LifeWise accepts both institutional and professional claims electronically. Claims may be submitted directly by the provider or through a billing agent.
- Professional—Includes medical, chiropractic, vision and durable medical equipment, and alternative medicine
- Institutional—Includes Facility and Hospital
Electronic Format
Currently, LifeWise uses ANSI 837 Healthcare Claim ASC X12N Version 4010A1 for the claim types:
- Professional Claims
- Institutional Claims
Please note: ANSI 837 Healthcare Claim ASC X12N Version 5010 will be mandated for use on June 30, 2012
Reporting
- The LifeWise EDI process will return a Functional Acknowledgement and an Electronic Claims Transaction Report to the submitting entity. Providers who submit claims via a billing agent will likely see only the Electronic Claims Transaction Report.
Electronic Claims Transaction Report
- This report shows detailed information on all claims that were rejected and accepted
- It is important that these reports are reviewed regularly, so rejected claims may be corrected and resubmitted. If you are currently submitting claims to LifeWise and are not receiving these reports, please contact your clearinghouse or billing agent to inquire about their availability.
Eligibility
LifeWise systems perform an upfront patient validation check on all claims received. Claims for which no eligibility can be found are listed as “rejected” on our Electronic Claims Transaction Report.
Tips to minimize rejections and expedite the processing of claims:
- Some of the most common HIPAA-related rejections are invalid diagnosis codes, invalid procedure codes and/or invalid code for the date of service being billed. Be sure all code set values are current
- You must send your National Provider Identifier as the Billing Provider primary identifier, and your Tax ID or Social Security Number (SSN) as the secondary Billing Provider identifier. Improperly formatted Provider Tax ID or SSN numbers: Tax ID and SSN numbers used for billing purposes should be submitted without dashes/hyphens or spaces. The number should be properly identified as either a Federal Tax ID or Social Security Number.
- Do not list the patient’s name as the insured, unless that is truly the case.
- Verify member’s ID number
- Verify that the spelling of both the insured and patient’s names are correct (accurate spelling of member names will assist in avoiding unnecessary eligibility rejections)
- Date of birth for patient should be accurate
- LifeWise cannot accept two different years for the date of service on one bill. Please bill dates of service for different years separately
- All anesthesia claims require time, in minutes