Top Billing Errors and How to Avoid Them

When the processing of claims is delayed, it’s frustrating for everyone involved — providers, administrative personnel, and members.

The chief cause of claim delays is missing, incomplete, or incorrect information. When that happens, then the claim cannot be processed.

What Can You Do

It’s important to double-check all appropriate fields before submitting a claim.

To help administrative personnel who submit claims, we’ve compiled a list of top errors and how to avoid them below.

Use this list as a “cheat sheet” when you do a final review before submitting a claim:

 Reporting Error  Correction
Incorrect provider number listed Generally, the billing provider number is the assignment account, while the performing provider number is the individual practitioner. If practices are unsure which National Provider Identifier (NPI) to use (assignment account/group or individual practitioner/group member), they should contact Highmark Provider Services using the Highmark provider portal.
Performing provider name and number The performing provider name and provider identification number should be reported on the claim when it is different than the billing provider identification number.
Invalid place of service codes submitted and/or the facility name and number are not listed Ensure the correct place of service code is being used. When the place of service is different than the billing provider’s address (e.g., Hospital or Skilled Nursing Facility), ensure a service facility location and identification number are reported.
NOC (not otherwise classified) codes listed without descriptions Descriptions of the service provided must be reported on the claim for NOC codes.
Applicable coordination of benefits/other insurance information and/or documentation are not accompanying the claim Please make an effort to report electronically or attach coordination of benefits/other insurance information.
Member identification numbers are incomplete List the complete member identification number, including any alpha prefix.
Claims are range-dated, but the number of services does not clearly correspond with the date range (e.g., indication that services were performed 01-01-23 through 01-10-23 but list only five services) When services span over a period of days, the number of services should correspond on a one-on-one basis if you are range-dating (indicating that services span from one date through another date). If they do not correspond on a one-on-one basis, you should itemize the services.
Submit Healthcare Common Procedure Coding System (HCPCS) codes that are not valid for the time the service was rendered (e.g., billing for a service performed in 2022 with a code that was not in place until 2023 or vice versa) Report correct procedure codes that are valid for the date of service.
Invalid diagnosis code Report diagnosis codes that are the highest degree of specificity and valid for the date of service.