Medicare code edit 058, identified as "REVENUE/CHARGE/CODE INVALID," is an administrative flag that appears on healthcare claims when specific issues are detected with the numerical formatting or validity of revenue codes or their associated charges. This edit serves as a critical checkpoint to ensure the accuracy and integrity of financial data submitted for reimbursement.
Understanding Edit 058: REVENUE/CHARGE/CODE INVALID
This particular Medicare claim edit is designed to halt the processing of a claim if the financial reporting of services contains errors related to revenue codes or their charges. When Edit 058 is posted, it signals that the claim contains data that is either non-numeric where numbers are expected, or that a revenue code falls outside the acceptable numerical range. Proper resolution of this edit is essential for a claim to move forward in the adjudication process.
When Does Edit 058 Occur?
Edit 058 is triggered under precise conditions involving the revenue code and the charge amount associated with it. A claim will receive this edit if:
- A revenue code has been entered on the claim, and
- The charge amount for that revenue code is non-numeric, or
- The revenue code itself is non-numeric, or
- The revenue code value is less than 001.
This edit applies to several primary types of claims, indicating its broad impact across various healthcare settings.
Claim Types Affected by Edit 058:
| Claim Type Code | Description |
|---|---|
| 01 | Inpatient Claims |
| 03 | Outpatient Claims |
| 06 | Home Health Claims |
Resolving Edit 058: Practical Solutions
When providers encounter Medicare edit 058, immediate action is required to correct the claim. The primary focus should be on ensuring the accuracy and proper formatting of revenue codes and their corresponding charges. Here are key steps for resolution:
- Numeric Verification: Confirm that all fields intended for revenue codes and their charges contain only numerical digits. Remove any non-numeric characters, such as letters, symbols, or extraneous spaces.
- Revenue Code Validation: Double-check that the revenue code used is a valid three or four-digit number and is not less than '001'. Revenue codes categorize services and supplies, and incorrect codes will lead to processing delays.
- Data Entry Review: Conduct a thorough review of data entry processes to minimize common errors like typos or transpositions that can lead to non-numeric data or incorrect code entries.
- System Configuration: If errors are consistently occurring, assess your billing software or electronic health record (EHR) system's configuration to ensure it is accurately mapping and submitting revenue code and charge information in the correct format as required by Medicare.
Addressing these issues directly and efficiently will help prevent further denials and facilitate timely claim processing and reimbursement.
