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