March 30, 2012
Claims Submission Reminder
Due to 5010 requirements and limitations, all claims need to include the patient date of birth and patient relationship to member. Otherwise, your claim could be denied. If any data including first name, last name and date of birth does not match between the patient and insured portions of the claim, it will be denied with the denial remark code “JP”. “JP” indicates the following description: Claim Denied. Information in Box 6 of Claim Form is either Missing, Incomplete, or Invalid Patient relationship to the Member.
The individual relationship code (IRC) value of “21” = “Unknown” should NOT be used when describing patient relationship to member. The most common indicators for patient relationship to member on electronic submissions are listed below:
39 Organ Donor
40 Cadaver Donor
53 Life Partner
G8 Other Relationship
Please call your professional relations representative or the Provider Network Services at 1-800-432-3587 or 785-291-4135, option 1, if you have any questions.