(Medicare Claims Processing Manual)

R - for RAC adjustment claims ;    A - for routine adjustment claims, not previously classified; and  C  for CMS -directed mass adjustment action (use specified by CMS).   The following indicator is only applicable to FISS -gene rated claims:  V - Void/cancel only claim   The 23- digit CRI shall be left- justified in the BHT 03 segment of the 837 flat file, with spaces used for the remaining 8 positions.  ( NOTE:   The CRI is unique inasmuch as no two files should ever contain the same combination of numbers.)    2.  NCPDP 23 -Digit Unique Identifier   Effective April 3, 2011, the DME MAC shared system shall also adopt a unique 23- digit format, referenced directly above under Populating the BHT 03 Portion of the ASC X12 837 Flat File.  However, prior to April 7, 2014, the system shall populate the unique 23- digit identifier (defined as future use) with spaces in field 504- F4 (Message) within the NCPDP file (field length=35 bytes).  The DME MAC shared system shall populate the unique identifier, left justified, in the field.  Spaces shall be used for the remaining bytes in the field.   Effective April 7, 2014, the DME MAC shared system shall ensure that its DME MACs have the ability to 1) execute actions that will result in the tr ansmission of their HUDC claims to CWF with Mass Adjustment Indicator set to O; and 2) transmit mass adjusted NCPDP D.0 COB claims to the BCRC under a 504- F04 (Message) field identifier of "C" (CMS -directed mass adjustment action) or "P" (mass adjustments tied to Affordable Care Act or Congressional/legislative mandate) as appropriate to the situation.  In addition, the DME MAC shared system shall ensure that all NCPDP D.0 crossover claims will now be sent to the BCRC with the 23rd byte 504- F04 (Message) field indicator completed, when appropriate, as indicated below.    O -- for all "original" NCPDP D.0 claims transmitted;   A-- for "routine adjustment claims" transmitted; and    R-- for recovery audit claims (RAC) adjustment claims transmitted.   B.  BCRC I nstitutional, Professional, and NCPDP Detailed Error Reports    The A/B MAC and DME MAC shared systems shall accept the BCRC Institutional, Professional, and NCPDP Detailed Error Reports received from the COB&R system supporting the BCRC.    Effective with A pril 5, 2021, the datasets that the COB&R system supporting BCRC will use to convey the BCRC Detailed Error Reports to the VDCs representing the MACs are as follows:   xxxx.FISP.HBADR.GHI.COB5ERR(+1)   [For Institutional Claims]  xxxx.MCSP.HBXDR.ADyy5ERC(+1)  [For Professional non- DMEPOS Claims]  xxxx.VMSP.COBC.A5010.ERROR.FILE(+1)   [For Professional DMEPOS Claims]    The formats for each of the Detailed Error Reports appear below.   Beginning with July 2007, all A/B MAC and DME MAC systems shall no longer interpret the percentage values received for ASC X12 837 institutional and professional claim 222 and 333 errors via the BCRC Detailed Error Reports as if the values contained a 1 -position implied decimal (e.g., 038 =3.8 percent).  DME MACs shall also no longer interpret the percentage values received for NCPDP claims for 333 errors via the BCRC Detailed Error Report for such claims as if the values should contain a 1 -position implied decimal.   In addition, A/B MACs and their systems shall now base their decision -making calculus for initiation of a claims repair of 111 (flat file) errors upon the number of errors received rather than upon an established percent parameter, as otherwise described within this section.   Effective with July 2009, the A/ B MAC and DME MAC shared systems shall accept the modified versions of the BCRC Detailed Error Reports for institutional and professional claims as reflected below.  As part of the July 2009 changes, the BCRC will, at CMSs direction, expand the length of the error description field. ( NOTE:   This means that the shared systems shall therefore include the expanded error description code as part of their special provider notification letters.)      The Institutional Error File Layout, including summary portion, will be used for Part A claim files.                                                               BCRC Detailed Error Report                                              Institutional Error File Layout -  (Detail Record)   Field  Description  Field Size  Reco rd Location  1 Date  8 1-8 2 Control Number  9 9-17 3 COBA ID  10 18-27 4 Subscriber ID/Medicare ID  12 28-39 5 Claim DCN/ICN  14 40-53 6 Record Number  9 54-62 7 Record/Loop Identifier  6 63-68 8 Segment  3 69-71 9 Element  2 72-73 10 Error Source Code  3 74-76 ('111', '222', or '333')  11 Error/Trading Partner Dispute Code  6 77-82 12 Filler  100 83-182 13 Field Contents  50 183-232 14 BHT 03 Identifier  30 233-262 (23 bytes used)  15 Claim DCN/ICN  23 263-285  Field  Description  Field Size  Reco rd Location  16 Error Description  300 286-585 17 Filler  15 586-600                                           Institutional Error File Layout -  (Summary Record)   Field  Description  Field Size  Record Location  1 Date  8 1-8 2 Total Number of Claims for Processing Date  10 9-18 3 Number of '111' Errors  10 19-28 4 Number of '222' Errors  10 29-38 5 Percentage of '222' Errors  3 39-41 6 Number of '333' Errors  10 42-51 7 Percentage of '333' Errors  3 52-54 8 Filler  19 55-73 9 Summary Record ID Error Source Code  3 74-76 ('999')  10 Filler  524 77-600  The Professional Error File Layout, including summary portion, will be used for Part B and DME MAC claim files.   BCRC Detailed Error Report   Professional Error File Layout -  (Detail Record)  Field  Description  Field Size  Record Location  1 Date  8 1-8 2 Control Number  9 9-17 3 COBA ID  10 18-27 4 Subscriber ID/Medicare ID  12 28-39 5 Claim DCN/ICN  14 40-53 6 Record Number  9 54-62 7 Record/Loop Identifier  6 63-68 8 Segment  3 69-71 9 Element  2 72-73 10 Error Source Code  3 74-76 ('111', '222', '333')  11 Error/Trading Partner Dispute Code  6 77-82 12 Filler  100 83-182 13 Field Contents  50 183-232 14 BHT 03 Identifier  30 233-262 (23 bytes used)  15 Claims DCN/ICN  23 263-285 16 Error Description  300 286-858 17 Filler  15 586-600  Professional Error File Layout  (Summary Record)   Field  Description  Field Size  Record Location  1 Date  8 1-8 2 Total Number of Claims for Processing Date  10 9-18 3 Number of '111' Errors  10 19-28 4 Number of '222' Errors  10 29-38 5 Percentage of '222' Errors  3 39-41 6 Number of '333' Errors  10 42-51 7 Percentage of '333' Errors  3 52-54 8 Filler  19 55-73 9 Summary Record ID Error Source Code  3 74-76 ('999')  10 Filler  524 77-600  The NCPDP Error File Layout, including summary portion, will be used by DME MACs for Prescription Drug Claims   BCRC Detailed Error Report    NCPDP Error File Layout -  (Detail Record)  Field  Description  Field Size  Record Location  1 Date  8 1-8 2 Batch Number  7 9-15 3 COBA ID  5 16-20 4 Medicare ID  12 21-32 5 CCN  14 33-46 6 Record Number  9 47-55 7 Batch Record Type  2 56-57 8 Segment ID  2 58-59 9 Error Source Code  3 60-62 ('111', or '333')  10 Error/Trading Partner Dispute Code  6 63-68 11 Error Description  100 69-168 12 Field Contents  50 169-218 13 Unique File Identifier  30 219-248 (23 bytes used)  14 CCN  23 249-271 15 Filler  18 272-289  NCPDP Error File Layout - (Summary Record)   Field  Description  Field Size  Record Location  1 Date  8 1-8 2 Total Number of Claims for Processing Date  10 9-18 3 Number of '111' Errors  10 19-28 4 Number of '333' Errors  10 29-38 5 Percentage of '333' Errors  3 39-41 6 Filler  18 42-59 7 Summary Record ID Error Source Code  3 60-62 ('999')  10 Filler  524 63-289    If the BCRC has rejected back to the A/B MAC and DME MAC shared system for 2 or more COBA Identification Numbers (IDs), the shared system shall receive a separate error record for each COBA ID.  Also, if a file submission from a shared system to the BCRC contains multiple  provider, subscriber, or patient level errors for one COBA ID, the shared system will receive a separate error record for each provider, subscriber, or patient portion of the file on which errors were found.  C.  Further Requirements of the COBA Detailed Error Report Notification Process   1.  Error Source Code   A/B MACs and DME MACs, or their shared systems, shall use all information supplied in the BCRC Detailed Error Report (particularly error source codes provided in Field 10 of Attachment B) to (1) ide ntify shared system changes necessary to prevent future errors in test mode or production mode (Test/Production Indicator= T or P) and (2) to notify physicians, suppliers, and providers that claims with the error source codes 111, 222, and 333 will not be crossed over to the COBA trading partner.   2.  Time Frames for Notification of All MACs Financial Management Staff and Providers   A/B MACs and DME MACs, or their shared systems, shall provide notification to MAC financial management staff for purpose s of maintaining an effective reconciliation of crossover fee/ complementary credits received within five (5) business days of receipt of the BCRC Detailed Error Report.   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: