New Claims Edit: Patient Date of Birth Validation Coming January 2027

Beginning in January 2027, we will implement a new claim edit to enhance the accuracy of patient information submitted through Electronic Data Interchange (EDI). This change will improve the efficiency of claims processing, eliminating unnecessary delays while standardizing our EDI best practices.

What This Means for You

When you submit claims through EDI, our system will now verify the patient’s date of birth (DOB) against the DOB we have on file for that patient.

If the DOB (month, day, and year) on the submitted claim doesn’t precisely match our records, the claim will be rejected. Once the DOB is corrected, the claim can be resubmitted.

What You Need To Do

• Verify patient DOB: Before submitting claims, ensure that the DOB you are submitting exactly matches the information that appears on their eligibility information in Availity Essentials.
• Work with your trading partners: If you receive a rejected claim due to a DOB mismatch, work with your billing office or trading partner to reconcile the incorrect DOB.
• Resubmit corrected claims: Once the correct DOB is obtained and updated, resubmit the claim for processing.