How to File Your Claims - pshpgeorgia.com

July 24, 2006

How to File Your Claims

Our goal is to ensure that our provider community is aware of required information
that must be provided when submitting claims to avoid claim denials and payment
delays. We appreciate your partnership with Peach State and the services that you
provide to our members. To ensure all claims are processed timely and accurately,
please adhere to the following guidelines:

► File all claims with the provider’s Medicaid Id number which consists of three
leading zeros and ends with an alpha character.

► The Medicaid number must be listed in Box 24K on the CMS 1500 forms OR in
Box 51 of the UB 92 forms.

► The Medicaid Id number is the provider identification number.
► A missing Medicaid Id Number will cause your claim to deny. If it is not

located in the appropriate field, the processing of your claim will be
delayed.
► To prevent claim delays, contact Peach State today to update your Medicaid Id
numbers for each practice location.

Additional information is available online, www.pshpgeorgia.com, select the “Provider
Resources” link for Peach State’s Claims Submission Guide. Please contact the
Provider Services Department regarding any claim inquiries at 1-866-874-0633.

Filing Electronically?

There are five clearinghouses available to our providers when filing electronically. If
your clearinghouse vendor is not listed below, please contact your current EDI vendor
to arrange claims submission through one of the vendors listed. You can reach our EDI
department at 1-800-225-2573, ext.25525.

Clearinghouses Payer Ids
ACS EDI Gateway, Inc 77084 Providers must register with ACS
Emdeon aka WebMD 68049
McKesson Professional P2417 and Institutional I1921
MedAvant akaProxyMed 68049
PayerPath 97245

Peach State Health Plan * Provider Relations Department * www.pshpgeorgia.com * If you have questions please feel free to call us at 1-866-874-0633

Peach State Payment Explanation (EX) Codes

Provided in the table below are the most common EX codes for claim denials with Peach

State. Please correct any errors associated with these codes before resubmitting your

claim. A complete listing of EX codes are available on the PeacJhuSlytat2e4w, e2b0s0ite6,
www.pshpgeorgia.com, select the link for “Provider Resources”.

EX Codes Descriptions
MA Medicaid Id number missing or not on file, please correct and resubmit.
18 Deny: Duplicate claim/service
DS Deny: Duplicate submission-original claim still in pend status
LO Deny: CPT & Location are not compatible, please correct and resubmit.

46 Deny: This service is not covered
I6 Deny: Diagnosis or CPT/HCPCS/ICD-9 procedure code invalid for date of service
MG Deny: Signature missing from box 31, please correct and resubmit
4D Deny: Non-specific diagnosis-requires 5th digit, please correct and resubmit
47 Deny: This diagnosis is not covered
MQ Deny: Member name/number/date of birth do not match, please correct and resubmit
28 Deny: Coverage not in effect when service provided
46 Deny: This service is not covered
16 Deny: Revenue code not reimbursable-CPT/HCPCS code required
A1 Deny: Authorization not on file

HIPAA Compliant EDI Rejection Codes

These codes are the standard national rejection codes for EDI submissions. All errors
indicated for the code must be corrected before the claim is resubmitted. Please see
Peach State’s list of common EDI rejections to determine specific actions you may need
to take to correct your claims submission. A complete listing is available on the website,
www.pshpgeorgia.com, select the link for “Provider Resources”.

Most Common EDI Rejections for Peach State

06 Invalid/Missing Provider Number
ƒ Provider Medicaid Id number not found in Peach State’s system (provider not enrolled or
setup)
ƒ Provider Medicaid Number not ten digits in length (number must be 10-digits with leading
zeros and ends in a alpha character)
ƒ Provider Medicaid Number not in REF*1D or REF*G2 segment
ƒ Provider using an Office Medical Management software package and provider number is not
setup correctly

02 - Member Id not found/ Invalid Id submitted.
74 - Dates of Service prior to 06/01/2006
08 – Invalid Member and Provider

Refer to reason codes 02 and 06

Important: Providers are encouraged to obtain the Claims Audit
(error/submission) Report from their clearinghouse vendor to confirm claims
were successfully submitted electronically. Please make certain all error codes
are resolved before resubmitting claims.

Peach State Health Plan * Provider Relations Department * www.pshpgeorgia.com * If you have questions please feel free to call us at 1-866-874-0633

EDI Professional 837 Companion Guide

Peach State has developed a technical companion guide to assist appliJcautiloyn2d4ev,e2lo0p0er6s

during the implementation process. The Professional 837 Companion Guide is available
on the Peach State website, www.pshpgeorgia.com, select the link for “Provider
Resources”. Please contact the EDI department with questions or concerns regarding EDI
at 1-800-225-2573, ext. 25525.

Electronic Funds Transfer (EFT)

The Electronic Funds Transfer Agreement is available on the website. Go to
www.pshpgeorgia.com and click on the link for “Provider Forms” to download the EFT
agreement. Please complete the form and return it via fax to 1-877-683-3155.

Peach State Secure Web Portal

The following services are available via the secure web portal: State website,
- Member eligibility,
- PCP verification,
- Submit claims and
- Claims inquiry.

The Web Enrollment Form is available on the Peach
www.pshpgeorgia.com, select the “Provider Forms” link.

If you are interested in Secure Web Portal training, please contact Provider Services at
1-866-874-0633 or [email protected].

Peach State Health Plan * Provider Relations Department * www.pshpgeorgia.com * If you have questions please feel free to call us at 1-866-874-0633