I get error messages like “ID incorrect” or “ICD‑9 code incorrect” when I submit claims electronically, but the same claims are paid when I submit them on paper. Why is that happening?

In the past, we sometimes corrected certain data errors on both paper and electronic claims when the issue involved information we could clearly identify and update. However, due to HIPAA requirements, we can no longer manually correct key data elements.

Today, claims must meet HIPAA Implementation Guide requirements and Blue Cross NC business edits exactly as submitted. Identification numbers, dates of service, place of service, diagnosis codes, procedure codes, and provider numbers can’t be changed manually during processing.

If a claim is submitted electronically with errors in any of these required fields, it will fail edits and be returned to you for correction, even if a similar paper claim may have processed in the past. To avoid rejections and delays, make sure all required data is accurate and complete before submitting the claim electronically.