(Medicare Claims Processing Manual)

Effective with the October 2005 release, A/B MACs and DME MACs and their shared syste ms shall receive BCRC Detailed Error Reports that contain BHT03 identifiers that indicate T (test) or P (production)  status for purposes of fulfilling the provider notification requirements.  ( Note:   The T or the P portion of the BHT03 indicator will be identical to the Test/Production indicator originally returned from CWF on the processed claim.)   a) Special Automated Provider Correspondence  A/B MACs and DME MACs, or their shared systems, shall also take the following actions indicated below only when they determine via the Beneficiary Other Insurance (BOI) reply trailer (29) that a COBA trading partner is in crossover production mode with the BCRC (Test/Production Indicator=P).  After an A/B MAC or DME MAC, or its shared system, has received a BCRC Detailed Error Report that contains claims with error source codes of 111 (flat file error), 222 (HIPAA ASC X12 error), or 333 (trading partn er dispute), it shall take the following two specified actions within five (5) business days:  1. Notify the physician/practitioner, supplier, or provider via automated letter  or other electronic or automated method that the claim did not cross over.  The let ter or report/notification  shall include specific claim information, not limited to, Internal Control Number (ICN)/Document Control Number (DCN), Medicare beneficiary identifier , Medical Record Number (for Part A only), Patient Control Number (only if it i s contained in the claim), beneficiary name, date of service, and the date claim was processed.  2. Effective with July 2007, A/B MACs and DME MACs and their systems shall ensure that, in addition to the standard letter language (the claim(s) was/were not cros sed over due to claim data errors and was/were rejected by the supplemental insurer), their A/B MACs and DME MACs special provider letters or  reports /notifications , which are generated for 222 and 333 error rejections in accordance with CR 4277, now include the following additional elements, as derived from the BCRC Detailed Error Report:  1) HIPAA H -series rejection code or other rejection code, and 2) the rejection codes accompanying description.  NOTE:   A/B MACs or DME MACs, or their shared system s, are not  required to reference the COBA trading partners name on the above described automated letter or report/notification , since the original remittance advice (RA)/electronic remittance advice (ERA) would have listed that information, if appropriate.  2.  Update its claims history to reflect that the claim(s) did not cross over as a result of the generation of the automated letter or report.  Effective with October 1, 2007, all A/B MACs and DME MACs shall modify their special provider notification le tters that are generated for 111, 222, and 333 error situations to include the following standard language within the opening paragraph of their letters or reports: This claim(s) was/were not crossed over due to claim data errors or was/were rejected by the supplemental insurer.  A/B MACs and DME MACs shall reformat their provider notification letters or reports  to ensure that, in addition to the new standard letter language, they continue to include the rejection code and accompanying description, as derived from the BCRC Detailed Error Report, for 222 or 333 errors in association with each errored claim.   Effective with the July 7, 2009, release, upon receipt of the BCRC Detailed Error Report (DER), the A/B MAC (A) and A/B MAC (HH) shared syst em shall configure the existing 114 report, as derived from the BCRC DER, so that it : 1) continues to display in landscape format; and 2) includes a cover page that contains the providers correspondence mailing address.  b) Special Exemption from Generati ng Provider Notification Letters /Reports    Effective July 7, 2008, upon their receipt of BCRC Detailed Error Reports that contain 222 error codes 000100 (Claim is contained within a BHT envelope previously crossed; claim rejected) and 00010 (Duplicate claim; duplicate ST- SE detected), all shared systems shall automatically suppress generation of the special provider notification letters or reports/notifications  that they would normally generate for their associated A/B MACs and DME MACs in accordance with the requirements of this section as well as 70.6.3 of this chapter.  In addition, upon receipt of BCRC Detailed Error Reports that contain 333 (trading partner dispute) error code 000100 (duplicate claim) or 000110 (duplicate ISA-IEA) or 000120 (duplicate ST- SE), all shared systems shall automatically suppress generation of the special provider notification letters or reports/notifications , as would normally be required in accordance with this section as well as 70.6.3 of this chapter.  NOTE:   When suppressing their provider notification le tters or reports/notifications  for the foregoing qualified situations, the A/B MACs and DME MACs shall also not update their claims histories to reflect the non -crossing over of the associated claims.   A/B MACs and DME MACs should, however, continue to account for  the volume of claims that they are suppressing for financial reconciliation purposes.  Effective with October 6, 2008, when the BCRC returns the 222 error code N22225 to A/B MACs and DME MACs via the BCRC Detailed Error Report, the A/B MACs and DME MACs shared systems shall suppress generation of the special provider notification letters or reports/notifications  that they would normally issue in accordance with CRs 3709 and 5472.  When suppressing their provider notification letters or reports/notifications  following their receipt of a N22225 error code, the A/B MACs and DME MACs shared systems shall also not update their claims histories to reflect the non -crossing over of the associated claims.  A/B MACs and DME MACs should, however, continue to account for  the volume of claims that they are suppressing for financial reconciliation purposes.  Effective with January 5, 2009, when the BCRC returns claims on the BCRC Detailed Error Report whose COBA ID falls in the range 89000 through 89999 (range designates Other -Health Care Pre-payment Plan [HCPP] and HMO Cost Plan), the A/B MACs and DME MACs systems shall take the following actions:  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