and they all do different things and have to come in a certain order in the claim file itself. There are trailers on a claim level, trailers on a batch level, as you can have multiple batches in a file and trailers on a file level, which is basically a trailer that totals up all the records and dollar amounts in the entire file.

Confused? You're not alone. Many professional billers feel that the insurance carriers put in all these requirements, that mind you are not required with paper claims, in order to make the process more complicated and provide

If you've been following our series on medical billing and more specifically, our series on electronic billing of claims using NSF 3.01 specifications, you have no doubt noticed that there are quite a few records involved with sending a claim to a carrier, whether it be Medicare, Medicaid, or a private insurance company. Well, before we go into explicit detail on the trailer record specifications themselves, a general overview on trailer records is probably in order. Why? Well, unfortunately, even if the individual claims in a submission are clean, meaning no errors or violations, a problem with any of the trailer records can get not just one, but ALL the claims rejected.

The individual records, or claims in a claims file, need to have all the individual I's dotted and T's crossed. But still, that isn't enough. Because all of those individual claims need to be totaled up. In other words, if the sum amount of all your claims comes out to $759.83, then your total record better show $759.83 in total claims and not $759.84. Just one penny off in your totals record and your whole batch, not just one claim, will be rejected.

Totals of dollars is not the only thing that has to be just right. The trailer, or totals records, count up a lot of other things as well. One of the main things that is counted in the trailer records is the actual number, not only of claims, but of records themselves. If you recall from our series so far, every claim has a C record, to identify the patient, a D record to identify the carrier, E records to identify the facility, F records to identify the item being billed, G records to identify any CMNs that are transmitted with the claim and H records to give any additional narrative information that has to be transmitted in order to justify the claim. Well, all of those records have to be totaled. Individually and together. If you're even one record off in your totals, the whole batch is denied along with every claim.

Aside from all of the above, other items are totaled as well, including all deductibles, co-pays, payer pays, patient pays and any other dollar amounts besides the actually claim dollars. And if that isn't complicated enough, there are different kinds of trailer records and they all do different things and have to come in a certain order in the claim file itself. There are trailers on a claim level, trailers on a batch level, as you can have multiple batches in a file and trailers on a file level, which is basically a trailer that totals up all the records and dollar amounts in the entire file.

Confused? You're not alone. Many professional billers feel that the insurance carriers put in all these requirements, that mind you are not required with paper claims, in order to make the process more complicated and provide f

o errors or violations, a problem with any of the trailer records can get not just one, but ALL the claims rejected.

The individual records, or claims in a claims file, need to have all the individual I's dotted and T's crossed. But still, that isn't enough. Because all of those individual claims need to be totaled up. In other words, if the sum amount of all your claims comes out to $759.83, then your total record better show $759.83 in total claims and not $759.84. Just one penny off in your totals record and your whole batch, not just one claim, will be rejected.

Totals of dollars is not the only thing that has to be just right. The trailer, or totals records, count up a lot of other things as well. One of the main things that is counted in the trailer records is the actual number, not only of claims, but of records themselves. If you recall from our series so far, every claim has a C record, to identify the patient, a D record to identify the carrier, E records to identify the facility, F records to identify the item being billed, G records to identify any CMNs that are transmitted with the claim and H records to give any additional narrative information that has to be transmitted in order to justify the claim. Well, all of those records have to be totaled. Individually and together. If you're even one record off in your totals, the whole batch is denied along with every claim.

Aside from all of the above, other items are totaled as well, including all deductibles, co-pays, payer pays, patient pays and any other dollar amounts besides the actually claim dollars. And if that isn't complicated enough, there are different kinds of trailer records and they all do different things and have to come in a certain order in the claim file itself. There are trailers on a claim level, trailers on a batch level, as you can have multiple batches in a file and trailers on a file level, which is basically a trailer that totals up all the records and dollar amounts in the entire file.

Confused? You're not alone. Many professional billers feel that the insurance carriers put in all these requirements, that mind you are not required with paper claims, in order to make the process more complicated and provide

l be rejected.

Totals of dollars is not the only thing that has to be just right. The trailer, or totals records, count up a lot of other things as well. One of the main things that is counted in the trailer records is the actual number, not only of claims, but of records themselves. If you recall from our series so far, every claim has a C record, to identify the patient, a D record to identify the carrier, E records to identify the facility, F records to identify the item being billed, G records to identify any CMNs that are transmitted with the claim and H records to give any additional narrative information that has to be transmitted in order to justify the claim. Well, all of those records have to be totaled. Individually and together. If you're even one record off in your totals, the whole batch is denied along with every claim.

Aside from all of the above, other items are totaled as well, including all deductibles, co-pays, payer pays, patient pays and any other dollar amounts besides the actually claim dollars. And if that isn't complicated enough, there are different kinds of trailer records and they all do different things and have to come in a certain order in the claim file itself. There are trailers on a claim level, trailers on a batch level, as you can have multiple batches in a file and trailers on a file level, which is basically a trailer that totals up all the records and dollar amounts in the entire file.

Confused? You're not alone. Many professional billers feel that the insurance carriers put in all these requirements, that mind you are not required with paper claims, in order to make the process more complicated and provide

and H records to give any additional narrative information that has to be transmitted in order to justify the claim. Well, all of those records have to be totaled. Individually and together. If you're even one record off in your totals, the whole batch is denied along with every claim.

Aside from all of the above, other items are totaled as well, including all deductibles, co-pays, payer pays, patient pays and any other dollar amounts besides the actually claim dollars. And if that isn't complicated enough, there are different kinds of trailer records and they all do different things and have to come in a certain order in the claim file itself. There are trailers on a claim level, trailers on a batch level, as you can have multiple batches in a file and trailers on a file level, which is basically a trailer that totals up all the records and dollar amounts in the entire file.

Confused? You're not alone. Many professional billers feel that the insurance carriers put in all these requirements, that mind you are not required with paper claims, in order to make the process more complicated and provide

and they all do different things and have to come in a certain order in the claim file itself. There are trailers on a claim level, trailers on a batch level, as you can have multiple batches in a file and trailers on a file level, which is basically a trailer that totals up all the records and dollar amounts in the entire file.

Confused? You're not alone. Many professional billers feel that the insurance carriers put in all these requirements, that mind you are not required with paper claims, in order to make the process more complicated and provide for a greater chance that the claims will be rejected. Why? Obviously so that the insurance companies don't have to pay. Yes, it is just one big conspiracy.

In our next installment of medical billing, we're going to discuss claim hierarchy so that you understand just how these records have to fall, what is allowed and what is not allowed when electronically transmitting a claim.