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Most Common Errors for ANSI 4010A1
- PREPASS EDIT M125. Medicare Part B claims submitted with a
2320/SBR01 with a value of P, then the 2320/AMT01 with a value of D is
required otherwise the claim will reject with pre-pass edit M125.
- MEDICARE PART B MSP. With primary payer claim level
information must be submitted with the 2320/AMT segment (payer amount paid
AMT01=D) and the 2320/CAS segment (claim level adjustment amount(s).
- MEDICARE PART B MSP. With primary payer claim level
information can be submitted with the 2430/CAS (line level adjustment amount(s)
in addition to the claim level payer amount paid and claim level adjustment
amount(s).
- PREPASS EDIT M384. Medicare Part B MSP claims with claim level information in the 2320/AMT, 2320/CAS and 2430/CAS segments must equal the
total claim charge in the 2300/CLM02 or the claim will reject with pre-pass
edit M384.
- MEDICARE PART B MSP. With primary payer detail line level
information must be submitted with the 2430/SVD segment (service line paid
amount) and the 2430/CAS segment (line level adjustment amount(s).
- PREPASS EDIT M383. Medicare Part B MSP claims with primary payer
detail line level information in the 2430/SVD and 2430/CAS segments
must equal the submitted charges in the 2400/SV102 or the claim will reject
with pre-pass edit M383.
- PREPASS EDIT M195. Medicare Part B MSP claims will reject with
pre-pass edit M195 if the sum of the 2400/AMT (AMT01=AAE) does not equal the
sum of the 2320/AMT (AMT01=B6).
- PREPASS EDIT 0574. Medicare Part B claims will reject with
pre-pass edit 0574 if the 2320/SBR05 is missing or not a valid value according
to the X12N ANSI 4010A1 Professional Implementation Guide.
- MEDICARE PART A MSP CLAIMS. Must be submitted with the 2320/AMT
(payers submitted charge AMT01=T3), the 2320/AMT (primary payers paid amount
AMT01=C4) and the 2320/CAS and/or the 2430/CAS adjustment amount(s).
- MEDICARE PART A MSP CLAIMS. Submitted with primary payer
adjustment information must balance. The primary payers submitted charge minus
all claim and line level adjustment amounts must equal the total primary
payers paid amount.
- MEDICARE PART A MSP CLAIMS. Medicare Part A MSP claims that do not
balance will reject out on the Medicare Part A rejection report with error
message PRIMARY PAYER CLAIM DOES NOT BALANCE.
- Invalid diagnosis codes.
- Invalid taxonomy codes.
- MCE - WHAT GOES IN THE EDI/MODEM/LOGIN.
Login is your submitter number.
Password is blank
Submitter is same as Login.
-
EDI FILE NAMING CONVENTIONS AND WHAT THEY MEAN
MEDICARE PART B 835
exxxx_079_052229_mb_p.835
(Submitter_Julian date_hhmmss_mb_prod.835)
MEDICARE PART A 835
- exxxx_073_052234_ma_p.835
- (Submitter_Julian date_hhmmss_ma_prod.835)
UPLOAD ACKNOWLEDGMENT
- exxxx_033900_070101.acknowledgment.p.txt
- (Submitter_hhmmss_yymmdd.ack.prod.txt)
997 REPORT
- exxxx.exxxx.837p.p.a.537.997.rpt
- (Submitter.submitter.837 professional.production.async.sequence .997.rpt)
TA1 REPORT
- exxxx.exxxx.837p.p.a.537.ta1.rpt
- (Submitter.submitter.837 professional.production.async.sequence.ta1.rpt)
BATCH PROCESSING REPORT
- exxxx.exxxx.837p.p.a.537.rpt
- (Submitter.submitter.837 professional.production.async.sequence.rpt)
MEDICARE PART A ACCEPT REPORT
- exxxx.912.a.fis
- (Submitter.sequence.async.fis)
MEDICARE PART A REJECT REPORT
- exxxx.911.a.fis
- (Submitter.sequence.async.fis)
276 REPORT
- exxxx_07014_085647_p.276
- (Submitter _yyJulian_hhmmss_professional.276)
277 REPORT
- exxxx_0714_1942_A.277
- (Submitter_277_yyJulian_hhmm_institutional.277)
- exxxx_0714_1942_B.277
- (Submitter_277_yyJulian_hhmm_professional.277)
277-997 REPORT
- exxxx_0714_1942_A.997
- (Submitter_yyJulian_hhmm_institutional.997)
- exxxx_0714_1942_B.997
- (Submitter_yyJulian_hhmm_professional.997)
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