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Electronic Connectivity (EDI)
EDI Documentation for Facility Providers: Claim Exclusions
The following institutional/hospital claims cannot be submitted electronically at this time:
- Medicare A bill types 33X (Home Health), 81X (Inpatient Hospice, Non Hospital based) and 82X (Inpatient Hospice Hospital based) for Medicare
- Medicare Advantage/Medicare Plus Blue bill types 81X (Inpatient Hospice, Non Hospital based) and 82X (Inpatient Hospice Hospital based)
- BCN and FEP when billing Tertiary payer COB claims
- FEP Bill types XX7 and XX8
- Out-of-State hospitals (Non-par) for Blue Cross, BCN and FEP
- BCN Secondary payer when billing Type of Bill XX7 and XX8
- BCN ESRD claims
Note: These claim exclusions reflect those listed in the current ANSI ASC X12N 837 & 835 Institutional Health Care Claim & Health Care Claim Payment/Advice Companion Document (PDF).
