evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
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
(Medicare Claims Processing Manual)
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
(Medicare Claims Processing Manual)
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  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  Error Code  Error Description  Control # COBA ID Medicare ID CCN  Loop ID Segment  Element  Content  BHT 03 Reject Level  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  320 2010BB.N3 not equal spaces  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  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
(Medicare Claims Processing Manual)
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  520 # of 2400 Loops GT 50 YES  YES  YES  YES  YES  YES  NO NO YES  CLM  575 2330A Not Found  YES  YES  YES  NO 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  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  598 2330B NM103 equals spaces and invalid COBA ID in 2330B NM109 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  610 # of 2430 Loops greater than 15  YES  YES  YES  YES  YES  YES
(Medicare Claims Processing Manual)
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  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
(Medicare Claims Processing Manual)
70.6.2  Coordination of Benefits Agreement (COBA) Full Claim File Repair Process  (Rev.  4069, Issued: 06- 08-18, Effective: 07-09- 8, Implementation: 07-09-18)  Effective with the July 2006 release, CMS implemented a full claim file repair process at its A/B MACs and DME MACs to address situations where one or more of the MAC shared systems inadvertently introduced a severe error condition into the claims processing cycle, with the effect being that the Health Insurance Portability and Accountability Act (HIPAA) ASC X12 837 Coordination of Benefits (COB) Institutional and Professional crossover claims files or National Council for Prescription Drug Programs (NCPDP) claim files become unusable for COB purposes .
(Medicare Claims Processing Manual)
When an A/B MAC or DME MAC, the BCRC,  or a COBA trading partner identifies a shared system problem that will prevent, or has prevented, the COBA trading partner from accepting an ASC X12 837 COB institutional or professional claims file from the BCRC , the A/B MAC and DME MAC shall work with its shared system maintainer to assess the feasibility of executing  a full claim file repair.  A/B MACs and DME MACs shall utilize the BCRC  Detailed Error Reports to determine the percentage of errors present for each error source code111 (flat file) errors, 222 (ASC X12 837 COB) errors, and 333 (trading partner dispute) errors.  When A/B MACs and DME MACs or their shared system maintainers determine that the error percentages are at or above the parameters discussed later within this section, the A/B MACs and DME MACs shall begin the process of analyzing the claim files for a possible full claim repair process.  If the A/B MACs and DME MACs and their shared systems subsequently initiate a full claim file repair process, that process shall be accomplished within a maximum of 14 work days, unless determined otherwise by CMS.  Effective  July 2, 2007, A/B MACs and DME 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 specified in 70.6.1 of this chapter.  If an A/B MAC or DME MAC receives even one (1) 111 error via the BCRC  Detailed Error Report, the MAC, working with its Data Center or shared system as necessary, shall immediately attempt a repair of  the claims file, in accordance with all other requirements communicated within this section.   1. A/B MAC or DME MAC or Shared System Identification of a Full Claim File Problem and Subsequent Actions
(Medicare Claims Processing Manual)
1. A/B MAC or DME MAC or Shared System Identification of a Full Claim File Problem and Subsequent Actions   When an A/B MAC or DME MAC, working with its shared system maintainer, identifies a severe error condition that will negatively impact the claims that it has transmitted to the BCRC , the A/ B MAC or DME MAC shall, upon detection, immediately notify CMS and the BCRC  by calling current BCRC  or CMS COBA crossover contacts and sending e- mail communications to:  COBAProcess@cms.hhs.gov and cobva@ghimedicare.com .  The A/B MAC or DME MAC shall work closely with its system maintainer to determine the timeframes for developing, testing, and applying a fix to correct the severe error(s) that was/were identified within the 837 or NCPDP files that were previously transmitted to the BCRC .  The A/B MAC and DME MAC shared system maintainers shall then report the timeframes for developing, testing, and applying a fix to the full claim file problem in accordance with their procedures as outlined in their systems maintenance contract.  If CMS determines that the time frames for affecting a full claim file repair of the previously transmitted claims exceed what is considered reasonable (a maximum of 14 work days, unless determined otherwise by CMS), a designated COBA team repr esentative will notify the A/B MACs and DME MACs and their shared system maintainers via e -mail to abort the full claim file repair process. ( NOTE :  This process will remain unchanged with the transition to future claim versions.)  Upon receipt of a notification from the CMS COBA team representative that indicates that the timeframes for fixing a full claim file problem exceed those that are acceptable to CMS, the A/B MACs and DME MACs shared systems shall abort the full claim file  repair process.  A/B MACs and DME MACs shall then  follow the requirements provided in 70.6.1 of this chapter with respect to the special provider notification and other COBA crossover operational processes.  In such cases, however, A/B MACs and DME MACs shall not be required to wait the customary five (5) business days before generating the special provider notification letters to their affected physicians, suppliers, or other providers of service.
(Medicare Claims Processing Manual)
2. Alerting A/B MACs or DME MACs to the Possible Need fo r a Full Claim File Repair via the BCRC Detailed Error Reports and Subsequent MAC Actions   a. Severe Error Percentage Parameters and Suppression of the Special Provider Notification Letters   Effective with July 2006, the CMS, working in conjunction with the BCRC , modified the BCRC  Detailed Error Report layouts, as found in 70.6.1 of this chapter, to include the following new elements:  Total Number of Claims for Date of Receipt; Total Number of 111 (flat file) Errors and corresponding percentage; Total Number of 222 (HIPAA ASC X12 837 COB) Errors and corresponding percentage; and Total Number of 333 (trading partner dispute) Errors and corresponding percentage.   Effective with July 2007, CMS directed its A/B MACs and DME MACs  to now base their severe error decision calculus upon the number of 111 errors received rather than percentage of such errors.  Therefore, when an A/B MAC or DME MAC or its shared system maintainer receives a BCRC  Detailed Error Report that indicates that the trading partner is in production and the number of 111 (flat file) errors is equal to or greater than one, the A/ B MACs and DME MACs shared system shall suppress the generation of special provider notific ations, as provided in  70.6.1 of this chapter, until after the severe error condition(s) has/have been analyzed.  ( NOTE:  If the 222 and/or 333 errors indicated on the BCRC  Detailed Error Report do not  exceed the four (4) percent parameter, then the A/B MAC and DME MAC shall continue with the generation of the provider notification letters for those errors while it is analyzing the 111 severe error(s).)
(Medicare Claims Processing Manual)
IMPORTANT:  Effective October 1, 2007, A/B MACs and DME MACs  and their systems shall have the capability to initiate a claims repair process, internally or at CMS direction, for situations in which they encounter high volume 222 or 333 error rejections that do not meet or exceed the established error threshold parameters.  Before initiating a cl aims repair for error situations that fall below the established percentage parameters, the affected A/B MACs and DME MACs shall first contact a member of the CMS COBA team to obtain clearance for that process.   When an A/B MAC or DME MAC or its shared sys tem maintainer receives a BCRC Detailed Error Report that indicates that the trading partner is in production and the percentage of 222 (HIPAA ASC X12 837) errors and 333 (trading partner dispute) errors is equal to or greater than four (4) percent, the  shared system shall suppress the generation of special provider notifications, as provided in 70.6.1 of this chapter, until after the severe error condition(s) has/have been analyzed.  NOTE:  If the number of 111 errors indicated on the  BCRC Detaile d Error Report is not  equal to or greater than one (1), then the A/B MAC or DME MAC shall continue with the generation of the provider notification letters for those errors while it is analyzing the 222 and 333 severe errors.   For each of the severe er ror situations discussed above, A/B MACs and DME MACs, or their shared systems, shall suppress the special provider notification for a minimum of five (5) business days.  The shared systems shall also have the capability to adjust the parameters for genera tion of the provider notification letters, as referenced in 70.6.1 of this chapter, of up to 14 work days while analysis of the claims that are being held for possible full claim file repair is proceeding.
(Medicare Claims Processing Manual)
Effective October 1, 2007, all A/B MACs and DM E MACs  shall have the capability to suppress their provider notification letters for a timeframe of up to 14 work days, or longer at CMS direction, where they initiate a claims repair process when claims with 222 or 333 errors fall below the normally established four (4) percent threshold.   Also, for each of the situations discussed above, the A/B MACs and DME MACs shared systems shall establish percentage parameters for each error source code (222 and 333) that allow for flexibility within a range ( e.g., 1 to 10 percent). b. Additional Information Highlighting Possible Severe Error Conditions on the BCRC Detailed Error Reports.   Effective with July 2006, the BCRC  will report one of the following error sources and error codes/trading partner dispute codes that may be indicative of a severe error condition on the returned BCRC  Institutional and Professional Detailed Error Reports:  1.) Error source code 111 will be reported in field 10, along with a 6-digit error code in field 11 (note:  unlike routine reporting of flat file errors, a full claim file error condition would be indicated if there were numerous instances of the same error code repeated throughout a Report); the description of the problem(s) that has/have caused the full claim file to  be unusable will be reported in field 12 (error description);  2.) Error source code 222 will be reported in field 10, along with a 6-digit error code in field 11 that begins with an N; the description of the problem(s) that has/have caused the full claim file to be unusable will be reported in field 12 (error description);  3.) Error source code 333 will be reported in field 10; an error/trading partner dispute code 999 (trading partner disputeother) will be reported in field 11, left- justified  and followed by spaces; and a description of the problem(s) that has/have caused the full claim file to be unusable will be reported in field 12 (error description).  DME MACs and their shared systems shall process NCPDP Detailed Error Reports returned from the BCRC  that contain the following combination of error source codes, error/trading partner dispute codes, and error descriptions within the Reports:
(Medicare Claims Processing Manual)
DME MACs and their shared systems shall process NCPDP Detailed Error Reports returned from the BCRC  that contain the following combination of error source codes, error/trading partner dispute codes, and error descriptions within the Reports:  1.) Error source code 111 will be reported in field 9, along with a 6-digit error code in field 10 (NOTE: U nlike routine reporting of flat file errors, a full claim file error condition would be indicated if there were numerous instances of the same error code repeated throughout a Report); and a description of the problem(s) that has/have caused the full claim file to be unusable will be reported in field 11; or   2.) Error source code 333 will be reported in field 9; an error/trading partner dispute code 999 will be reported in field 10, left-justified and followed by spaces; and a description of the proble m(s) that has/have caused the full claim file to be unusable will be reported in field 11 (error description).   c. A/B MAC and DME MAC Actions Following Suppression of the Special Provider Notification Letters to Analyze Possible Severe Error Conditions   When A/B MACs and DME MACs receive BCRC  Detailed Error Reports that contain 222 or 333 errors with percentages that are at or above the established parameters or if the MACs receive 111 errors that are at or above zero (0) they shall work closely wi th their  shared system maintainers to determine the timeframes for developing, testing, and applying a fix to correct the severe error(s) that was/were identified within the ASC X12 837 or NCPDP files that were previously transmitted to the BCRC .  The shared system maintainers shall then report the timeframes for developing, testing, and applying a fix to the full claim file problem in accordance with their procedures as outlined in their systems maintenance contract.  If CMS determines that the timeframes for affecting a full claim file repair of the previously transmitted claims exceed what is considered reasonable (a maximum of 14  work days, unless determined otherwise by CMS), a designated COBA team representative will notify the A/B MACs and DME MACs an d their shared system maintainers via e -mail to abort the full claim file repair process.
(Medicare Claims Processing Manual)
As noted above, effective October 1, 2007, all A/B MACs and DME MACs shall have the capability to suppress their provider notification letters for a timeframe of up to 14 work days, or longer at CMS direction, where they initiate a claims repair process when claims with 222 or 333 errors fall below the normally established four (4) percent threshold.  Upon receipt of a notification from the CMS C OBA team representative that indicates that the timeframes for fixing a full claim file problem exceed those that are acceptable to CMS, the A/B MACs and DME MACs shared systems shall abort the full claim file repair process.  A/B MACs and DME MACs shall then follow the requirements provided in 70.6.1 of this chapter with respect to the special provider notification and other COBA crossover operational processes.  In such cases, however, A/B MACs and DME MACs shall not be required to wait the customary fi ve (5) business days before generating the special provider notification letters to their affected physicians/practitioners, suppliers, or other providers of service.  In the event that CMS indicates that a full claim file repair process is feasible, the A /B MACs and DME MACs shared systems shall have the ability to cancel the generation of the provider notification letters, as stipulated in 70.6.1 of this chapter, for the repaired claims and only generate the provider notification letters for the claims containing legitimate 111, 222, or 333 errors not connected with the severe error condition(s).   3. Steps for Ensuring that Only Repaired Claims are Re -transmitted to the BCRC   Once the A/B MACs and DME MACs shared systems have determined that they ar e able to affect a timely repair to the full claim files that were previously transmitted to the BCRC , they shall take the following actions:   a) Apply the fix to the unusable claims;   b) Compare the claims files previously sent to the BCRC  with the repaired claims file to isolate the claims that previously did not  contain the error condition(s);
(Medicare Claims Processing Manual)
a) Apply the fix to the unusable claims;   b) Compare the claims files previously sent to the BCRC  with the repaired claims file to isolate the claims that previously did not  contain the error condition(s);   c) Strip off the claims that did not contain the error condition(s), including claims that conta ined 111, 222, and 333 errors that were not connected with the severe error condition(s).  For the latter set of claims (those with 111, 222, and 333 errors that were not connected to the severe error condition), MACs shall then generate the provider notif ication letters, as stipulated in 70.6.1 of this chapter and specified in the concluding paragraph of the above sub- section entitled, Contractor Actions Following Suppression of the Special Provider Notification Letters to Analyze Possible Severe Error Conditions;   d) Recreate the job; and   e) Send only the repaired claims to the BCRC .  The shared systems shall add an indicator18 to the BHT02 (Beginning of the Hierarchical Transaction/Transaction Set Purpose Code) segment of the HIPAA ASC X12 837 flat file  to designate that the file contains only repaired claims.  In addition, the shared systems shall include the repaired claims in different ST -SE envelopes to differentiate the repaired claims from normal ASC X12 837 flat file transmissions.    The DME MAC sh ared system shall add an indicator R after the COBA ID reported in the Batch Header Record in the Receiver ID field (field number 880- K7) of the NCPDP claim when transmitting the repaired claims to the BCRC .  4. COBA Repair Process Changes Effective with  July 2012