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Although the pre-adjudication edits are relaxed, the claims will reject in the adjudication process and will still be reported on the rejection report.

Correction to yesterday's alert:

We are still processing laboratory claims.

• Claims adjustment
• Laboratory claim processing
• CRC claim processing

CBH will notify providers when these activities are resumed.

For the next month, CBH will make a 277 file available to the providers which will give a warning as to what claims would have failed with the edits enforced.  Although the pre-adjudication edits are relaxed, the claims will reject in the adjudication process and will still be reported on the rejection report.  The edits will be enforced again beginning July 7, 2004.

Receiver ID is missing
Receiver ID is not “232766661”
Billing Provider PROMISe ID is missing
Billing Provider PROMISe ID is not a 13 digit number
Pay-To Provider PROMISe ID is missing if Pay-To Provider information is sent
Pay-To Provider PROMISe ID is not a 13 digit number if Pay-To Provider information is sent
Subscriber’s CIS Number is missing
Subscriber’s CIS Number is not a 10 digit number
Payer ID is not “232766661”
Prior authorization number is missing
Prior authorization number is not numeric
Principal diagnosis code is missing
Principal diagnosis code is not 3 to 5 characters
Any diagnosis code contains a decimal
Rendering provider’s promise ID is not a 13 digit number if sent
Service unit count is missing
Service unit count is not greater than “0”
Patient is sent as a dependent instead of as a subscriber

Submitter ID is missing
Submitter ID is not a 13 digit number

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