News
ATTN: New York Customers
Beginning March 21, 2010 the following edit changes will be implemented for all trading partners submitting claims for BlueCross BlueShield of Western New York, BlueShield of Northeastern New York, or HealthNow New York, Inc.
Eligibility editing on all Professional, Institutional and Dental claims will now require a birth date match. (This new edit will be a warning for 30 days.) Claims will reject beginning April 20, 2010 when the Patient ID number and date of birth do not match the data on the payers eligibility file. This edit will be bypassed for newborns that are less than 60 days old.
| Edit Code |
Edit Message |
| H244 |
Patient ID and Date of Birth Mismatch |
All diagnosis codes submitted on Professional claims will be validated with the following edits. This editing will apply to diagnosis codes submitted regardless of whether there is a diagnosis code pointer.
| Edit Code |
Edit Message |
| H245 |
Diagnosis Code is Invalid |
| H400 |
Service Dt prior to Prin Dx Cd Effective Date |
| H401 |
Service Dt after Prin Dx Cd Cancel Date |
| H402 |
Service from Dt prior to Prin Dx Cd Effective Date |
| H403 |
Service thru Dt after Prin Dx Cd Cancel Date |
The following edit will be removed. Only the organizational/billing NPI will need to be enrolled.
| Edit Code |
Edit Message |
| H104 |
Rendering NPI not tied to TP number |
| H105 |
Rendering NPI - failed EDI Authentication |