be denied because the name was not transmitted in the right positions.

If this sounds nit picky, it's not. There is a ton of medical information that is transmitted in each claim. If the information is not sent correctly or in the expected positions, then the receiver, or the insurance carrier, won't know what to do with the claim as there are no "human eyes" to see that the name was meant to be placed in the box or area to the left of where it was. And even then, they'll probably still reject your claim as paper billing do

This is the first in a series of articles that is going to be primarily for the tech head or somebody who is actually in the medical billing industry and sends claims electronically. This is information that you mostly get from experience, so hopefully it will be of use to those of you who fit the above description. This particular article will provide an overview of the electronic billing records in the format. Future articles will go into more detail as far as each individual record itself so you understand the major requirements of each record and field within the record. This way, if you're confronted with rejected claims, you'll have a decent idea of where to look and what to look for.

Whenever a medical record is sent electronically when doing electronic medical billing, the records have to be sent in a particular sequence, they must have all required field filled out and each required record itself must be transmitted. There are some records that are only submitted under certain conditions and they will be covered as well, but without the main records being transmitted, the entire claim will be denied.

Unlike paper claims, electronic billing formats are not easily read by the human eye unless you are really used to working with them. The only data being transmitted is the field data itself. In other words, when doing medical billing on a paper HCFA, where you would see the actual header "Patient First Name" printed on the form itself with the actual name typed in after, with an electronic billing record, the only thing that gets transmitted is the actual patient name, such as "John Doe". The header is implied. So the question most people ask is, "How does the receiver know that the name being transmitted is the patient's name if there is no header?" The answer is simple. Each piece of data is transmitted in a certain position in that particular record. This is a standard format that the receiver has been programmed to recognize. So if the patient's name is supposed to appear in the first record in positions 30 through 60 and instead is transmitted in positions 61 though 90, the claim will be denied because the name was not transmitted in the right positions.

If this sounds nit picky, it's not. There is a ton of medical information that is transmitted in each claim. If the information is not sent correctly or in the expected positions, then the receiver, or the insurance carrier, won't know what to do with the claim as there are no "human eyes" to see that the name was meant to be placed in the box or area to the left of where it was. And even then, they'll probably still reject your claim as paper billing doe

s of each record and field within the record. This way, if you're confronted with rejected claims, you'll have a decent idea of where to look and what to look for.

Whenever a medical record is sent electronically when doing electronic medical billing, the records have to be sent in a particular sequence, they must have all required field filled out and each required record itself must be transmitted. There are some records that are only submitted under certain conditions and they will be covered as well, but without the main records being transmitted, the entire claim will be denied.

Unlike paper claims, electronic billing formats are not easily read by the human eye unless you are really used to working with them. The only data being transmitted is the field data itself. In other words, when doing medical billing on a paper HCFA, where you would see the actual header "Patient First Name" printed on the form itself with the actual name typed in after, with an electronic billing record, the only thing that gets transmitted is the actual patient name, such as "John Doe". The header is implied. So the question most people ask is, "How does the receiver know that the name being transmitted is the patient's name if there is no header?" The answer is simple. Each piece of data is transmitted in a certain position in that particular record. This is a standard format that the receiver has been programmed to recognize. So if the patient's name is supposed to appear in the first record in positions 30 through 60 and instead is transmitted in positions 61 though 90, the claim will be denied because the name was not transmitted in the right positions.

If this sounds nit picky, it's not. There is a ton of medical information that is transmitted in each claim. If the information is not sent correctly or in the expected positions, then the receiver, or the insurance carrier, won't know what to do with the claim as there are no "human eyes" to see that the name was meant to be placed in the box or area to the left of where it was. And even then, they'll probably still reject your claim as paper billing do

records being transmitted, the entire claim will be denied.

Unlike paper claims, electronic billing formats are not easily read by the human eye unless you are really used to working with them. The only data being transmitted is the field data itself. In other words, when doing medical billing on a paper HCFA, where you would see the actual header "Patient First Name" printed on the form itself with the actual name typed in after, with an electronic billing record, the only thing that gets transmitted is the actual patient name, such as "John Doe". The header is implied. So the question most people ask is, "How does the receiver know that the name being transmitted is the patient's name if there is no header?" The answer is simple. Each piece of data is transmitted in a certain position in that particular record. This is a standard format that the receiver has been programmed to recognize. So if the patient's name is supposed to appear in the first record in positions 30 through 60 and instead is transmitted in positions 61 though 90, the claim will be denied because the name was not transmitted in the right positions.

If this sounds nit picky, it's not. There is a ton of medical information that is transmitted in each claim. If the information is not sent correctly or in the expected positions, then the receiver, or the insurance carrier, won't know what to do with the claim as there are no "human eyes" to see that the name was meant to be placed in the box or area to the left of where it was. And even then, they'll probably still reject your claim as paper billing do

me, such as "John Doe". The header is implied. So the question most people ask is, "How does the receiver know that the name being transmitted is the patient's name if there is no header?" The answer is simple. Each piece of data is transmitted in a certain position in that particular record. This is a standard format that the receiver has been programmed to recognize. So if the patient's name is supposed to appear in the first record in positions 30 through 60 and instead is transmitted in positions 61 though 90, the claim will be denied because the name was not transmitted in the right positions.

If this sounds nit picky, it's not. There is a ton of medical information that is transmitted in each claim. If the information is not sent correctly or in the expected positions, then the receiver, or the insurance carrier, won't know what to do with the claim as there are no "human eyes" to see that the name was meant to be placed in the box or area to the left of where it was. And even then, they'll probably still reject your claim as paper billing do

be denied because the name was not transmitted in the right positions.

If this sounds nit picky, it's not. There is a ton of medical information that is transmitted in each claim. If the information is not sent correctly or in the expected positions, then the receiver, or the insurance carrier, won't know what to do with the claim as there are no "human eyes" to see that the name was meant to be placed in the box or area to the left of where it was. And even then, they'll probably still reject your claim as paper billing doesn't give you much wiggle room either.

The main records for transmission of medical claims are the AA0, BA0, CA0, DA0, EA0, FA0, XA0, YA0 and ZA0 records. Each of these records transmits different pieces of information that are all related. For example, the CA0 record transmits patient information such as name and address.

In future articles, we'll cover each of these records plus the conditional records in more detail. Medical billing in electronic format is an exact science. One wrong character and your whole claim can be toast.