patient election periods in Patient Management.

0

1

61UNITS

Units of Service

Less than 8 hrs/day on some/all ContinuousCare days

Continuous Care requires a minimum of 8 hours, with no partial hour rounding.

0

1

61LOCMIS

Location

Location '%1' could not be found or HCPCS not defined for it.

Associate with a valid location or add the HCPCS to it.

1

0

61LOCGEN

Location

Claim contains a place of service not appropriate for general inpatient care.

Associate with a valid place of service.

0

1

61LOCRSP

Location

Claim contains a place of service not appropriate for respite care.

Associate with a valid place of service.

0

1

61LOCCC

Location

Claim contains a place of service not appropriate for continuous home care.

Associate with a valid place of service.

0

1

61LOCGIP

Location

Claim contains a place of service not appropriate for GIP or respite care.

Associate with a valid place of service.

0

1

70SQ1UNITS

Units of Service

Continuous Care units do not match visit hours.

Ensure supporting visit hours are appropriate for continuous care units.

0

1

701PDIAGV

Primary Diagnosis

Effective with date of service 01/01/2008, 'V' codes can no longer be the primary diagnosis code on your patient bill.

Designate a primary diagnosis that is not a 'V' code in 'Patient Prognosis/Diagnosis.'

1

0

80CERTPHYS

Certifying Physician

Certifying physician not found.

Certifying physician cannot be identified.  Attending will be used.

0

1

80NF

Nursing Facility

Required element missing.

Select a Nursing Facility in 'Patient Level of Care'

0

1

80NFNPI

Nursing Facility NPI

Required element missing.

Enter a Nursing Facility NPI in 'Nursing Facilities'

0

1

CBSA2006

CBSA

CBSA is no longer valid after 9/30/2006.  The current CBSA of %1 was looked-up and used to Calculate the Net Charges.

Update CBSA in 'Address/Phones'.

0

1

20NOCOUNTY

Patient County

No county selected in patient address. Reimbursement will be affected.

Enter county in 'Address/Phones'.

0

1

01NOMCRPVD

Medicare Provider Number

Required element missing.

Enter a Medicare Provider Number in 'Master Files'

1

0

61GIPDAYS7

Quantity

Patient Gen Inpatient stay greater than 7 days.

The level of care indicates a general inpatient stay exceeding 7 days.  Confirm level of care screen accurately reflects patient's GIP stay.

0

1

VISIT0HOS

Time Value

A visit on this patient has a zero or negative duration.

Ensure visit hours are appropriate for the visit.

0

1

40OCCGAP

OccurrenceCode / Date

A gap between 2 or more election periods.  Missing coverage.

Update patient election periods in Patient Management.

0

1

40REVOCOD1

Condition Code

Invalid Code Combination

Verify Condition Codes. Medicare will return Hospice Claims that contain both 52 and H2.

0

1

40REVOCOD2

Condition Code

Invalid Code Combination

Verify Condition Code and Occurrence Code. Medicare will return Hospice Claims that contain CC 52 and OC 42.

0

1

40REVOCOD3

Condition Code

Invalid Code Combination

Verify Condition Code and Occurrence Code. Medicare will return Hospice Claims that contain CC H2 and OC 42.

0

1

40REVOCOD4

Condition Code

Invalid Code Combination

Verify Patient Status and Condition Code. Medicare will return Hospice Claims that contain CC 52 when Patient Status is 30.

0

1

40REVOCOD5

Condition Code

Invalid Code Combination

Verify Patient Status and Condition Code. Medicare will return Hospice Claims that contain CC H2 when Patient Status is 30.

0

1

40NOOCC55

Occurrence Code

Occurrence code 55 must be present when patient discharge code is that of expired (20, 40, 41 or 42).

Update occurrence code values on discharge codes in Reference Files, screen Admit / Dischg Status codes.

0

1

NOFORMAT

Billing Format

No billing format is specified for Payor: %1, Plan: %2

Save a billing format for the plan

1

0

NOPLAN

Billing Format

No billing options are saved for Payor: %1

Save billing options for the plan

1

0

F2FNODOCHS

Face to Face Document

The F2F document is missing for cert period %1 - %2.

Create a F2F Document.

0

1

F2FHOSDATE

F2FDate

The F2F date is missing for cert period %1 - %2.

Insert the F2F date on patient Election Period tab.

0

1

F2FOORHOS

F2FDate

The F2F date %1 is outside the accepted range. Acceptable range is %2 - %3.

Verify the date entered is the correct date.

0

1

F2FNOSIGHS

Physician Signature Date

F2F encounter documents exist for this patient but the document may not be returned/signed by a physician or marked permanent.

The F2F document has not been signed by physician.

0

1

PHYSOORHOS

Physician Signature Date

The physician signature date %1 is outside the accepted range. Acceptable range is %2 - %3

Verify the date entered is the correct date.

0

1

F2FENCMHOS

Certify Date

The F2F date is missing for this billing period.

Insert the F2F date on patient Clinical Document tab.

0

1

F2FENCIHOS

Certify Date

The F2F date %1 is outside the accepted range. Acceptable range is %2 - %3.

Verify the date entered is the correct date.

0

1

IPOCPO

Initial Plan of Care / Physicians Orders

There are Initial Plan of Care/Physicians Orders not signed by a physician and/or medical director.  Order Ids: (%1).

Use Document Tracking/Orders or firstCPO to log your orders as received/signed.

1

1

VSTNRHOS

Visit Status

Visit(s) exist within the billing date range that need to be cancelled and/or released: %1

Cancel or release the visit

0

1

IPOCPOV6A

Initial Plan of Care / Physicians Orders

There are Initial Plan of Care/Physicians Orders not signed by an Attending Physician. Order Ids: (%1).

Use Document Tracking/Orders or firstCPO to log your orders as received/signed.

0

1

IPOCPOV6H

Initial Plan of Care / Physicians Orders

There are Initial Plan of Care/Physicians Orders not signed by a Hospice Physician. Order Ids: (%1).

Use Document Tracking/Orders or firstCPO to log your orders as received/signed.

0

1

RPOCPO

Recert Plan of Care / Physicians Orders

There are Recert Plan of Care/Physicians Orders not signed by either an Attending or Hospice Physician. Order Ids: (%1).

Use Document Tracking/Orders or firstCPO to log your orders as received/signed.

0

1

INVPRMDIAG

Primary Diagnosis

Invalid Primary Diagnosis Code

Medicare will RTP all claims with this principal diagnosis as of 10/1/2014 due to Change Request 8877. The principal diagnosis should be the condition determined by the certifying hospice physician(s) as the diagnosis most contributory to the terminal decline.

0

1

HSPNOACPT

NOE Accept Date

The NOE Accept Date for the admission is not populated.

Populate the NOE Accept Date on the Admission Screen.

0

1

NOICD10

Diagnosis Codes

Claim requires ICD-10 codes, but the admission has diagnosis codes with no corresponding ICD-10 code selected.

Resubmit the rejected admission with ICD-10 codes included.

0

1

MEDFILLQTY

Medication fill package quantity

Medication fill package cannot equal 0.00

Ensure all package quantities in medication fills are properly entered or imported.

0

1

MISSINGPER

Missing Benefit Periods

You have indicated the patient was previously on hospice care, but no prior benefit period information exists which may impact the calculation for Routine Home Care.

Enter the Custom Historical Election Period(s) that exist for the patient.

0

1

ZEROCHARG

Visit Total Charges

Total charge for %1 visit cannot equal $0.00

Ensure that all visits in productivity for this patient have a charge associated.

0

1

SERVICE50

Service Details

Claim Level - There are more than 50 service lines on this claim.

Select a revenue code grouping option in 'Billing Formats'.

0

1

O1MCRSUB

Medicare Submitter ID

Medicare Submitter ID is missing from Agency.

Add Medicare Submitter ID to Agency Master File for office being billed.

1

0

80PHYSECID

Medicaid Provider IDs

The attending physician (%1) is missing their Medicaid Provider ID in Master Files. State=%2.

In Physician Master Files add the attending's state Medicaid number to the Physician record.

0

1

30MCDSTATE

Plan Medicaid State Form

The plan (%1 / %2) does not have a Medicaid State Form state specified.

In the Billing Formats tab of the Payors/Plans master file editor, select a Medicaid State Form state. This is necessary when Use Medicare Provider Number is checked.

0

1

01AGCITY

Agency Office Address, City, State and Zip Code

The office Address, City, State and/or 9-digit Zip Code is blank.

Please enter agency office address, city, state, and full 9-digit zip code.

1

0

30PROVNPI

National Provider ID

The office NPI number is blank.

Please enter the National Provider Identifier for the office being billed.

1

0

2010AAN301

Agency Pay-To Physical Address

Agency physical address must be complete when the agency address is a PO Box.

Enter a complete Physical Address Line1, City, State and Zip in the agency master files Pay-To Address tab.

1

0

61HOSSVCDT

Service Date

Service line From date (%1) is outside the statement span (%2-%3).

Correct service date.

0

1

01RECEIVER

Receiver ID

Payor does not have a receiver selected.

Assign a receiver to the payor.

1

0

01MCRSUBID

AgencyReceiver

Receiver %1 is not associated with the office %2.

In the Agency | Electronic Submitters screen, associate receiver %1 with office %2.

1

0

01AGENCYCT

Office Phone or Fax or Email

Agency contact information is missing or invalid.

Please enter an agency contact office phone number, fax number or email address.

1

0

61HCPCS

HCPCS

HCPCS code is required on Hospice Medicare claims.

Verify Location of Care set on Patient Level of Care screen shows Location HCPCS value. If not, update in Location Codes.

0

1

61UNITBLAN

Units

Service line units are missing.

Correct service line units.

0

1

61MAXUNITS

Units

Cannot bill more than 96 units per day of Continuous Care.

Correct daily hours to equal 96 units or 24 hours total.

0

1

20PAYSRCNM

Payment Source

Payment Source does not match receiver ID.

Update the payor's payment source to be Medicare A or update the payor's receiver ID to not be a Medicare receiver ID.

0

1

80FACILITY

Facility NPI, address, city, state and zip

Service Facility Information invalid or incomplete.

Verify Service Facility NPI, address, city, state and 9 digit zip exist.

1

0

20PAYSRCM

Payment Source

Payment Source does not match receiver ID.

Update the payor's payment source to not be Medicare A or update the payor's receiver ID to be a Medicare receiver ID.

0

1

20PTADRRNG

Patient Effective Address Dates

Patient does not have effective address dates that span this billing date range.

Updated the Effective Thru date for the address to span the entire billing period.

0

1

DOCLOCNV

Document Status

Document(s) exist within the billing date range that are locked but Visit Details not completed: %1

Enter the appropriate Visit Details (P-Page) information and save the document.

0

1

DOCNLOC

Document Status

Document(s) exist within the billing date range that are not locked and Visit Details not completed: %1

Users can either check the Time Not Recorded box within the document (to indicate visit details are not required) or enter the Visit Details (P-Page) information and lock the document. Additionally, users have the option to delete the entire document.

0

1

DOCNLOCV

Document Status

Visit(s) exist within the billing date range that are attached to Visit Details and document is not locked: %1

Lock the document.

0

1