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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:

01  Spouse
18  Self
19  Child
20  Employee
21  Unknown
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.