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McKesson Lytec & Medisoft – Claim Rejections at RelayHealth for Missing/Invalid Diagnosis Codes

• Release impacted: Lytec 2014 and 2015 or Medisoft 19 and 20
• Customer impact: Claim rejections at RelayHealth for Missing/Invalid Diagnosis Codes

Issue:
Claims sent to RelayHealth are being rejected for Missing/Invalid Diagnosis Codes. When the codes that are on the claims are checked they are valid ICD-10 diagnosis codes. The reason for the rejection is NOT the diagnosis codes but the diagnosis code qualifiers. Instead of the ABK or ABF qualifiers being sent on the claims the ICD-9 qualifiers are being sent (BK and BF).

Possible Resolution:
In Revenue Management click on Configure then Receivers. Highlight the receiver that is being used to send claims with and scroll to the right. Click on the TX Sets field to open. Then check what Iguide is showing in the Iguide field. If the Iguide field is blank the program will select a 4010 Iguide as a default. Or if a 4010 Iguide is selected the ICD-10 qualifiers (ABK or ABF) will not be sent on the claims.

For Lytec the Iguide selected should be “Outbound Claims (837P Ly2014 5010 Claims – Standard)” for professional claims.

For Medisoft the Iguide selected should be “Outbound Claims (837P MS19 5010 Claims – Standard)”.

If that does not resolve the claim rejections then a call into support will be required for further troubleshooting.

Sincerely,

MPM Support