Medical Billing XA0 Record Fields 9 Through 17

div id="body" > When doing medical billing and baby carrier electronically transmitting claims, trailer records may only be a bunch of totals to some of us. But to the insurance carrier who is being billed, these trailer records could very well mean the difference between your whole claim file being accepted or rejected. In this installment we resume our review of the XA0 claim trailer record, picking up with field number 9. XA0 field 9, positions 33 - 34, is the HXX record count. This is the number of H records, or narrative records being transmitted to the carrier. Because narrative information can be required for just about any reason, this count can be just about anything. XA0 field 10, positions 35 - 37, is the claim total record count. This is the total number of C, D, E, F, G and baby carrier H records being transmitted to the carrier. The max number allowed to be transmitted in a batch for one patient is 999. If more records need to be sent then it has to be sent in a separate batch. XA0 field 11, positions 38 - 77, is reserved and baby carrier not supported. This is a very strange mapping since there is nothing in this area that conflicts with any other record. No explanation is given in the manual as to why this area is not used. XA0 field 12, positions 78 - 84, is the total claim charges. This is the total of all billable charges to the carrier, taken from all the F records, or line item records. The max amount billable is $99,999.99. If more than this has to be billed, which is rare, then the claims must be broken up into two batches. XA0 field 13, positions 85 - 91, is the total disallowed cost containment. This is the total number of charges that are not allowed by the carrier. This figure can't be greater than the total number of charges in field 12. XA0 field 14, positions 92 - 98, is the total disallowed other. This is the total number of other charges that are not allowed by the carrier. This figure plus the figure in field 13 cannot be greater than the total number of charges. XA0 field 15, positions 99 - 105, is the total allowed amount. This is the total amount of the charges that are allowed by the carrier. This total MUST be equal to the total number of charges minus all disallowed totals or the whole claim file will be denied. XA0 field 16, positions 106 - 112, is the total deductible amount. Most insurance policies come with a deductible that needs to be met by the patient. This field is the total of all deductibles owed. XA0 field 17, positions 113 - 119, is the total coinsurance amount. This is the total amount that is covered by other insurance that the patient has. In our next installment of medical billing and baby carrier the electronic transmission of claims using NSF 3.01 specifications, we'll be covering the last six fields of the XA0 record.