“What Box Does my G-Code Go Into?”: Responding to Outdated Questions Related to Paper Billing Claims

Today’s blog comes from WebPT’s Billing Onboarding & Operations Manager Stacey Abelman. Thanks Stacey! 

Members often ask: where does my G-code go? Or what box does my NPI go into? Additionally, we—as the WebPT Billing Service—receive such requests as “I need my facility address changed in Box 32” or “I need to use my Tax ID instead of my SSN in box 24j.” But these “boxes” that Members sometimes refer to don't exist anymore in modern billing. In fact, they’ve become my personal four letter word. For a typical practice, 99% of claim submissions are electronic and sent in an ANSI 5010 837 format. If you are still printing paper claims for more than 1% of your payers, let’s be frank, you're outdated. And in this situation, trust me, you don't want to be outdated. 

So what is ANSI 5010 837?

This is the electronic format you should use to send claims transmissions to various carriers. ANSI stands for the American National Standards Institute; they provide hundreds of standardized formats for multiple industries. To put this in perspective, every time you swipe your debit card, the store sends an ANSI format to your financial institution, which then replies with a status message confirming that your transaction is complete. The same concept applies for medical claims: An ANSI 837 file is sent from your software vendor through a clearinghouse then onto the payer. In response, the payer then submits a return 997 acknowledgment status confirming that the electronic claim transmission was successful. 

The use of ANSI in healthcare started when users began sending electronic claims and needed a uniformed structure for practical implementation. The initial HIPAA act of 1996 made it a requirement for all payers to receive ANSI claims in an effort to provide greater patient health information security. ANSI is here to stay, and the electronic carriers—which make up 99% of all carriers—only allow you to submit claims in an ANSI 5010 837 format.

“But I really like stuffing envelopes,” you might say. “Do I have to use ANSI?”

To answer this question, I need to ask a few of my own: “Do you like to use your resources on printing, stuffing, and mailing? Do you enjoy waiting for up to two months for return paper check reimbursement? Or would you rather send your daily claims with a few clicks every evening and receive payments in about two weeks?” There are two simple arguments in support of going electronic:

1. Medicare requires you to be electronic. Granted, there are a few practices that are able to skirt around this requirement and send paper claims—for now. But, eventually this won’t be the case. Medicare will no longer want to operate the scanning equipment it takes to receive paper claims. They will require electronic claims submission only soon—very soon—so it’s in your best interest to send claims electronically. Not to mention that as soon as Medicare requires an industry standard change, the other payers are quick to follow in Medicare’s footsteps.

2.Electronic claims simply pay faster. On average, a paper claim will take four to six weeks to mail, receive, and process. Then, it’ll take another one to two weeks to receive payment. A payer generally accepts and processes an electronic claim within the first week of submittal with payment sent the following week. Personally, I’d much prefer to receive reimbursement for my services within two weeks rather than waiting eight. 

What does ANSI look like?

At first glance, an ANSI file will appear as one large data file full of names, numbers, and special characters all running together (think: someone throwing up your computer keyboard and playing 52 card pickup with all of the keys). But once you learn the ANSI language, the data file begins to tell a story. Instead of the various data elements you would find grouped together in similar boxes on a HCFA form, the data is now sectioned into loops and segments. The loops are like the paragraphs in a story and the segments are the sentences contained in each paragraph. When writing a story, the topic of each paragraph ecompasses all the sentences that fall within it, and the same applies for ANSI. Each loop will contain like information about similar topics such as rendering provider, patient demographics, payer data, and claim level details. Special characters are punctuation in ANSI. For example, spaces between data elements are indicated with an asterisk (*) and segments are completed with a tilde (~).

The bottom line:

Paper claims are on their way out—they’re expensive, time consuming, and frankly, a waste of our precious natural resources. Going electronic and using modern billing methods is not just a trend; this technology is here to stay. And that’s a good thing because by going electronic, your clinic will be able to increase your claims, decrease reimbursement times, and reduce your accounts receivable (A/R).

By the way, to answer the initial question, “what box does my G-code go into?” If you must stay in the dark ages, then populate the G-Code like any other procedure code in 24D.

Or, to receive payments faster and smarter, populate G-codes in Loop 2400 segment SV1:

LX*1~SV1*HC:G8978*11*UN*1***1~DTP*472*D8*20130111~REF*6R*75616~