(Medicare Claims Processing Manual)

1)  Suppress generation of the special provider letters or reports/notifications ; and   2)  Not updat e their affiliated A/B MACs and DME MACs claims histories to indicate that the BCRC will not  be crossing the affected claims over.    70.6.1.1 - Coordination of Benefits Agreement (COBA) ASC X12 837 5010 Coordination of Benefits (COB) Flat File Errors  (Rev. 3714, Issued: 02- 03-17; Effective: 07 -01-17; Implementation: 07 -03-17)  Effective with the implementation of the Health Insurance Portability and Accountability Act (HIPAA) ASC X12 837 5010 COB requirements, the BCRC  will return the error codes shown in the chart below to all A/B MACs and DME MACs whose flat file submissions lack structural elements necessary for the building of outbound HIPAA compliant crossover claims.   The shared systems shall, in addition, make modifications to any 111 error tables that they maintain, in accordance with the following charts, only in association with ASC X12 837 5010 COB flat files.  BCRC DETAILED ERROR REPORT 111 ERROR CRITERIA FOR 837 VERSION 5010  INSTITUTIONAL COB CLAIMS   Error Code  Error Description  Control # COBA ID Medicare ID CCN  Loop ID Segment  Element  Content  BHT 03 Reject Level  100 No ST Segment  NO NO NO NO NO YES  NO NO NO HEAD  101 No BHT Segment  YES  NO NO NO NO YES  NO NO NO HEAD  103 Missing 1000A Records  YES  NO NO NO YES  YES  NO NO YES  HEAD  104 Missing 1000B Records  YES  NO NO NO YES  YES  NO NO YES  HEAD  105 Invalid 1000A.NM109 YES  NO NO NO YES  YES  YES  YES  YES  HEAD  110 Invalid 1000B.NM103 YES  NO NO NO YES  YES  YES  YES  YES  HEAD  115 Invalid 1000B.NM109 YES  YES  NO NO YES  YES  YES  YES  YES  HEAD  120 Multiple 1000A per ST/SE  YES  NO NO NO YES  YES  NO NO YES  HEAD  125 Multiple 1000B per ST/SE  YES  NO NO NO YES  YES  NO NO YES  HEAD   Error Code  Error Description  Control # COBA ID Medicare ID CCN  Loop ID Segment  Element  Content  BHT 03 Reject Level  199 All 2000B Rejected  YES  YES  NO NO YES  YES  NO NO YES  HEAD  200 Missing 2000A  YES  YES  NO NO YES  YES  NO NO YES  PROV 201 Missing 2010AA  YES  YES  NO NO YES  YES  NO NO YES  PROV 210 Multiple 2010AA per 2000A  YES  YES  NO NO YES  YES  NO NO YES  PROV 211 Multiple 2010AB per 2000A  YES  YES  NO NO YES  YES  NO NO YES  PROV 212 Invalid presence of 2010AC per 2000A  YES  YES  NO NO YES  YES  NO NO YES  PROV 300 Missing 2000B  YES  YES  NO NO YES  YES  NO NO YES  SUB  301 Missing 2010BA  YES  YES  NO NO YES  YES  NO NO YES  SUB  302 Missing 2010BB Loop YES  YES  YES  NO YES  YES  NO NO YES  SUB  305 Multiple 2010BB per 2000B  YES  YES  YES  NO YES  YES  NO NO YES  SUB  306 Multiple 2010BA per 2000B  YES  YES  YES  NO YES  YES       NO NO YES      SUB  310 2010BB.NM109 not equal 1000B.NM109 YES  YES  YES  NO YES  YES  YES  YES  YES  SUB   Error Code  Error Description  Control # COBA ID Medicare ID CCN  Loop ID Segment  Element  Content  BHT 03 Reject Level  320 2010BB.N3 not equal spaces  YES  YES  YES  NO YES  YES  YES  YES  YES  SUB  321 2010BB.N4 not equal spaces  YES  YES  YES  NO YES  YES  YES  YES  YES  SUB  351 More than 100 2300 per 2000B  YES  YES  YES  NO YES  YES  NO NO YES  SUB  355 2300 REF01 Equal F5 Missing  YES  YES  YES  NO YES  YES  NO NO  YES  SUB  356 2300 HI Invalid  YES  YES  YES  NO YES  YES  NO  NO  YES  SUB  399 All 2300 Loops Rejected  YES  YES  YES  NO YES  YES  NO NO YES  SUB  400 2010CA Found  YES  YES  YES  NO YES  YES  NO NO YES   500 2300 Not Found  YES  YES  YES  NO YES  YES  NO NO YES  CLM  505 2320 Not Found  YES  YES  YES  NO YES  YES  NO NO YES  CLM  506 # of 2320 Loops GT 10 YES  YES  YES  YES  YES  YES  NO NO YES  CLM  507 2320 OI Not Found  YES  YES  YES  YES  YES  YES  NO NO YES  CLM  515 2400 Not Found  YES  YES  YES  YES  YES  YES  NO NO YES  CLM   Error Code  Error Description  Control # COBA ID Medicare ID CCN  Loop ID Segment  Element  Content  BHT 03 Reject Level  520 # of 2400 Loops GT 999 YES  YES  YES  YES  YES  YES  NO NO YES  CLM  575 2330A Not Found  YES  YES  YES  NO YES  YES  NO NO YES  CLM  576 2330B Not Found YES  YES  YES  NO YES  YES  NO NO YES  CLM  580 2320.SBR01 not equal P (must be at least one P segment)  YES  YES  YES  NO YES  YES  YES  YES  YES  CLM  581 2320.SBR Field Invalid (SBR09 does not equal MB when Medicare is primary in SBR01)  YES  YES  YES  NO YES  YES  NO NO YES  CLM  590 Multiple 2330A  YES  YES  YES  NO YES  YES  NO NO YES  CLM  591 Multiple 2330B  YES  YES  YES  NO YES  YES  NO NO YES  CLM  595 2330B.REF02 Equal  YES  YES  YES  YES  YES  YES  YES  YES  YES  CLM  596 2330B.NM109 Invalid COBA ID  (Not Used)  YES  YES  YES  YES  YES  YES  YES  YES  YES  CLM  597 2330B REF not found YES  YES  YES  YES  YES  YES  YES  YES  YES  CLM   Error Code  Error Description  Control # COBA ID Medicare ID CCN  Loop ID Segment  Element  Content  BHT 03 Reject Level  598 2330B NM103 equals spaces and invalid COBA ID in 2330B NM109 YES  YES  YES  YES  YES  YES  YES  YES  YES  CLM  610 # of 2430 Loops greater than 15  YES  YES  YES  YES  YES  YES  NO NO YES  CLM  620 2430.SVD01 not equal 1000A.NM109  YES  YES  YES  YES  YES  YES  YES  NO YES  CLM  999 SE Segment Missing  YES  YES  NO NO NO YES  NO NO YES  HEAD   BCRC DETAILED ERROR REPORT 111 ERROR CRITERIA FOR PROFESSIONAL COB CLAIMS