Is there any built in functionality to split claims with more than 12 diagnoses? We are getting rejections from the clearinghouse and need to figure out a solution. I understand the limit on the 1500 form, but don’t really understand why an x12 file would get rejected except for limitations on the receiving end.
Any insight or guidance on this is appreciated. I have searched the forums and not found this discussion so far. Thank you.
hi @echocron, this code block was removed with this PR
from a billing perspective only the codes that justify the procedure should go on the claim
Thanks Stephen. We are able to submit more than 12 diagnoses on the claim. The problem is it is getting rejected by our clearing hose and they are asking to split it into two claims.
We are not submitting fee for service claims but are in a capitated model where we manage risk and have to submit claims as proof of services provided to CMS. As such we need to include as many diagnosis as appropriate for that purpose, which sometimes exceeds 12.
pretty sure 837 X12P specs limit to 12
