| When doing medical billing, a lot of | | | | or tertiary. You can have up to three DA0 |
| information needs to be transmitted. So far | | | | records for each claim, designated DA0-01, |
| in this series we have covered information | | | | DA0-02 and DA0-03.DA0 field 3, positions 6 - |
| that identifies the provider of services and | | | | 22, is the patient ID number. This is the |
| the patient. Now, we have to cover | | | | number that identifies the patient and must |
| information that identifies the insurance | | | | match the number transmitted in the CA |
| carrier the claim is actually going to. | | | | records, both CA0 and CA1, as well as the CB |
| While this may seem unnecessary, since the | | | | records if they are sent as well. Notice the |
| person receiving the claims knows who they | | | | positions are all the same. This makes it |
| are, this is actually a safeguard to make | | | | easier to check for accuracy.DA0 field 4, |
| sure that claims don't get sent to the wrong | | | | position 23, is the claim filing indicator. |
| insurance carrier. The record that sends | | | | This indicates if the claim is primary, |
| this information is the DA0 record. We'll | | | | secondary, etc. This is important so the |
| begin going over the specifications for that | | | | carrier knows how much they are to be paying. |
| record in this review.DA0 field 1, positions | | | | Most primaries pay 80% and most secondaries |
| 1 - 3, is the record type. This needs to be | | | | pay the remaining 20%.DA0 field 5, position |
| filled in with DA0 or the claim will be | | | | 24, is the payment source. This tells the |
| denied.DA0 field 2, positions 4 - 5, is the | | | | carrier where the payment is supposed to be |
| sequence number. This requires a little | | | | coming from. Again, you would think they |
| explaining and also clarifies why this record | | | | would know this, but it is to assure that the |
| needs to go at all.When medical billing a | | | | right carrier gets the right claim.DA0 field |
| claim to an insurance carrier, whether it be | | | | 6, positions 25 - 26, is the insurance type |
| Blue Cross, Medicare, Medicaid, or some | | | | code. This is a code that the software |
| private insurance, many patients have more | | | | usually gets from a lookup table in the |
| the one type of coverage. Some have Medicare | | | | program that identifies what type of |
| and Medicaid. Others have Blue Cross and a | | | | insurance the patient has.DA0 field 7, |
| private insurance like Prudential. In these | | | | positions 27 - 31, is the National Payer |
| cases, especially in the cases of Medicare | | | | Organization ID number. This is a number |
| which usually only covers 80% of the costs, | | | | that is assigned to every payer in the |
| multiple insurance carriers are billed. To | | | | country. This number must match the actual |
| do this, you need to send multiple DA0 | | | | payer you're billing or the claim won't be |
| records. The sequence numbers, 01, 02, etc., | | | | paid.In the next article in this series, |
| designate the number of the insurance carrier | | | | we'll continue with DA0 field number 8. |
| being billed, such as the primary, secondary | | | | |