Some errors in the claim file (EDI 837) and their impact

There can be errors in the following fields in a claim file:

1. Diagnosis and procedure codes: These codes are used to identify the patient's medical condition and the medical services provided, respectively. Incorrect codes or coding errors can result in inaccurate or incomplete information being transmitted, which can impact patient care and payment.
2. Claim information: This includes fields such as the total amount charged for the medical services, the amount paid by the insurance company, and the amount owed by the patient. Errors in these fields can result in overpayment or underpayment, which can lead to financial losses for healthcare organizations and confusion for patients.
3. Patient demographic information: This includes fields such as the patient's name, address, and insurance information. Errors in these fields can result in misidentification of patients, delays in treatment, or incorrect billing.
4. Referral information: If the patient was referred to a specialist or another healthcare provider, errors in this field can result in delays or errors in treatment, as well as incorrect billing.

For related reading, a good resource is available on the Los Angelese county, US website: https://publichealth.lacounty.gov/sapc/NetworkProviders/ITForms/CriticalErrorReportGuide837Files.pdf