ICD-10 Common Hard Copy Claims Submission Issues
ICD-10 Issues
Rule
Claim
The ICD-10 surgical procedure codes should not
contain a decimal point
Institutional (UB-04): Box 74
Professional (CMS-1500): NA
Incorrect
Correct
Example: UB-04 Box 74
1
Rule
Claim
The ICD-10 diagnosis codes should not contain a
decimal point
Institutional (UB-04): Box 67, 69, 70
Professional (CMS-1500): Box 21
Incorrect
Correct
Example: UB-04 Box 67, 69, 70
Incorrect
Correct
Example: CMS-1500 Box 21
2
Rule
Claim
The ICD Indicator should be 9 for ICD-9-CM codes Institutional (UB-04): Box 66
or 0 for ICD-10-CM codes
Professional (CMS-1500): Box 21
Incorrect
Correct
Example: UB-04 Box 66
Incorrect
Correct
Example: CMS-1500 Box 21
3
Rule
Claim
The diagnosis codes should be ordered
horizontally (vs vertically)
Institutional (UB-04): Box 67
Professional (CMS-1500): Box 21
Incorrect
Correct
Example: UB-04 Box 67
Incorrect
Correct
Example: CMS-1500 Box 21
4
Rule
Claim
Enter the code reference letter (pointer) as shown Institutional (UB-04): NA
in item Number 21 to relate the date of service
and the procedures performed to the primary
Professional (CMS-1500): Box 24E
diagnosis.
Incorrect
Correct
Example: CMS-1500 Box 24E
5
Other Issues
Rule
Hand written claims are difficult for our systems
to capture data accurately
Claim
All
Rule
Claim
AlohaCare does not accept black and white claim All
forms
Rule
Claim
The birth date of the member should be accurate Institutional (UB-04): Box 10
Professional (CMS-1500): Box 3
6
Rule
Claim
The bill type should be four characters (e.g., 131
vs 0131)
Institutional (UB-04): Box 4
Professional (CMS-1500): NA
Incorrect
Correct
Example: UB-04 Box 4
7
Rule
Claim
The revenue codes should be four characters
(e.g., 250 vs 0250)
Institutional (UB-04): Box 42
Professional (CMS-1500): NA
Incorrect
Correct
Example: UB-04 Box 42
8
Rule
Claim
Insured’s Policy Group or FECA Number should
not be left blank (put ‘None’ if there is not
applicable number
Institutional (UB-04): NA
Professional (CMS-1500): Box 11
Incorrect
Correct
Example: CMS-1500 Box 11
9
Rule
Claim
The units on claim lines should be populated (and Institutional (UB-04): Box 46
not left blank)
Professional (CMS-1500): Box 24G
Incorrect
Correct
Example: UB-04 Box 46
Incorrect
Correct
Example: CMS-1500 Box 24G
10