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New 837 V4010A1
Implementation Guide Editing
Currently, Empire Medicare Services
(EMS) performs several levels of editing prior to a file
being passed to the Medicare claims system. The levels
are as follows: transmission level editing, standard
level editing, implementation guide editing, and
submitter/provider authorization edits. All Medicare Part
A editing currently returns a complete file (ISA-IEA),
transaction set (ST-SE) or provider batch (HL level)
along with the Electronic Media Claims (EMC) Receipt
Control Report.
Per Centers for Medicare & Medicaid
Services (CMS) instruction CR 2879, edit returns are to
be at the appropriate level. Contractors are instructed
to return individual claims when a claim level
implementation guide edit is encountered. The new IG Edit
Module will edit the entire file and return based on the
occurrence of the error. Batch level returns will still
occur for errors that are encountered at the provider
level and above. Individual claims will be returned for
errors that occur at the subscriber and claim levels. The
Medicare Part A Inbound Reject Report will display all
files that contain all levels of errors. If the errors
are prior to the claim level, they will be displayed
within the header of the report (ex., submitter and
provider errors). If the errors are within the claim
level loops, the beneficiary and claim information will
be displayed within the claim detail section of the
report. Please note, this report is in addition to the
EMC Receipt Control Report, and the new process does not
eliminate file/batch level returns.
A sample of the Medicare Part A Inbound
Reject Report can be found on the Empire Medicare
Services (EMS) Web site at:
www.empiremedicare.com. This report will be
returned to the submitter on the next business day after
the file/batch is received. Claims identified on the
report need to be corrected and resubmitted. Please be
aware that some of the error messages displayed on this
report are a result of testing, and this example is being
used primarily to communicate the format of the new
report. The report is also structured to break on
Submitter ID and Provider ID for distribution
purposes.
The Medicare Part A Inbound Reject
Report will be in production on July 6, 2004. Information
regarding the new edits is documented in the 837
Companion Document.
Pub. 100-4, Transmittal # 49, CR#
2879
Posted: 05/18/2004
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