DMERC EDI User™s Manual · 2001-08-20 · DMERC EDI User™s Manual Section 1 Œ Getting Started...

DMERC EDIDMERC EDIDMERC EDIDMERC EDIUser�s ManualUser�s ManualUser�s ManualUser�s Manual

Palmetto GBAPalmetto GBAPalmetto GBAPalmetto GBAA HCFA ContractedIntermediary and Carrier June 2001

DMERC EDI User's Manual Table of Contents

Palmetto GBA Page iJune 2001

TABLE OF CONTENTS

SECTION 1 � GETTING STARTED 1

Acquiring a Submitter ID...........................................................................................................1Electronic Data Interchange Enrollment Forms ........................................................................1Testing and Certification Requirements ....................................................................................1

Software Vendors ............................................................................................................................ 1Suppliers, Billing Services, or Clearinghouses................................................................................ 1Connectivity Testing for Entities Certified by Other DMERCs ...................................................... 2

Submitting Tests and Reviewing Errors ....................................................................................2Submitting Tests .............................................................................................................................. 2Retrieving Your Error Reports......................................................................................................... 2About Your Error Reports ............................................................................................................... 2

SECTION 2 � REPORTING EDI PROBLEMS 3

Palmetto GBA EDI Call Resolution ..........................................................................................3Using the Palmetto GBA EDI Technology Support Center ......................................................3

SECTION 3 � NSF DATA ENTRY INSTRUCTIONS 5

Addresses ...................................................................................................................................5Address 1 and Address 2 ................................................................................................................. 5City................................................................................................................................................... 5State ................................................................................................................................................. 5ZIP Code .......................................................................................................................................... 5

Dates ..........................................................................................................................................5Identification Numbers ..............................................................................................................5Individual Names .......................................................................................................................6

Last Name and First Name .............................................................................................................. 6Middle Initial ................................................................................................................................... 6

Company Names........................................................................................................................6Patient Control Number .............................................................................................................6Telephone...................................................................................................................................6

SECTION 4 � GLAD YOU ASKED... 7

SECTION 5 � NSF FRONT-END ERRORS 10

How To Use The Error Log.....................................................................................................10NSF Front End Errors ..............................................................................................................11

001 � 291 ....................................................................................................................................... 11Deciphering Form/Q Errors ........................................................................................................... 42Form/Q Error Correction Summary............................................................................................... 42292 - 461 All Form/Q Errors ......................................................................................................... 42

SECTION 6 � ELECTRONIC CLAIMS REPORT ERROR MESSAGE ABBREVIATIONS 71

DMERC EDI User�s Manual

Page ii Palmetto GBAJune 2001

DMERC EDI User�s Manual Section 1 � Getting Started

Palmetto GBA Page 1June 2001

SECTION 1 � GETTING STARTED

Acquiring a Submitter IDAny entity (vendor, supplier, billing service, or clearinghouse) wishing to become certified by Region Cmust obtain a Submitter ID from Palmetto GBA Electronic Data Interchange (EDI). Enrollment packagesmay be obtained from the website at www.PalmettoGBA.com, by calling the Palmetto GBA EDITechnology Support Center toll-free at 1-866-749-4301, or by sending a written request to:

Palmetto GBA EDIPO Box 100145Columbia SC 29202-3145

These forms are self-explanatory and request information such as your modem type and speed, the filetransmission protocol you will use, your software vendor (if any), monthly claims volume, anddemographic information about your company.

Electronic Data Interchange Enrollment FormsEDI Enrollment is required for all suppliers. HCFA requires the original signed agreement beforeproduction claims are submitted. Copies or faxes are NOT acceptable. EDI Enrollments wereprovided with the �Getting Started� package that you received from Region C when you requested yourSubmitter ID.

Testing and Certification RequirementsSOFTWARE VENDORS

Software vendors must submit tests to Palmetto GBA if they want their software certified to transmitDMEPOS claims and Certificates of Medical Necessity (CMN) in the National Standard Format (NSF).This is done using a batch of self-created or customer-created claims, representative of the types of claimsthat will regularly be submitted by the provider that the vendor serves. Because filing regulations aredynamic and the needs of each vendor�s provider community vary, EDI does not provide test packages.

Once a vendor is NSF certified by one DMERC, that vendor is considered certified by all fourDMERCs. It is not necessary to perform NSF certification testing with more than one DMERC.

After successfully testing (receiving 100%), the vendor will be notified of certification by Palmetto GBAand placed on the Certified Vendor List. This list is distributed to potential electronic submitters andcontains demographic and certification information about each vendor certified by each DMERC.

SUPPLIERS, BILLING SERVICES, OR CLEARINGHOUSES

Submitters seeking certification must achieve a 95% or better claims acceptance rate on a minimum of20 claims comprised of any of the following combinations:

♦ One batch of 20 or more �live� claims�the submitter�s own, actual claims that he plans to submit inproduction once he is certified.

♦ One batch containing 20 �made-up� DMEPOS claims representative of the types of claims thesubmitter will most often submit.

♦ A 20-claim batch consisting of any combination of live and made-up claims.

Submitters will not be contacted after submitting test(s) unless they have satisfied certification criteria(see guidelines below). When you have achieved certification, a Palmetto GBA EDI staff member willcontact you by telephone within 24 hours of receiving your successful test.

Section 1 � Getting Started DMERC EDI User�s Manual

Page 2 Palmetto GBAJune 2001

CONNECTIVITY TESTING FOR ENTITIES CERTIFIED BY OTHER DMERCS

Any entity wishing to submit claims to Palmetto GBA must test for connectivity with Palmetto GBA.Connectivity testing involves testing the ability to transmit claims to Palmetto GBA and retrieve errorreports. Call the Palmetto GBA EDI Technology Support Center and indicate that you have alreadycompleted NSF certification with another DMERC, and would like to acquire a Submitter ID for Region C.Once you have submitted a test for connectivity, please contact the EDI Technology Support Center toindicate that you have successfully connected to Palmetto GBA. Your test/production status can bechanged or verified at that time.

Submitting Tests and Reviewing ErrorsSUBMITTING TESTS

Palmetto GBA test cycles run at 1:00 p.m. and 8:00 p.m. EST daily, Monday through Saturday. Submityour test claims according to the guidelines outlined above. You do not need to contact Palmetto GBAEDI before submitting a test.

RETRIEVING YOUR ERROR REPORTS

Following the submission of your test claims, retrieve the Control and Error reports electronically afterthe next test cycle is generated. Bulletin Board System (BBS) users can retrieve test error reports thefollowing morning for all submissions received before 8:00 p.m. Monday through Friday. (If you are adiskette or tape submitter and cannot retrieve your reports electronically, include a note with your tape ordiskette submission indicating that you would like your error reports mailed or faxed to you. Include yourfax number for faxed reports. Error reports will be faxed or mailed to tape and diskette submitters only.)

Almost all certified software vendors include a �script� or program to retrieve your reports. Consult yourPalmetto GBA user�s manuals for detailed instructions on report retrieval if you are using PACES software.

Please ensure that your vendor has installed a report retrieval program and that it is in working order beforecontacting Palmetto GBA about problems in retrieving reports. Palmetto GBA does not provide supportfor vendor�s software. If you are certain that your report retrieval program is installed and in workingorder, but you still have difficulty retrieving your reports, please contact the Palmetto GBA EDI TechnologySupport Center toll-free at 1-866-749-4301.

If your software vendor does not have a program built into your system for report retrieval, contact yourvendor and request that this feature be added. In the meantime, contact the Palmetto GBA EDITechnology Support Center and request a copy of the DMERC Technical Specifications, which will helpyou retrieve your reports.

Once you retrieve your error reports, they are marked for deletion and will be deleted from your mailboxthe following morning at 3:00 a.m. Please conscientiously keep track of your error reports. Be advisedthat report restoration is not always possible.

ABOUT YOUR ERROR REPORTS

Your error reports will tell you how many claims you sent, how many and which claims were acceptedand rejected, and provide a brief explanation of all NSF front-end errors in the records of each rejectedclaim. Section 5 of this manual provides a detailed explanation of how to read and use your error reports.All front-end NSF errors are documented in detail, including the location of the error, resolution, andcorrect coding details are also located in Section 5 of this manual. Review your errors carefully, correctthem, and submit another test. Make sure that you submit at least 20 claims. Repeat this process until youhave achieved the 95% acceptance rate required for EDI certification.

DMERC EDI User�s Manual Section 2 � Reporting EDI Problems


SECTION 2 � REPORTING EDI PROBLEMS

Palmetto GBA EDI Call ResolutionThe Palmetto GBA EDI department is responsible for:

♦ Receiving your electronic claims in the National Standard Format for DMEPOS claims.

♦ Performing front-end edits to ensure that the claims have been entered in the correct format.

♦ Providing error reports to you electronically (or, in the case of tape or diskette submitters, by mail).

♦ Facilitating usage of Claim Status Inquiry and the retrieval of Electronic Remittance Notices.

Types of calls EDI can resolve:

Problem Description

Connectivity Connecting to the Palmetto GBA host for the purpose of submittingclaims, retrieving reports/ERNs and connecting to Claim StatusInquiry (supported protocols only).

Acquiring ID Acquiring a submitter ID.Testing Getting started with and performing testing.Data Retrieval Retrieving error reports and ERNs (Palmetto GBA PACES users

and users of vendor software after the vendor has been contacted).Clarification Assistance interpreting error reports after Section 5 in this manual

has been referred to. Assistance with format clarification.Software Acquiring low-cost software (PACES) and using PACES.Obtaining Technical Information Certified vendor list, NSF specifications, and/or NSF matrix.

Calls that should not be directed to EDI:

Questions Should be directed to:

Acquisition of NSC Supply Numbers National Supplier Clearinghouse1-866-238-9652 (toll-free)

Valid codes, Medical Policy, payment on claims, development ofclaims, advanced payment, supplier workshops, claimsadjudication, crossover contracts

DMERC Operations Team1-866-238-9650 (toll-free)

Claims data entry software other than the Palmetto GBA low-cost software

Contact your software vendor

DMERC claims Contact the appropriate DMERC

Using the Palmetto GBA EDI Technology Support CenterIf you have testing or production problems that EDI can resolve, please contact the Palmetto GBA EDITechnology Support Center toll-free at 1-866-749-4301. State that you are currently �testing� or �inproduction� and provide the specific nature of your problem. For example:

�I am testing and need assistance analyzing my error report.�

The key word in this example is �testing.� Being this specific will help us better direct your calls. Yourcall will be logged and routed to the appropriate Palmetto GBA EDI staff member, who will return yourcall in the order in which it was received.

Section 2 � Reporting EDI Problems DMERC EDI User�s Manual


To help us respond to your call as quickly as possible:

1. Do not contact individual EDI staff members on their personal extension. Such calls will not bereturned. Please place a call to the Palmetto GBA EDI Technology Support Center. All EDI staffrespond to problem calls logged through the Technology Support Center in order to retain an accuraterecord of your calls and to respond to all calls in the order received.

2. Ensure that you have made use of the resources you have at your disposal before calling the PalmettoGBA EDI Technology Support Center. It will help us respond to you more quickly if the calls wereceive are truly those �tricky� calls that require our assistance. For example:

a. Refer to this manual to resolve your errors before calling Palmetto GBA EDI Technology SupportCenter.

b. If you are using Palmetto GBA software, use your Palmetto GBA manuals to answer simplequestions about the software.

c. Contact your software vendor if you receive errors that are documented as software errors inSection 5 of this manual.

DMERC EDI User�s Manual Section 3 � NSF Data Entry Instructions


SECTION 3 � NSF DATA ENTRY INSTRUCTIONS

AddressesADDRESS 1 AND ADDRESS 2♦ ADDRESS 1 may not contain a blank in the first position.

♦ If entered, ADDRESS 2 may not contain a blank in the first position.

♦ Must contain at least one embedded blank.

♦ May contain alpha characters A-Z and numeric characters 0-9.

♦ No other special characters are allowed.

CITY

♦ First position must not be blank.

♦ May contain A-Z.


STATE

♦ Must be a valid, two character, alpha (A-Z) postal state code.

ZIP CODE

♦ Must be a valid postal zip code.

♦ Position 6-9 is optional but must be numeric if entered.

♦ If the state code is a foreign country a zip is not required.

♦ DO NOT put a space in the first position of the zip code.

Dates♦ The valid date format is CCYYMMDD. The fields on the screens in your software may not look like

the date is being entered in this format; this is because your software is translating the date as youenter it into this required format.

♦ The century must be a value of �18,� �19,� or �20.�

♦ The year must be a value of �00� through �99.�

♦ The month must be a value of �01� through �12.�

♦ The day must be a value of �01� through �31� dependent on the month.

Identification Numbers♦ The first position of an identification number may not be blank.

♦ May contain alpha characters A-Z and numeric characters 0-9.

♦ No embedded blanks are allowed.

Section 3 � NSF Data Entry Instructions DMERC EDI User�s Manual


Individual NamesLAST NAME AND FIRST NAME

♦ The first position of a first or last name must contain an A-Z. Make sure that there is not a space inthe first position of the first or last name.


♦ Titles such as �Mr.,� �Dr.,� Jr.� are not allowed.

♦ Must be at least two (2) positions in length.

MIDDLE INITIAL

♦ Must contain A-Z or blank.

Company Names♦ The first position of a company name must contain an A-Z. Make sure that there is not a space in the

first position of the first or last name.


♦ Must be at least two (2) positions in length.

Patient Control Number♦ First position must not be blank.

♦ May contain alpha A-Z and/or numeric 0-9.

♦ May contain the following symbols:

/ (forward slash)

. (period)

, (comma)

- (hyphen)

# (pound sign)

a blank(s), but never in the first position!

Telephone♦ The correct format for telephone numbers is AAAXXXSSSS.

(AAA = area code, XXX = exchange, SSSS = station number).

♦ Must contain numeric 0-9 only.

♦ No special characters (parentheses, hyphens, etc.) or blanks are allowed.

♦ Must contain a valid area code.

DMERC EDI User�s Manual Section 4 � Glad You Asked�


SECTION 4 � GLAD YOU ASKED...

Q. What kinds of identifying numbers do I need to acquire before I can begin testing?

A. Make sure you have your Supplier Number from the National Supplier Clearinghouse (1-866-238-9652,toll-free) and your Submitter ID from Palmetto GBA EDI (803-788-9751) before you begin testing.

Q. How many Submitter IDs do I need to submit claims electronically to the DMERC?

A. Only one Submitter ID is required to send claims to any or all of the four DMERCs.

Q. Must I test for certification with each DMERC?

A. No. Once you are NSF certified with one DMERC, you are considered to be certified by allDMERCs. However, you must test for connectivity (the ability to connect with the host computer)with each DMERC to which you plan to submit claims.

Q. Do suppliers whose claims are submitted through a billing service have to test before the billingservice can submit their claims?

A. No, they do not.

Q. I know that there are differences in submitting claims to the DMERCs. Where do I look forinformation on claims filing?

A. Keep your Supplier Manual (acquired from Palmetto GBA Professional Relations), this manual, andyour software user manual (from your software vendor) handy while preparing your first test batch.

Q. How do I know if my claims have errors or not?

A. Make sure your software vendor has your software set up for you to transmit your claims to PalmettoGBA and to retrieve your error reports. Retrieve your error report for a complete overview of yoursubmission. (See Section 5 for a detailed discussion of error reports.)

Q. When does Palmetto GBA run tests? When can I retrieve my error reports?

A. Palmetto GBA test runs are at 1:00 p.m. and 8:00 p.m. EST, Monday through Saturday. Direct-dialsubmitters can retrieve their error report(s) approximately one hour after the test run that the claimswere tested in. For example, if you submitted a test at 12 noon, it will run at 1:00 p.m. and you canretrieve your error reports around 2:00 p.m. If you submitted your claims at 7:00 p.m., your test willrun at 8:00 p.m. and your reports can be retrieved at 9:00 p.m. Bulletin Board System (BBS)submitters can retrieve their error report the following morning for all submissions received before8:00 p.m. EST, Monday through Friday.

Q. When does Palmetto GBA run production claims?

A. Production claims are run Monday through Friday at 7:00 p.m. EST. You can retrieve your errorreports the next morning.

Q. What should I do if I don�t achieve a 95% acceptance rate on my test?

A. Review your errors, correct them, and submit another test.

Section 4 � Glad You Asked� DMERC EDI User�s Manual


Q. Once I have achieved a 95% acceptance rate on my test batch of 20 or more claims, how will Iknow that I have been certified?

A. If you have achieved a 95% pass rate on 20 or more claims submitted in test, a Palmetto GBA EDIrepresentative will contact you with a telephone confirmation that you can begin submittingproduction claims within a day of our receipt of your error reports. No call from you is necessary.Please DO NOT log an unnecessary call to our EDI Technology Support Center! You will becontacted the day after we receive your successful test and all system updates enabling you tosubmit production claims will be made before you receive your confirmation call.

Q. What percentage of claims in a production batch must be accepted before I must resubmit theentire batch?

A. There is no percentage of acceptance or rejection considered when submitting production claims:

♦ All claims that are accepted through EDI will be indicated on your error report with an �A� in theStatus field on the E300 portion of your error report. Accepted claims are assigned a ClaimsControl Number (CCN), also listed on the E300 report. All accepted claims will be forwarded tothe adjudication (processing) system.

♦ Claims that have an �R� in the Status field on the E300 portion of the error report and have notbeen assigned a CCN have been rejected for errors. Correct the errors on these claims andresubmit them.

Q. I want to bill for several stores, all owned by one corporation. Is this possible?

A. A corporate home office or billing site may bill for any number of satellite stores, provided the homeoffice provides a supplier number for each satellite store and completes an Addendum to SupplierEMC Agreement, indicating that the home office accepts contractual responsibility for all claimssubmitted through the corporate home office.

Q. I submit most of my claims to another region. Must I have EDI Enrollments with PalmettoGBA if I plan to send only a few claims to you?

A. Yes. Palmetto GBA requires the appropriate signed EDI Enrollments from any and all submitterssubmitting claims directly or indirectly to Palmetto GBA.

Q. I�ve never submitted my claims electronically before. How can I acquire software to beginsubmitting claims electronically?

A. Palmetto GBA will provide a Certified Vendor List, which lists all vendors certified by a DMERC.The list provides all demographic information about the vendor entity. Palmetto GBA also offers abasic, claims data-entry software package.

To request information on acquiring a Certified Vendor List or Palmetto GBA�s low-cost software,visit our website at www.PalmettoGBA.com, contact the Palmetto GBA EDI Technology SupportCenter toll-free at 1-866-749-4301, or request an order form by writing to:

Palmetto GBA EDIPO Box 100145Columbia SC 29202-3145

DMERC EDI User�s Manual Section 4 � Glad You Asked�


Q. I�m a participating provider. Will Palmetto GBA electronically crossover my Medigap andMedicaid claims?

A. Yes. Complete and submit the appropriate Secondary Insurance information when submitting claimsfor patients with Medigap or Medicaid secondary insurance. Be sure to include the OCNA number(found in the Supplier Manual) when submitting Medigap claims.

Q. I am a non-participating provider. Will Palmetto GBA electronically crossover my Medigapand Medicaid claims?

A. Palmetto GBA will provide electronic crossover of Medicaid claims for all providers (participatingand non-participating) as long as the appropriate Secondary Insurance information is submitted in theproper format. However, electronic crossover of Medigap claims is provided for participatingproviders only.

Q. I�ve heard that sometimes Medigap and other complementary insurance are crossed overelectronically for both participating and non-participating providers. And I�ve also heard thatthis can be done without submitting any Secondary Insurance information electronically.

A. Some insurance companies that offer Medigap and complementary insurance have a contractualarrangement with Palmetto GBA that facilitates automatic crossover of insurance for theirbeneficiaries. If an insurance company has such a contractual agreement, no electronic submission ofSecondary Insurance information by the user is required, because the insurance company providesPalmetto GBA with an �eligibility file� that lists the Medicare numbers of those beneficiaries whohave their insurance. Palmetto GBA checks this eligibility file each time a Medicare primaryDMEPOS claim is submitted and, if a match is found, electronically crosses over the claim. Theremittance advice will indicate that this has been done.

Section 5 � NSF Front-End Errors DMERC EDI User�s Manual


SECTION 5 � NSF FRONT-END ERRORSWhen you transmit your claims and Certificates of Medical Necessity (CMNs) electronically to PalmettoGBA, they are run through �front-end� edit programs to ensure that they have been correctly formatted(arranged) in the National Standard Format (NSF). These front-end edits are designed to ensure that theinformation required for each claim is present and readable by all Palmetto GBA systems. By stopping�up front� claims that are incorrectly formatted, suspension, development, and denials can be decreased.

The front-end edits:

♦ Verify that all diagnosis and procedure codes on claims are valid and that they match the codes on theCMN when one is required.

♦ Ensure that all required claim/CMN information has been submitted.

♦ Check to see that all information is entered within the required data entry rules of the NSF.

In short, it is the responsibility of Palmetto GBA EDI to receive your claims, validate that they have beensubmitted in the National Standard Format, and provide you with a detailed error report to help youresolve any front-end edits.

Your software vendor has provided you with claims entry software that formats your claims and CMNsinto the National Standard Format. Vendors use a matrix (a set of programming instructions) andspecifications (detailed specifics about how information is to be formatted) to create your software.

When you receive a front-end NSF error, your error report will give you the number of the error and a briefdescription of the error. When you reference the Error Log, it will tell you where an error occurred andgive you the NSF name of the field where the error was made.

Claim information is entered into fields (screen locations) in your software. These fields have two kindsof names, the descriptive names that your software uses to label fields (e.g., the field for insurance typecode may be called �Ins Type� in your software) and the NSF field name. NSF field names include arecord name made up of letters and numbers and a field name made up of numbers (e.g., the �Ins Type�field noted above is the �DA0-06.0� field in NSF). If you know the NSF name for a field, but you don�tknow where that field is located in your software, your vendor can help you locate that field.

There are more than 700 front-end edit errors. These errors are comprised of both user-errors and from-errors in your software. This section provides an overview of how to use your error reports.

In this section, you will find the Error Log, which contains:

♦ A numbered listing of all NSF front-end edit errors that you may see on your error report.

♦ The NSF field name where the error occurred.

♦ The appropriate codes required for completion of each field in the NSF.

♦ A listing of the abbreviations used on your error reports.

How To Use The Error LogAfter you have retrieved your error report, follow these steps:

1. Review your error report.

2. Determine what error(s) you have for each claim that was rejected.

3. Refer to the Error Log to determine why you have received each error.

DMERC EDI User�s Manual Section 5 � NSF Front-End Errors


4. Using the detailed information listed in the Error Log, correct the error. Contact your software vendor if:

a. You cannot identify in your software the field referenced in the Error Log.

b. The Error Log identifies an error as a software error.

5. Using the detailed information listed in the Error Log, correct the error(s).

6. Resubmit only those claims that were rejected for errors.

If you receive the same error after carefully reviewing, correcting, and resubmitting the claim, contact theEDI Technology Support Center toll-free at 1-866-749-4301 and ask to have your call logged to �525N.�A Palmetto GBA EDI staff member will return your call in the order it was received and provideassistance.

Note: EDI does not send updated Error Logs when new edits are installed. The error report notes willannounce any newly installed edits. Insert the user notes from your error report into your Error Log tokeep it up to date.

NSF Front End Errors001 � 291

MessageCode Text

Pos Explanation/Resolution NSF

001 Sequence Error -AA0

1-3 The first record in a submission must be a Fileheader (AA0) record. This error indicates that thefirst record in the submission is not the AA0 record.Contact your software vendor if you receive thiserror.

AA0-01.0

002 Submitter IDMissing

4-19 The Submitter ID has not been entered. Enter the 9-character Submitter ID assigned by DMERC.

AA0-02.0

003 Test Subm ID inProd

4-19 The Submitter ID has not been set up for production.Claims cannot be filed to a DMERC if the submitterhas not been certified. Contact the DMERC thatcertified you if you have been certified and receivethis error.

AA0-02.0

004 Submitter IDInvalid

4-19 This error indicates that the Submitter ID entered isnot recognized as a valid Submitter ID assigned byone of the DMERCs. Ensure that no alphas �Os� or�Ls� have been used as numeric zeros or ones. Keythe Submitter ID exactly as received from theDMERC. Contact the DMERC that issued theSubmitter ID if keying of the Submitter ID has beenverified and the error persists.

AA0-02.0



MessageCode Text


A valid submission type must be entered. Thisindicator identifies the method being used to submitclaims. This will often be programmed into yoursoftware. Contact your software vendor if youreceive this error and do not enter the submissiontype yourself. Valid codes are:

DISKETTEASYNCASYASY003ASY012ASY024ASY048ASY096

BISYNCBSYBSY024BSY048BSY096BSY192

CPUCPU DSK

DSK8SSDSK8SDDSK8DDDSK5DDDSK5SS

DSK5SDDSK5HDDSK3SSDSK3SDDSK3DDDSK3HD

005 Submit TypeInvalid

29-34

FAXFAX

RJERJERJE024RJE048RJE096RJE192

SYNCNDM

TAPETPCRTGTP0800TP1600TP6250

SCANNERSCNSCNOCRSCNICR

AA0-04.0

006 Submiss NBRMissing

35-40 A file inventory number must be assigned by yoursystem and must be unique for each new filesubmitted. Contact your software vendor if youreceive this error.

AA0-05.0

007 ZA0 RecordMissing

� The ZA0 (file trailer) record is missing. This is thelast record in a submission (ZA0) Contact yoursoftware vendor if you receive this error.

ZA0

008 Create DateMissing

213-220 The date the file was created must be entered. Thiserror indicates that the �create date� is missing.Contact your software vendor if you receive this error.

AA0-15.0

009 Create DateInvalid

213-220 The date the file was created must be entered in theCCYYMMDD format. Your software shouldarrange this date in the correct format for you.

AA0-15.0

010 Create Dt < CurrDt

213-220 The date the file was created cannot be later than thedate the file is received by the DMERC. Contactyour software vendor if you receive this error.

AA0-15.0

011 Nat Vers CdeInvalid

244-248 Valid National Version code is �003.01.� Contactyour software vendor if you receive this error.

AA0-19.0

012 Recv Type Not =C

1-3 The receiver of all DMEPOS claims must beMedicare. The correct code for Medicare is �C.�You probably will need assistance from yoursoftware vendor if this error is received, unless yoursoftware allows you to enter the receiver typeyourself).

AA0-18.0

013 Sequence Error -BA0

1-3 The Batch Header (BA0) record is out of sequencein the file. Contact your software vendor if youreceive this error.

BA0

014 EMC Prov IDMissing

4-18 This error indicates that the Supplier Number hasnot been entered. The first 6 positions of theSupplier Number (the number received from theNational Supplier Clearinghouse) must be entered inthis field.



MessageCode Text


015 EMC Prov ID Not= YA0

4-18 The Supplier Number was somehow not carriedthrough your system to the Batch Trailer Record.Contact your software vendor if you receive thiserror.

YA0-02.0

016 EMC Prov IDInvalid

4-18 The Supplier Number entered has been entered in aninvalid format. Check the Supplier Number forcorrectness, ensuring that no alphas �Os� or �Ls�have been used as numeric zeros or ones and thatthe number has been keyed in correctly.

BA0-02.0

017 Batch NumberMissing

22-25 You or your software must enter a sequential batchnumber, incremented by one for each BA0 (batch)record. If you receive this error, no batch numberwas submitted with your batch. This error usuallyrequires assistance from your software vendor.

BA0-04.0

018 Batch Nbr Invalid 22-25 This error indicates that an invalid batch number hasbeen submitted. Batch numbers must be numeric(0001-9999). The first batch number for eachprovider or new batch type must be �0001.� If youenter the batch numbers yourself, correct the batchnumber. If your system assigns batch numbersautomatically, contact your software vendor if youreceive this error.

BA0-04.0

019 Prov Med NbrInvalid

48-62 This error again refers to the Supplier Number.Your software should carry the Supplier Numberthroughout your system. Contact your softwarevendor if you receive this error.

BA0-09.0

020 Med Nbr Not=EMCID

48-62 This error indicates that the Supplier Number hasnot been carried throughout your systemconsistently (by your software). Again, the SupplierNumber is also sometimes referred to as the�Provider Medicare Number� in the NSF. Contactyour software vendor if you receive this error.

BA0-09.0

021 YA0 RecordMissing

� This error indicates that the YA0 (Batch Trailer)record is missing. There must be a Batch TrailerRecord (YA0) for each BA0 (Batch) record in a file.Contact your software vendor if you receive thiserror.

YA0

022-040 Not Used N/A These error codes are not used in the DMERCversion of the NSF.

041 Sequence Error -CA0

1-3 The CA0 (Claim Header) record is out of sequence.Contact your software vendor if you receive thiserror.

CA0



MessageCode Text


042 Pat Cntl NbrMissing

6-22 A patient control number is an account numberassigned by the user (or, in some cases, by yoursoftware) to each patient. Your software should linkthis number to its patient and carry it throughout thesystem as a patient identifier. See Section 3 forPatient Control Number Data Entry Instructions. Ifyou receive this error and assign patient controlnumbers manually, ensure that your patient controlnumbers are formatted as indicated in Section 3. Ifyour patient control numbers are automaticallygenerated by your software, contact your softwarevendor if you receive this error.

CA0-03.0

043 Patient CTRLNBR Invalid

A patient control number is an account numberassigned by the user (or, in some cases, by yoursoftware) to each patient. Your software should linkthis number to its patient and carry it throughout thesystem as a patient identifier. See Section 3 forPatient Control Number Data Entry Instructions. Ifyou receive this error and assign patient controlnumbers manually, ensure that your patient controlnumbers are formatted as indicated in Section 3. Ifyour patient control numbers are automaticallygenerated by your software, contact your softwarevendor if you receive this error.

CA0-03.0

044 Patient NameInvalid

23-55 The first name, last name, or middle initial enteredfor the patient is incorrectly formatted. Refer to theIndividual Names Data Entry Instructions in Section3 of this manual.

CA0-04.0,05.0, 06.0

045 Pat Dt BirthMissing

59-66 The patient�s date of birth is required and has notbeen entered.

CA0-08.0

046 Pat Dt Birth Invalid 59-66 The patient�s date of birth is incorrectly formatted.See Dates Data Entry Instructions in Section 3 ofthis manual.

CA0-08.0

047 Pat DOB Not <Srv Dt

59-66 This error indicates that the patient�s date of birthentered is after the date of service. The patient�sdate of birth must be before the date of service.

CA0-08.0

048 Patient SexMissing

67 The patient�s sex must be entered and it has notbeen. Valid codes to indicate patient sex are:

M = MaleF = Female

CA0-08.0

049 Patient Sex Invalid 67 An invalid code for the patient�s sex has beenentered.

CA0-08

050 Pat AddressMissing

69-159 The patient�s address is required and has not beenentered.

CA0-11.0,12.0, 13.0,14.0, 15.0

051 Pat AddressInvalid

69-159 There is a formatting error in the patient�s address.See Addresses Data Entry Instructions in Section 3of this manual.

CA0-11.0,12.0, 13.0,14.0, 15.0



MessageCode Text


052 Pat Death IndMissing

173 This error indicates that a code indicating whetheror not the patient is deceased is required and has notbeen entered. Valid codes are:

D = DeceasedN = Not deceased

CA0-20.0

053 Pat Death IndInvalid

173 The code entered to indicate whether or not thepatient is deceased is invalid. Valid codes are:

D = DeceasedN = Not deceased

CA0-20.0

054 Pat Death DtInvalid

174-181 The patient�s date of death cannot be earlier than thedate of service and must be formatted according toDates Data Entry Instructions in Section 3 of thismanual.

CA0-21.0

055 XA0 RecordMissing

� There must be an XA0 (Claim Trailer) record foreach CA0 (Patient Data) record in a file. This errorindicates that there is not. Contact your softwarevendor if you receive this error.

XA0

056 Not Used057 Clm Edit Ind

Missing183 This error indicates that no Claim Edit Indicator has

been entered. This field is most likely automaticallyentered by your software. The value must be �C.� Ifyou do not manually key in a Claim Edit Indicator,you can assume your software does thisautomatically and contact your software vendor ifyou receive this error. If you enter the Claim EditIndicator yourself, ensure that you have a �C�entered in this field. �C� is the only valid value forthis field.

CA0-23.0

058 Clm Edit IndInvalid

183 This field is most likely automatically entered byyour software. The value must be �C.� If you do notmanually key in a Claim Edit Indicator, you canassume your software does this automatically andcontact your software vendor if you receive thiserror. If you enter the Claim Edit Indicator yourself,ensure that you have a �C� entered in this field. �C�is the only valid value for this field.

CA0-23.0

059 Leg Rep IndMissing

186 If someone other than the beneficiary (patient) is toreceive the explanation of benefits and/or payment, a�Y� must be entered in this field. If the beneficiary(patient) is to receive the explanation of benefitsand/or payment, an �N� must be entered in this field.This error occurs when no code has been entered inthe field.

CA0-25.0



MessageCode Text


060 Leg Rep IndInvalid

186 This error occurs when a code other than �Y� or �N�has been entered in the �Legal RepresentativeIndicator� field. If someone other than thebeneficiary (patient) is to receive the explanation ofbenefits and/or payment, a �Y� must be entered inthis field. If the beneficiary (patient) is to receive theexplanation of benefits and/or payment, an �N�must be entered in this field.

CA0-25.0

061 CB0 Name/AddMissing

23-146 When there is a legal representative that is to receivethe explanation of benefits and/or payment on behalfof the beneficiary and the code in the Legal RepIndicator field CA0-25.0 equals �Y,� the name andaddress of the legal representative must be entered.CB0-04.0-11.0 indicates that this information ismissing.

CB0-04.0- 11.0

062 Sequence Error -CB0

1-3 The Legal Representative Data Record (CB0) recordis out of sequence in the file. It must come afterCA0 record and before the DA0 record; and therecan only be one CB0 record for each claim. If youreceive this error, contact your software vendor.

CB0


6-22 This error indicates that a Patient Control Number(s)is missing. You must enter (or your software mustautomatically generate) a patient control number (or�patient account number�) that identifies the patientto the provider. This number is carried throughoutyour system and must be the same in the CA0through XA0 record. If you get this error, ensure thatyou have assigned a Patient Control Number to eachpatient. If your software automatically generates thisnumber and you receive this error, contact yoursoftware vendor. See Section 3 for Patient ControlNumber Data Entry Instructions if you enter thesenumbers manually.

CB0-03.0

064 Pat Cntl NbrInvalid

6-22 The patient control number is in an invalid format.You must enter (or your software must automaticallygenerate) a patient control number (or �patientaccount number�) that identifies the patient to theprovider. This number is carried throughout yoursystem and must be the same in the CA0 throughXA0 records. If you get this error, ensure that youhave assigned a Patient Control Number to eachpatient. If your software automatically generates thisnumber and you receive this error, contact yoursoftware vendor. See Section 3 for Patient ControlNumber Data Entry Instructions if you enter thesenumbers manually.

CB0-03.0



MessageCode Text


065 Leg Rep NameMissing

23-55 This error indicates that the name of the patient�slegal representative is missing. If a �Y� was enteredin the �Legal Representative� field (CA0-25.0),indicating that someone other than the patient is toreceive the explanation of benefits and/or paymentfor the patient�s claim(s), you must enter the nameof patient�s legal representative in fields CB0-04.0,05.0, 06.0.

CB0-04.0,05.0, 06.0

066 Leg Rep NameInvalid

23-55 The legal representative�s name is entered in aninvalid format. See Individual Names Data EntryInstructions in Section 3 of this manual.

CB0-04.0,05.0, 06.0

067 Leg Rep AddrMissing

56-146 If there is a Legal Rep Payee, his/her address mustbe entered. This error indicates the legalrepresentative�s address is missing.

CB0-07.0,08.0, 09.0,10.0, 11.0

068 Leg Rep AddrInvalid

56-146 The address of the patient�s legal representative isentered in an invalid format. See Addresses DataEntry Instructions in Section 3 of this manual.

CB0-07.0,08.0, 09.0,10.0, 11.0

069 Sequence Error -DA0

1-3 The Insurance Information (DA0) record is out ofsequence in the file. It must come after a CA0, CB0,DA0, DA1, or DA2 record and before a DA0, DA1,DA2, or EA0 record. There cannot be more thanthree DA0 records per claim. Contact your softwarevendor if you receive this error.

DA0

070 Sequence NbrInvalid

4-5 DA0 records must come in numerical sequence ineach claim (01, 02, 03). Contact your softwarevendor if you receive this error.

DA0-02.0

071 First Seq Nbr Not01

4-5 The first sequence number for the initial DA0 recordfor a claim must be 01. Your software probablygenerates this sequence number when you enter aprimary insurance record. If so, contact yoursoftware vendor if you receive this error. If youenter the sequence number yourself, ensure that youhave entered �01� for the first DA0 record for aclaim (the primary insurance record comes first).

DA0-02.0



DA0-03.0



MessageCode Text



6-22 The patient control number is in an invalid format.You must enter (or your software must automaticallygenerate) a patient control number (or �patientaccount number�) that identifies the patient to theprovider. This number is carried throughout yoursystem and must be the same in the CA0 throughXA0 record. If you get this error, ensure that youhave assigned a Patient Control Number to eachpatient. If your software automatically generates thisnumber and you receive this error, contact yoursoftware vendor. See Section 3 for Patient ControlNumber Data Entry Instructions if you enter thesenumbers manually.

DA0-3.0

074 Ins Type CdeInvalid

25-26 This error indicates that an invalid insurance typecode has been entered. Valid codes for MedicareDMEPOS claims are:MP = Medicare PrimaryMG = MedigapOT = Medicaid

Note: The code �SP� (Supplemental) will pass frontend edits, provided all accompanying information isentered in a correct format. However, thisinformation is not required for electronic crossoverby the DMERCs based on eligibility for crossoveras outlined in Section 4. Those submitters whosecomputer systems do not provide the ability tosuppress secondary insurance being submitted whenthey are not eligible for electronic crossover can usethis code. Please see Section 4 for an explanation ofthose secondary claims that can be crossed overelectronically.

DA0-06.0

075 Payer NameMissing

36-68 The name of the payer organization (insurancecompany) for secondary Medicaid (crossed over forall providers), Medigap insurance (see Section 4 fordetails on Medigap crossovers), and for primaryinsurance when Medicare is secondary (MSP) mustbe entered and has not been.

DA0-09.0

076 Payer NameInvalid

36-68 The payer organization�s (insurance company�s)name has been entered in an invalid format. SeeIndividual Names Data Entry Instructions in Section3 of this manual.

DA0-09.0

077 Group Nbr Missing 69-88 This error indicates that the group number for asecondary insurer is missing. The identificationnumber of the patient�s insurance group or plan (forMedicaid and Medigap secondary insurers orprimary insurers when Medicare is secondary) mustbe entered.

DA0-10.0

078 Group NumberInvalid

69-88 The group number entered has invalid character(s).Valid characters are 0-9, A-Z, and a blank within.No other characters are allowed.

DA0-10.0



MessageCode Text


079 Group Nbr=PayerID

69-88 The group number (DA0-10.0) entered is the sameas the Payer ID number (DA0-07.0). The groupnumber and Payer ID cannot be the same.

DA0-10.0

080 Grp Nbr=Ins IDNbr

69-88 The group number (DA0-10.0) is the same as theInsurance ID Number (DA0-18.0). The groupnumber and the Insurance ID Number cannot be thesame.

DA0-10.0

081 GrpNbr=Zero/Space

69-88 The group number entered is made up of all zeros orzeros and spaces. The group number cannot bemade up of all zeros or zeros and spaces.

DA0-10.0

082 Grp Nbr=All Nines 69-88 The group number entered is made up of all nines ornines and zeros. The group number (except forcertain commercial claims which allow �999999�followed by spaces) cannot be made up of all 9�s or9�s and zeros.

DA0-10.0

083 Group NameInvalid

89-121 The group name entered contains either a formattingerror (see Section 3 for Individual Names Data EntryInstructions) or has been entered as �UNKNOWN,��123456789,� �INDIVIDUAL,� �NONE,� �SELF,��N/A,� or �NOT APPLICABLE.�

DA0-10.0

084 Group Nbr=GrpName

89-121 The group number (DA0-10.0) entered is the sameas the group name (DA0-11.0). The group name andnumber cannot be the same.

DA0-10.0

085 Pri Auth NbrMissing

138-152 No prior authorization number has been entered.The procedure code you entered requires that a priorauthorization number be entered.

DA0-14.0

086 Assign Ind Missing 153 If you are a participating provider and the patienthas Medigap insurance, you must enter anassignment of (Medigap) benefits indicator on thesecondary (Medigap) insurance record. Valid codesare:

Y = Benefits have been assigned to the providerN = Benefits have not been assigned to the

providerNot required on Medicare DA0 records.

DA0-15.0

087 Assign Ind Invalid 153 The assignment of benefits indicator is invalid.Valid codes are:

Y = Benefits have been assigned to the providerN = Benefits have not been assigned to the

providerNot required on Medicare DA0 records.

DA0-15.0

088 Pat Rel NotNumeric

155-156 The patient relationship to insured code must benumeric. Codes one through nine must be enteredwith a leading zero; i.e., 01, 02, etc.

DA0-17.0

089 Pat RelationInvalid

155-156 The patient relationship to insured code must bebetween 01 and 19; �01� (self) and �02� (spouse)are the most often used codes in filing MedicareDMEPOS claims.

DA0-17.0



MessageCode Text


090 HIC NumberInvalid

157-181 The Insured�s Identification Number (a.k.a.Medicare number, HIC number) has been entered inan invalid format. Identification numbers maycontain numeric (0-9) and alpha characters (A-Z).

DA0-18.0

091 Medigap Ins IDReq

157-181 The Insured�s Identification Number enteredcontains all nines or zeros. The Insured�sIdentification Number cannot be all nines or allzeros.

DA0-18.0

092 Ins ID Nbr Invalid 157-181 The Insured�s Identification Number cannot be�UNKNOWN,� �INDIVIDUAL,� �SELF,��NONE,� or �1234567890.�

DA0-18.0

093 Insured NameInvalid

182-214 There are two possible reasons for this error:1. The Insured�s name has been entered in an

invalid format. See Data Entry Instructions inSection 3 of this manual.

2. This error occurred in a secondary insuranceclaims and the patient is not the insured. The�Patient Relationship� field contains a valueother than �01� (self) to indicate that the patientis not the insured. Therefore, thename/sex/birthdate information required is that ofthe insured rather than the patient. Check to see ifthis scenario applies and ensure that if it does, thename/sex/birthdate information entered belongsto the insured.

DA0-19.0,20.0, 21.0

094 Ins Locator IDMissing

229-235 The two digit code indicating the state in which thepatient is eligible for Medicaid. If the patient is noteligible for Medicaid, this field may be blank.

DA0-27.0

095-096 Not Used097 Sequence Error -

DA11-3 The Insurance Information Record (DA1 - Payer

Data 2) is out of sequence in the file. The DA1 recordmust come after a DA0 record and before a DA0,DA2, or EA0 record. Contact your software vendor ifyou receive this error.

DA1


4-5 The sequence number associated with a DA0, DA1,and DA2 record must be 01, 02, or 03. Contact yoursoftware vendor if you receive this error.

DA0-2.0



DA0-03.0



MessageCode Text




DA0-03.0

101 Payer AddrMissing

23-113 The claim payer address for the primary payer (ifnot Medicare; i.e., on an MSP claim) has not beenentered. The claim payer address of the primarypayer (if not Medicare; i.e., on an MSP claim) mustbe entered.

DA1-04.0,05.0, 06.0,07.0, 08.0

102 Payer Addr Invalid 23-113 The payer�s claim mailing address has been enteredin an invalid format. See Addresses Data EntryInstructions in Section 3 of this manual.

DA1-04.0,05.0, 06.0,07.0, 08.0

103 Disallow CSTInvalid

114-120 This error indicates that the amount disallowed bythe payer due to the failure to meet the costcontainment provisions is entered in an invalidformat. The amount disallowed by the payer due tothe failure to meet the cost containment provisionsmust be a positive, unsigned numeric value.

DA1-09.0

104 Disallow OthInvalid

121-127 This error indicates that the amount disallowed bythe primary payer for reasons other than the failureto meet the cost containment provisions is entered inan invalid format. The amount disallowed by thepayer for reasons other than the failure to meet thecost containment provisions must be a positive,unsigned numeric value.

DA1-10.0

105 Allowed AmtInvalid

128-134 This error indicates that the maximum allowedamount determined by the primary payer has beenentered in an invalid format. The maximum amountdetermined by the payer must be entered as apositive, unsigned numeric value.

DA1-11.0

106 Deduct AmtInvalid

135-141 This error indicates that the deductible amount forthe primary payer is entered in an invalid format.The deductible amount must be entered as apositive, unsigned amount.

DA1-12.0

107 Coinsure AmtInvalid

142-148 This error indicates that the coinsurance amount forthe primary payer has been entered as a positive,unsigned amount.

DA1-13.0

108 Payer Pd AmtInvalid

149-155 This error indicates that the payer paid amount isentered in an invalid format. The payer paid amountmust be entered as a positive, unsigned amount.

DA1-14.0



MessageCode Text


109 Zero Pay IndInvalid

156 The zero payment indicator entered is invalid. Thisamount, derived from the EOB or remittance of theprimary payer, is indicated by the following values:

Z = Zero payment notification has not beenreceived from this payer

N = Payment amount is greater than zero

DA1-15.0

110 Sequence Error -DA2

1-3 The additional insurance information record (DA2)is out of sequence in the file. It must come after aDA0 or DA1 record and before a DA0 or EA1record. Contact your software vendor if you receivethis error.

DA2


4-5 The sequence number associated with a DA0, DA1and DA2 record must be 01, 02, or 03. Contact yoursoftware vendor if you receive this error.

DA0,DA1, DA2



DA2-03.0



DA2-03.0

114 Insured AddrInvalid

23-113 The mailing address of the insured (on MSP claims)has been entered in an invalid format. SeeAddresses Data Entry Instructions in Section 3 ofthis manual.

DA2-04.0,05.0, 06.0,07.0, 08.0

115 Insure PhoneInvalid

114-123 The telephone number of the insured (on MSPclaims) has been entered in an invalid format. SeeTelephone Data Entry Instructions in Section 3 ofthis manual.

DA2-09.0



MessageCode Text


116 Ins Retire DtInvalid

124-131 The Insured�s retirement date (on MSP claims) hasbeen entered in an invalid format. See Dates DataEntry Instructions in Section 3 of this manual.

DA2-10.0

117 Spouse Retir DtMiss

132-139 The spouse�s retirement date (on MSP claims) hasnot been entered. Enter the spouse�s retirement date.

DA2-11.0

118 Spouse Ret DateInv

132-139 The spouse�s retirement date has been entered in aninvalid format. See Dates Data Entry Instructions inSection 3 of this manual.

DA2-11.0

119 Ins Emp NameInvalid

140-172 The name of the insured�s employer has beenentered in an invalid format. See Individual NamesData Entry Instructions in Section 3 of this manual.

DA2-12.0

120 Ins Emp AddrMissing

173-263 The address of the insured�s employer has not beenentered. Enter the employer�s address.

DA2-13.0,14.0, 15.0,16.0, 17.0

121 Ins Emp AddrInvalid

173-263 The address of the insured employer has beenentered in an invalid format. See Addresses DataEntry Instructions in Section 3 of this manual.

DA2-13.0,14.0, 15.0,16.0,17.0

122 Employer IDMissing

264-275 The identification number assigned by the employerto employee has not been entered and is required.Enter the employee ID number.

DA2-18.0

123 Employer IDInvalid

264-275 The employee�s identification number assigned byemployer has been entered in an invalid format. SeeIdentification Numbers Data Entry Instructions inSection 3 of this manual.

DA2-18.0

124 Sequence Error -EA0

1-3 The Claim Data (EA0) record is out of sequence inthe file. If must come after a DA0, DA1, or DA2record and before an EA1 or FA0 record. Contactyour software vendor if you receive this error.

EA0



EA0-03.0



MessageCode Text




EA0-03.0

127 Pat Ctl Nbr Not =CA0

6-22 The patient control number must be the same as thepatient control number in positions 6-22 of CA0(Patient Data) record. Contact your software vendorif you receive this error.

EA0-03.0

128 Empl Rel IndMissing

23 The employment related indicator, which indicateswhether or not the patient�s medical condition isemployment related, has not been entered and isrequired. Valid codes are:

Y = Employment relatedN = Not employment relatedU = Unknown

EA0-04.0

129 Empl Rel IndInvalid

23 The employment related code, which indicateswhether the patient�s medical condition isemployment related must be valid. Valid codes are:

Y = Employment relatedN = Not employment relatedU = Unknown

EA0-04.0

130 Accident IndInvalid

24 A code indicating whether the patient�s medicalcondition is the result of an accident must beindicated. This error means that the code entered isnot valid. Valid codes are:

A = Auto accidentO = Other, non-auto accidentN = No accident

EA0-05.0

131 Accident Dt Invalid 26-33 If you have indicated that the patient�s medicalcondition is the result of an accident, the date of thataccident must be entered. This error indicates thatthe date is entered in an invalid format or indicatesan inappropriate time of accident (i.e., after thesupply was prescribed). See Dates Data EntryInstructions in Section 3 of this manual.

EA0-07.0

132 Accident St Invalid 40-41 If you indicated that the patient�s medical conditionis the result of an accident, you must indicate thestate in which the accident occurred. This errorindicates that the state code entered is invalid. Entera valid Postal service state code.

EA0-10.0



MessageCode Text


133 Rel of Info Invalid 45 A code indicating whether or not the provider has asigned release of information form must be entered.This error indicates that the code entered is invalid.Valid codes are:

M = Modified. The provider has limited orrestricted authority to release medical/billinginformation for purposes of claiminginsurance benefits

N = No. The provider does not have permission torelease any medical/billing information

Y = Yes. The provider has on file a signedstatement permitting release of Medical/billinginformation for purposes of claiminginsurance benefits

EA0-13.0

134-139 Not Used140 Diagnosis 1

Invalid179-183 This error indicates that the first (#1) diagnosis code

entered on the claim is either an invalid code or isentered in an invalid format. Things to rememberabout diagnosis codes:♦ The code must be the most specific diagnosis

code allowed in the ICD-9 CM format♦ Do not �pad� the diagnosis code field with extra

zeros. For example, if the code is �123,� enter�123,� not �12300.

♦ Do not enter decimal points in diagnosis codes.The decimal is always implied between the thirdand fourth position of this field.

EA0-32.0

141 Diagnosis 2Invalid

184-188 This error indicates that the second (#2) diagnosiscode entered on the claim is either an invalid codeor is entered in an invalid format. Things toremember about diagnosis codes:♦ The code must be the most specific diagnosis




EA0-33.0



MessageCode Text



189-193 This error indicates that the third (#3) diagnosiscode entered on the claim either an invalid code oris entered in an invalid format. Things to rememberabout diagnosis codes:♦ The code must be the most specific diagnosis




EA0-34.0


194-198 This error indicates that the fourth (#4) diagnosiscode entered on the claim is either an invalid codeor is entered in an invalid format. Things toremember about diagnosis codes:♦ The code must be the most specific diagnosis




EA0-35.0

144 Not Used145 Prv Assn Ind

Missing199 A code indicating whether or not the provider

accepts assignment must be entered. This field maynot be blank. This error indicates that no code hasbeen entered. Valid codes are:

A = AssignedN = Not AssignedP = Patient refuses to assign benefits

EA0-36.0

146 Prov Assn IndInvalid

199 The code you entered indicating whether or not theprovider accepts assignment is invalid. This fieldmay not be blank. Valid codes are:

A = AssignedN = Not AssignedP = Patient refuses to assign benefits

EA0-36.0

147 Facility NameInvalid

209-241 The name of the facility where services wererendered has been entered in an invalid format. SeeIndividual Names Data Entry Instructions in Section3 of this manual. This field may be blank if servicessubmitted on this claim were not rendered in ahospital, nursing facility, or laboratory.

EA0-39.0

148 Prv Sign IndInvalid

200 The code indicating whether or not the providersignature is on file is invalid. Valid codes are:

Y = signature of provider is on fileN = signature of provider is not on file

EA0-37.0



MessageCode Text


149 Document IndInvalid

242 The code indicating if/where documentation can befound is invalid. Valid codes are:

3 = on file at provider�s site4 = on file at payer�s site5 = cert record in this claim (with or without

narrative)6 = narrative record included in this claim9 = no documentation

EA0-40.0


EA11-3 The EA1 (Claim Data) record is out of sequence in

the file. It must come after an EA0 record andbefore an FA0 record. Contact your software vendorif you receive this error.

EA1



EA1.03.0



EA1.03.0

155 Pat Ctl Nbr Not =CA0

6-22 The patient control number must be the same as thepatient control number in positions 6-22 of CA0(Patient Data) record. Contact your software vendorif you receive this error.

EA1.03.0

156 Record NotRequired

� An EA1 record is not required if aFacility/Laboratory Name (place of service) is notentered in the Facility Name (EA0-39) field. If theservices rendered for this claim were not rendered ina hospital, nursing facility, or laboratory, this recordis not required.

EA1

157 Not Used



MessageCode Text


158 Facility AddMissing

53-143 If the patient resides in a facility or the servicesrendered for the submitted claim were rendered in alab, the address of the facility or lab must be entered.This error indicates that the address is missing.

EA1-06.0,07.0, 08.0,09.0, 10.0

159 Facility Add Invalid 53-143 If the patient resides in a facility or the servicesrendered for the submitted claim were rendered in alab, the address of the facility or lab must beentered. This error indicates that the address of thefacility in which the patient resides or the lab inwhich the services were rendered is entered in anincorrect format. See Addresses Data EntryInstructions in Section 3 of this manual.

EA1-06.0,07.0, 08.0,09.0, 10.0


FA01-3 The Service Line Detail (FA0) record is out of

sequence in the file. It must come after an EA0,EA1, FA0, FB0, FA1, or FD0 record and before anFB0, FB1, FD0, HA0, XA0, or Certification record.Contact your software vendor if you receive thiserror.

FA0

177 Sequence NbrMissing

4-5 Your software should generate a sequence numberindicating the FA0 (01-99). Contact your softwarevendor if you receive this error.

FA0-02.0


4-5 A sequence number must be between 01-99. Contactyour software vendor if you receive this error.

FA0-02.0



FA0-03.0



FA0-03.0



MessageCode Text


181 No Capped RentK Mod

60-79 This error will display when a procedure code for acapped rental item is entered with the RR modifier,but the appropriate K modifier is not also included.Enter the appropriate K modifier to resolve theerror.

FA0-09.0- 12.0

182 Svc Frm DateMissing

40-47 A valid date indicating the date the service wasinitiated must be entered. This error indicates thatno �service from� date was entered.

FA0-05.0

183 Svc Frm DateInvalid

40-47 A valid date indicating the date the service wasinitiated must be entered. If you receive this error,the date you entered has been entered in an invalidformat. See Dates Data Entry Instructions in Section3 of this manual.

FA0-05.0

184 Svc To DateMissing

48-55 A valid date indicating the date through which theservice extends must be entered. This error indicatesthat no �to� or �through� date was entered.

FA0-06.0

185 Svc To DateInvalid

48-55 A valid date indicating the date through which theservice extends must be entered. This error indicatesthat the �to� or �through� date has been entered inan invalid format. See Dates Data Entry Instructionsin Section 3 of this manual.

FA0-06.0

186 To Date < FromDate

40-55 The �service to� date (FA0-06.0) must be greaterthan or equal to the �service from� date (FA0-06.0).This error indicates that the �to� date entered is lessthan (earlier) than the �service from� date.

FA0-06.0

187 Place of SvcMissing

56-57 A place of service code indicating where theservices were performed must be entered. This errorindicates that no place of service code was entered.Valid codes are:

11 = Office12 = Home21 = Inpatient Hospital22 = Outpatient Hospital23 = Emergency Room Hospital24 = Ambulatory Surgical Center25 = Birthing Center26 = Military Treatment Facility31 = Skilled Nursing Facility32 = Nursing Facility33 = Custodial Care Facility34 = Hospice41 = Ambulance � Land42 = Ambulance � Air or Water50 = Federally Qualified Health Center51 = Inpatient Psychiatric Facility52 = Psychiatric Facility Partial Hospitalization53 = Community Mental Health Center54 = Intermediate Care Facility/Mentally Retarded55 = Residential Substance Abuse Treatment

Center

FA0-07.0



MessageCode Text


56 = Psychiatric Residential Treatment Center60 = Mass Immunization Center61 = Comprehensive Inpatient Rehabilitation

Facility62 = Comprehensive Outpatient Rehabilitation

Facility65 = End Stage Renal Disease Treatment Facility71 = State or Local Public Health Clinic72 = Rural Health Clinic81 = Independent Laboratory99 = Other Unspecified Facility

188 Place of SvcInvalid

56-57 This error indicates that the place of service codeentered is invalid or has been entered in an invalidformat (place of service codes are two-charactercodes). Valid codes are:


Center56 = Psychiatric Residential Treatment Center60 = Mass Immunization Center61 = Comprehensive Inpatient Rehabilitation



FA0-07.0



MessageCode Text


189 Proc Cds/ModInvalid

60-70 This error will result when the procedurecode/modifier combination entered is not a validcombination. HCPCS codes must be the latestedition HCPCS procedure codes. An outdated codemay have been entered. Ensure that no alphas �Os�or �Ls� have been used as numeric zeros or ones.HCPCS codes with unnecessary or invalid modifiersfor the code will be rejected. Make sure, if using amodifier, that it is valid with the HCPCS code,keyed correctly, and necessary. Also, ensure whenusing modifiers that the pricing modifier is alwaysthe first modifier used. Pricing modifiers includeNU (new), UE (used), RR (rental), and MS(maintenance service).

190 Procedure CdMissing

60-64 A procedure code is always required on a claim,except when you are filing for Oral Cancer Drugs.This error indicates that there is no procedure codefor the claim. Enter a valid procedure code on theclaim.

FA0-09.0

191 HA0 Required forNOC

� This error will display if you have entered an �NOC�(not otherwise classified) procedure code, but havenot entered the NOC descriptor in the extra narrativearea provided by your software (HA0 record). Enterthe NOC descriptor in the extra narrative area withinyour software. Contact your software vendor if youdo not know where to locate the extra narrative areawithin your software.

HA0

192 Capped Rent#SVE

82-85 This error will display if you have entered aprocedure code for a rental on the detail line and theunits of services is not �1.� The units of service for arental must equal �1.�

Related Note: The �from� and �to� dates must bethe same and the number of services must be �1� fora rental procedure code.

FA0-18.0

193 Line Chg NotNumeric

71-77 The submitted charges for a line of service must beentered as a positive, unsigned numeric value. Thiserror indicates that the line charge is not numeric.Ensure that no alphas �Os� or �Ls� have been used asnumeric zeros or ones when the line charge wasentered.

FA0-13.0



MessageCode Text


194 Diag PointerInvalid

78-81 On each claim, the diagnosis codes that apply to thespecific procedure being filed for must be indicatedin order of importance. Most software has slotsnumbered 1, 2, 3, and 4 for entry of diagnosis codes.Later, at the line level, the valid diagnosis pointercode (1, 2, 3, or 4) is required to identify whichdiagnosis goes with each line. The pointer enteredmust point to a non-blank header diagnosis field. Forexample, if you entered a �3� as the diagnosispointer, and the diagnosis code field 3 is blank, thiserror would be received. Or, if an invalid diagnosispointer code is entered (e.g., �7� or �8�), the errorwill display. If you receive this error and do not knowwhere your diagnosis pointer fields are, contact yoursoftware vendor and reference the field/record keyprovided.

FA0-14.0,15.0, 16.0,

17.0

195 Unit of Svc Invalid 82-85 This error indicates that the number of services isentered in an invalid format. The number of servicesrendered in days or units must be entered as apositive, unsigned numeric value. Notes on units ofservice entry:♦ If the same service is performed more than once

on the same day, it must be billed on one lineitem with the number of services provided

♦ The units of service for a rental must equal �1.�♦ To indicate fractional services, use the fourth

position of the field with an assumed decimal♦ Contact your software vendor if you have

questions on how to enter units of service♦ This field is required in all cases except when

submitting for Oral Cancer Drugs

FA0-18.0

196 Cap Rent FR=TODT

40-47,48-50

This error displays when the �to� and �from� datesfor a rental procedure code are not equal. �To� and�from� dates for rental procedure codes must be thesame.

FA0-05.0,06.0

197 Not Used198 Rend Prov ID

Missing93-107 This error means that the Supplier Number (the 10-

digit number received from the National SupplierClearinghouse) has not been entered. Enter thecomplete Supplier Number to resolve this error.

FA0-23.0

199 Rend Prov IDInvalid

93-107 The Supplier Number has been entered in an invalidformat or is not a valid Supplier Number assignedby the National Supplier Clearinghouse. Ensure thatno alphas �Os� or �Ls� have been used as numericzeros or ones. The full 10 digits of the suppliernumber must be entered.

FA0-23.0



MessageCode Text


200 Modifier 1 Invalid 65-66 This error indicates that the first modifier entered onthe claim is not a valid modifier value. Consult yourSupplier Manual to determine valid modifier valuesand ensure that you have not made a keying errorwhen entering modifiers.

FA0-10.0

201 Modifier 2 Invalid 67-68 This error indicates that the second modifier enteredon the claim is not a valid modifier value. Consultyour Supplier Manual to determine valid modifiervalues and ensure that you have not made a keyingerror when entering modifiers.

FA0-11.0

202 Modifier 3 Invalid 69-70 This error indicates that the third modifier enteredon the claim is not a valid modifier value. Consultyour Supplier Manual to determine valid modifiervalues and ensure that you have not made a keyingerror when entering modifiers.

FA0-12.0

203 Modifier 4 Invalid 186-187 This error indicates that the fourth modifier enteredon the claim is not a valid modifier value. Consultyour Supplier Manual to determine valid modifiervalues and ensure that you have not made a keyingerror when entering modifiers.

FA0-36.0

204 Disallow CCInvalid

126-132 This field is not used, but may generate this error ifnot zero filled. Contact your software vendor if youreceive this error.

FA0-27.0

205 Disallow OthInvalid

133-139 Field is not used, but error may occur if not zerofilled. Contact your software vendor if you receivethis error.

FA0-27.0

206 Review CodeInvalid

140 You may wish to enter an indicator describingextenuating circumstances or justification that mightassist in any review of the medical necessity for aservice. This is not a required field and may beblank. Valid review code indicators are:

A = Case turned over to a consultantB = Pre-Admission testingC = X-ray/Lab procedure related to a covered

surgeryD = Provider/Supplier determined the service is

not covered, but the patient is requesting aformal review by the payer

E = Beneficiary was notified that the item mightnot be considered medically necessary andhas agreed in writing to pay for the item�asigned waiver is on file with the provider

F = Beneficiary was notified that the item mightnot be considered medically necessary andhas not agreed to pay for the item�no signedwaiver is on file with the provider

FA0-27.0



MessageCode Text


207 Primary PaidInvalid

179-185 This error indicates that the amount paid by thepayer under the provisions of the contract is invalidor entered in an invalid format. The amount must bethe actual amount paid by the payer and must be apositive, unsigned numeric value.

FA0-35.0


FB01-3 The Service Line Detail Record (FB0) is out of

sequence in the file. It must come after an FA0record and before an FA0, FB1, HA0, XA0, or anyGU0 record. Contact your software vendor if youreceive this error.

FB0


4-5 A sequence number that matches record to FA0record must be entered. This number will begenerated by your software. Contact your softwarevendor if your receive this error.

FB0-02.0



FB0-03.0



FB0-03.0

215 Natl Drug CdInvalid

110-120 If you are submitting for an Oral Cancer Drug, youmust enter a valid National Drug Code. This errorindicates that an invalid National Drug Code or acode entered in an invalid format has been entered.If you have verified your data entry and are certainthat the code is properly entered and you stillreceive this error, contact your Operations Team forassistance in obtaining a valid National Drug Code.

FB0-15.0



MessageCode Text


216 Natl Drug UnitsInv

121-127 When you are submitting for an Oral Cancer Drug,you must enter the national drug units, or thedispensing quantity, based on the unit of measure asdefined by the National Drug Code number. Thisfield may be blank.

FB0-16.0

217 Allowed AmtMissing

47-53 This error indicates that the allowed amount has notbeen entered. This amount is derived from thePrimary Payer EOB and is required on MSP claims.The amount allowed by the primary payer must beentered. If the allowed amount equals zero(0000000) for an MSP claim, use the HA0-05.0 toexplain. Enter the amount allowed by the PrimaryPayer to resolve this error.

FB0-06.0

218 Allow Amt notNumerc

47-53 The amount allowed by the Primary Payer must beentered as a positive, unsigned, numeric value.Ensure that all numbers have been entered in thisfield.

FB0-06.0

219 Deduct AmtMissing

54-60 The amount applied to the deductible by the PrimaryPayer (from the Primary Payer EOB) must beentered on an MSP claim. This error indicates that ithas not been entered.

FB0-07.0

220 Deduct Amt NotNumer

54-60 The amount applied to the deductible by the PrimaryPayer (from the Primary Payer EOB) must beentered as a positive, unsigned, numeric value onMSP claims.

FB0-07.0

221 Coinsure AmtMissing

61-67 The amount deducted by the Primary Payer (fromthe Primary Payer EOB) as the coinsurance amountmust be entered on an MSP claim.

FB0-08.0

222 Coins Amt NotNumer

61-67 The amount deducted by the Primary Payer (fromthe Primary Payer EOB) as the coinsurance amountmust be entered as a positive, unsigned, numericvalue on MSP claims.

FB0-08.0


FB11-3 The Service Line Detail (FB1) record is out of

sequence in the file. It must come after an FA0 orFB0 record and before a FB0, HA0, XA0, or anyGU0 record. Contact your software vendor if youreceive this error.

FB1


4-5 A sequence number that matches the precedingFA0-02.0 must be entered by your software. Contactyour software vendor if you receive this error.

FB1-02.0



MessageCode Text




FB1-03.0

259-261 Not Used262 Ord Prv Name

Invalid73-105 The name of the physician who ordered the supply

(ordering provider) has been entered in an invalidformat. See Individual Names Data EntryInstructions in Section 3 of this manual.

FB1-06.0,07.0, 08.0

263 Ord Prv UPINInvalid

106-120 The ordering provider�s UPIN number has beenentered in an invalid format. UPIN numbers consistof either one alpha and five numeric (e.g., C12345)or three alphas and three numeric.

FB1-09.0

264 Sequence Error -FB2

1-3 The Service Line Detail (FB2) record is out ofsequence in the file. Contact your software vendor ifyou receive this error.


4-5 Your software must enter a sequence number thatmatches this record to the preceding FA0-02.0record. Contact your software vendor if you receivethis error.

FB2-02.0



FB2-03.0



MessageCode Text




FB2-03.0

268 Prov Type AInvalid

40-41 This error is relevant to Versions 001.03 or 001.04.This information is not required in Version 002.0.The error means that the code entered to indicate theprovider (physician who prescribed the supply) typeis invalid. Valid codes are:

CP = Consulting PhysicianAP = Attending PhysicianOO = Other Ordering Physician

FB2-05.0

269 Prov A AddrInvalid

42-132 This error is relevant to Versions 001.03 or 001.04.This information is not required in Version 002.0.The error means that the mailing address of thephysician in FB2-05.0 (attending, consulting, orother ordering) has been entered in an invalidformat. See Addresses Data Entry Instructions inSection 3 of this manual.

FB2-06.0,07.0, 08.0,09.0, 10.0

270 Sequence Error -GU0

1-3 The Certification Record (GU0) is out of sequencein the file. It must come after an FA0, FB0, FB1, orFB2 record and before an FA0, HA0, or XA0record. Contact your software vendor if you receivethis error.

GU0


4-5 Your software must enter a sequence number (01-99) that matches the preceding FA0-02.0 to the GU0(cert) record. Contact your software vendor if youreceive this error. (GU0-02.0)



GU0-03.0



MessageCode Text




GU0-03.0

274 Cert Type Invalid 23 The certification type entered is invalid. Valid codesto identify the type of certification being submittedare:





GU0-04.0



MessageCode Text


275 Place of SvcInvalid

24-25 The place of service code on the CMN is invalid.Valid codes are:





GU0-05.0

276 Replace IndInvalid

26 The code indicating whether or not the supply is areplacement for a previously purchased item isinvalid. Valid code values are:

Y = YesN = No

Completion of this field is not required on form08.02 (Version 002.00).

GU0-06.0

277 Not Used278 Warranty Ind

Invalid34 The code entered indicating whether the item is

covered by a warranty is invalid. Valid codes are:Y = Yes, the item is covered by a warranty.N = No, the item is not covered by a warranty.D = Warranty information does not apply.

Not currently used for DMERC Version 00301.

GU0-09.0



MessageCode Text


279 Warranty LenInvalid

35-36 If the item is covered by a warranty and this isindicated with a �Y� response in the warranty replyfield (GU0-09.0), a code indicating the length of thewarranty period in months must be entered. Thiserror indicates that the code entered is invalid. Enterthe length of the warranty in months, 01-99; 01 =one month, 03 = three months, 24 = two years, etc.Not currently used for DMERC Version 00301.

GU0-10.0

280 Warranty TypInvalid

37 If the response to the warranty reply is �Y� (the itemis covered by a warranty), a code must be entered inthe warranty type field indicating the warranty typeand coverage. This error indicates that the codeentered is invalid. Valid codes are:

1 = Full Replacement2 = Pro-rated replacement3 = Parts and labor4 = Parts only


GU0-11.0


38-42 This error indicates that the first diagnosis codelisted on the CMN is either an invalid code or isentered in an invalid format. This field may not beblank. Things to remember about diagnosis codes:♦ The diagnosis code on a line in the claim must

match the diagnosis code for that line item onthe CMN.

♦ The code must be the most specific diagnosiscode allowed in the ICD-9 CM format.

♦ Do not �pad� the diagnosis code field with extrazeros. For example, if the code is �123,� enter�123,� not �12300.�


GU0-12.0

282 Pat Height Invalid 58-59 The patient�s height is entered in an invalid format.Enter the patient�s height in inches. For example, ifthe patient is 5 feet, two inches tall, enter 62 inches.

GU0-16.0

283 Pat Weight Invalid 60-61 This error indicates that the patient�s weight hasbeen entered in an invalid format or as all zeros. Thepatient�s weight must be greater than zero. Thepatient�s weight must be entered on CMNs 2, 8, 9,and 10. This is a three-position field. Be sure toenter weights less than 100 pounds with a leadingzero; i.e., a weight of 90 pounds would be entered�090.�

GU0-17.0

284 Last Exam DtInvalid

63-70 The date the patient was last examined is eitherentered in an invalid format or is not �reasonable.�For example, if the last exam date was after thepatient died or before the patient was born, the datewould be considered unreasonable. See Dates DataEntry Instructions in Section 3 of this manual.

GU0-18.0



MessageCode Text


285 Initial Date Invalid 71-78 The initial date is the beginning of the certifiedperiod of medical necessity. This error indicates thatthe initial date is entered in an invalid format or isan unreasonable date. See Section 3 for Dates DataEntry Instructions.

GU0-19.0

286 Rec/Rev DateInvalid

79-86 The effective date of the revision or recertificationprovided by the certifying physician has beenentered in an invalid format or is an unreasonabledate.

GU0-20.0

287 Rev Dt Not > InitDt

79-86 The revision or recertification date entered is notgreater than the initial date. You cannot revise a certor recertify a supply unless it has already beeninitially submitted. Enter a revision or recertificationdate later than the initial date.

GU0-20.0

288 Len Of NeedInvalid

87-88 The number of months covered by the certificationis invalid. Enter the length of need in months 01-99.�99� = lifetime.

GU0-21.0

289 Date SignedInvalid

89-96 This error indicates that the date the CMN wassigned by the physician was entered in an invalidformat or is an unreasonable date. See Section 3 forDates Data Entry Instructions.

GU0-22.0

290 Prov PhoneInvalid

97-106 The telephone number of the physician was enteredin an invalid format. See Telephone Data EntryInstructions in Section 3 of this manual. Ensure thatyou have not mis-keyed the area code or entered aspace before entry of the telephone number.

GU0-23.0

291 Cert on File Invalid 107 The code indicating the supplier�s guarantee that acopy of the hardcopy certification (signed and datedby the physician) is on file at the supplier�s office isinvalid. Valid codes are:

Y = Yes, certification is on fileN = No, certification is not on file.

GU0-24.0

292-461 Form/Q Errors � Explanations on deciphering and resolvingCertificate of Medical Necessity question set errorsfollows.



DECIPHERING FORM/Q ERRORS

�Form/Q� errors are errors within a Certificate of Medical Necessity (also known as a �cert� or �CMN�)question set. All Form/Q errors are displayed in the same format and they all mean the same thing�thereis missing or invalid information within the form (CMN) and/or question (Q) referenced. For example:Form 01/Q1/GU0-26, indicates that there is invalid or missing information in question 1 on form 01 of theCertificate of Medical Necessity. Using this example, decipher all Form/Q errors as follows:

Error DescriptionForm 01 This is the CMN for Hospital Beds/Support Surfaces. The Form part of a

Form/Q error always indicates which DMERC CMN contains the error.Q1 (Question #1 onForm CMN)

The Q portion of a Form/Q error always indicates what question within a form(CMN) is in error. Reference the hardcopy CMN included in the Region CSupplier Manual to determine an appropriate response for the question inerror. Enter a valid response.

GU0-26 This identifies which record (it will always be �GU0� in Form/Q errorsbecause �GU0� is the NSF �name� that identifies the CMN record) and inwhich field (-26) the error occurred. While this information is of little help toyou, it is helpful to EDI personnel when they are assisting you with erroranalysis and to your vendor when you identify a field in error so that the vendorcan cross-match that field with the field it represents in your software.

FORM/Q ERROR CORRECTION SUMMARY

1. Determine which form the error is in.

2. Determine which question has missing or invalid information.

3. Reference the appropriate hardcopy CMN and determine the correct response for the Form/Q.

4. Enter a correct response to resolve the Form/Q error and resubmit your claim.

292 - 461 ALL FORM/Q ERRORS

MessageCode Text


462 GU0 Form NbrInvalid

108-111 This error indicates that you have submitted a CMNthat is not appropriate for the procedure code youare submitting. This means, for example, that youare submitting a claim for a TENS unit (CMN #6),but trying to submit the CMN appropriate foroxygen. Verify that you are using the CMNappropriate for the procedure code you aresubmitting by reviewing the list in your DMERCAdvisory or Supplier Manual, or consult yourOperations Team at the number listed in Section 2of this manual.

GU0

463 Procedure Not =FA0

� This error indicates that the procedure code on theCMN (GU0-07.0) does not match the procedurecode on the claim (FA0-09.0). The procedure codeindicated for a supply on the claim must match theprocedure code indicated for a supply on the CMN.



MessageCode Text


464 Sys Error FormNbr

108-111 This error means that the form number of theDMERC Certification of Medical Necessity used isinvalid. Valid CMN form numbers are:01.02 = Hospital Bed and Support Services02.03 = Manual and Motorized Wheelchairs03.02 = Respiratory Equipment04.03 = Orthotics, Lymphedema Pump,

Osteogenesis Stimulator, and TherapeuticShoes

05.02 = Surgical Dressings and UrologicalSupplies

06.02 = TENS07.02 = Seat Lift Mechanisms and Power

Operated Vehicle (POV)08.02 = Immunosuppressive Drugs09.02 = Infusion Pump and Home Glucose

Monitor10.02 = Parenteral and Enteral Nutrition484.2 = Oxygen

If you key in your own CMN numbers, verify thatyou entered the number without decimals and thatno alphas �Os� or �Ls� have been used as numericzeros or ones. If your software generates thisnumber, contact your software vendor if you receivethis error.

GU0-25.0


43-47 This error indicates that the second (#2) diagnosiscode entered on the CMN (GU0-13.0) is either aninvalid code or is entered in an invalid format.Things to remember about diagnosis codes:♦ The code must be the most specific diagnosis

code allowed in the ICD-9 CM format.♦ Do not �pad� the diagnosis code field with extra



GU0-13.0


189-193 This error indicates that the third (#3) diagnosiscode entered on the CMN (GU0-14.0) is either aninvalid code or is in an invalid format. Things toremember about diagnosis codes:♦ The code must be the most specific diagnosis


zeros. For example, if the code is �123,� enter�123,� not �12300


GU0-14.0



MessageCode Text



194-198 This error indicates that the fourth (#4) diagnosiscode entered on the CMN (GU0-15.0) is either aninvalid code or is in an invalid format. Things toremember about diagnosis codes:♦ The code must be the most specific diagnosis


zeros. For example, if the code is �123,� enter�123,� not �12300


GU0-15.0

468 Not Used469 R/R Too Far Futr 79-86 The recert/revision date entered on the CMN is too

far in the future; recert/revision dates must be lessthan 60 days in the future.

GU0-20.0

470 Cert Not On File 107 You have answered �N� (no) to the question thatasks you to indicate that a copy of the paper CMN,signed and dated by the physician, is on file at thesupplier�s office. While �N� is a valid NSFresponse, this edit has been implemented to reject�N� responses and ensure that the submitter doesactually have the required copy of the signed, datedCMN on file in the supplier�s office, and thuspreclude certain denial of the claim once it is passedto adjudication.

GU0-24


GX01-3 The Oxygen Certification (GX0) record is out of

sequence in the file. It must come after an FA0,FB0, or FB1 record and before an FA0, GX1, GX2,HA0, or XA0 record. Contact your software vendorif you receive this error.

GX0


4-5 A sequence number matching this record (GX0)with the preceding FA0-02.0 must be entered andmust be the same sequence number value as that in theFA0-02.0. Contact your software vendor if youreceive this error.

GX0-02.0


4-5 The sequence number entered is invalid. It must bebetween 01 and 99 and be identical to positions 4-5of subsequent GX1 and GX2 records. Contact yoursoftware vendor if you receive this error.

GX0-02.0



MessageCode Text




GX0-03.0



GX0-03.0

489 Cert Type Missing 23 The type of certification (initial, recertification,revision) being billed must be entered. This errorindicates that it has not been entered. Valid codesare:

1 = Initial certification2 = Revised certification3 = Renewal/Recertification

GX0-04.0

490 Cert Type Invalid 23 This error indicates that the certification type codeentered is invalid. Valid codes are:

1 = Initial certification2 = Revised certification3 = Renewal/Recertification

GX0-04.0

491 Oxy Sys TypeMissing

24 The oxygen system type must be entered on theCMN. This error indicates that the type of oxygensystem code is missing. Valid codes are:

Y = Yes, ordering portable oxygen and patient ismobile within the home

N = No, ordering portable oxygen and patient isnot mobile within the home

D = Does not apply; portable oxygen is not beingordered

GX0-05.0



MessageCode Text


492 Oxy Sys TypeInvalid

24 The code indicating type of oxygen system deliveryis invalid. Valid codes are:

Y = Yes, ordering portable oxygen and patient ismobile within the home

N = No, ordering portable oxygen and patient isnot mobile within the home

D = Does not apply; portable oxygen is not beingordered

GX0-05.0

493 Len Of NeedInvalid

25-26 The numbers indicating the length of time oxygentherapy will be required is entered in an invalidformat. The length of need must be entered as thenumber of months covered by certification (01-99).Enter 99 if the length of need is �lifetime.�

GX0-06.0

494 Type EquipmtMissing

27 The specific type of equipment being prescribed fordelivery of oxygen must be entered. This errorindicates that the type of equipment has not beenentered. Valid codes are:

A = ConcentratorB = Liquid stationaryC = Gaseous stationaryD = Liquid portableE = Gaseous portableO = Other


GX0-07.0

495 Type EquipmtInvalid

27 The code indicating the type of delivery equipmentbeing prescribed is invalid.Valid codes are:

A = ConcentratorB = Liquid stationaryC = Gaseous stationaryD = Liquid portableE = Gaseous portableO = Other

Not currently used for DMERC Version 00301

GX0-07.0

496 Flow Rate Not >.4 See note This error indicates that an oxygen flow rate of lessthan 0.4 (four-tenths) has been entered. You mustenter a flow rate of more than 0.4.

This is a three-position field in which the thirdposition (furthest to the right) is an �implieddecimal.� This means that the DMERC systems willassume that the position furthest to the right is afraction (one-tenth through nine-tenths). Do notenter a decimal. For example, if the flow rate is �1,�enter �010.� If the flow rate is 10.5, enter �105.�

GX0-14.0



MessageCode Text


497 Cert Not On File � You have answered �N� (no) to the question thatasks you to indicate that a copy of the paper OxygenCMN, signed and dated by the physician, is on fileat the supplier�s office. While �N� is a valid NSFresponse, this edit has been implemented to reject�N� responses and ensure that the submitter doesactually have the required copy of the signed, datedOxygen CMN on file in the supplier�s office, andthus preclude certain denial of the claim once it ispassed to adjudication.

GX0-35.0

498 Equip ReasonInvalid

29-92 Under �unusual circumstances� a free-formdescription of reasons why certain equipment isrequired has been entered in an invalid format(contact your Dedicated Work Team for details).This free form text must be left justified.

GX0-09.0

499 Presc Frm DtMissing

93-100 Oxygen prescribed �from� date is either blank, allzeroes, or low values. This date is required on alloxygen CMNs.

GX0-10.0

500 Presc Frm DtInvalid

93-100 The beginning date of the oxygen prescription isentered in an invalid format (see Section 3 for DatesData Entry Instructions) or is unreasonable (i.e.,after the patient�s death or before the patient�sbirth).

GX0-10.0

501 Recert/Rev DTMissing

101-108 This error indicates that the CMN type in GX0-04.0pos 23 is either a 2 or a 3 and the date in GX0-11.0is either blank, all zeroes, or low values.

502 Recert/Rev DT Inv 101-108 This error indicates that the CMN type in GX0-04.0pos 23 is either a 2 or a 3 and the date in GX0-11.0 isinvalid.

503 Dt PrescribeMissing

109-116 The date the oxygen was prescribed or the date thephysician signed a prescription renewal must beentered. This error indicates that the date is missing.

GX0-12.0

504 Dt PrescribeInvalid

109-116 The date oxygen was prescribed is entered in aninvalid format (see Section 3 for Dates Data EntryInstructions) or is unreasonable (i.e., after thepatient�s death or before the patient�s birth).

GX0-12.0

505 Dt Pat EvalMissing

117-124 The date the patient was last examined by thephysician to determine need for oxygen therapymust be entered. This error indicates that the date ismissing.

GX0-13.0

506 Dt Pat Eval Invalid 117-124 The date the patient was last examined by thephysician to determine need for oxygen therapy isentered in an invalid format (see Section 3 for DatesData Entry Instructions) or is unreasonable (i.e.,after the patient�s death or before the patient�sbirth).

GX0-13.0

507 Ox Flow RateMissing

125-127 The oxygen flow rate in liters per minute must beentered for stationary equipment. This errorindicates that the flow rate has not been entered.

GX0-14.0



MessageCode Text


508 Freq of UseMissing

128-129 The number of times per day the patient must useoxygen is required if the physician has prescribedoxygen use for specified periods (e.g., during exercise,while sleeping, etc.). This error indicates that thenumber is missing. Enter the frequency of use as atwo-position response; e.g., �04� would indicate thatthe patient is to use oxygen four times a day. If thepatient is to use oxygen continuously, enter �01.�

GX0-15.0

509 Duration Missing 130-131 The hours per period of oxygen use (see GX0-15.0,Frequency of Use) must be entered as a value of 01-24. For example, if a patient is to use oxygen fourtimes a day (see previous error documentation) fortwo hours each time, enter �02.� If a patient is to useoxygen continuously (note that �01� is entered inGX0-15.0, Frequency of Use) enter �24� in thisfield. This error indicates that no value has beenentered.

GX0-16.0

510 No ABG orOximetry

212-217 The Arterial Blood Gas and/or the OxygenSaturation (oximetry) test results must be entered inthe Arterial Blood Gas (GX0-22.0) and/or OxygenSaturation (GX0-23.0) fields. This error indicates itis missing.

511 ABG ResultsInvalid

212-214 The arterial blood gas test results (at rest breathingroom air) must be entered. This is a three-positionfield in which the third position (furthest to theright) is an �implied decimal.� This means that theposition furthest to the right is a fraction (one-tenththrough nine-tenths). Do not enter a decimal. Note:Arterial Blood Gasses are also known as �PO2levels.�

GX0-22.0

512 Oximetry Invalid 215-217 The arterial blood oxygen saturation (oximetry) testresults (at rest breathing room air) must be entered.This is a three-position field in which the thirdposition (furthest to the right) is an �implieddecimal.� This means that the position furthest to theright is a fraction (one-tenth through nine-tenths). Donot enter a decimal.

GX0-23.0

513 Dt Test PerfMissing

218-225 The date the patient was tested for arterial blood gasand/or oxygen saturation at rest breathing room airmust be entered. This error indicates that the date ismissing.

GX0-24.0

514 Dt Test PerfInvalid

218-225 The date of arterial blood gas and/or oxygensaturation tests is entered in an invalid format (seeSection 3 for Dates Data Entry Instructions) or isunreasonable (i.e., after the patient�s death or beforethe patient�s birth).

GX0-24.0

515 Test FacilitMissing

226-258 This error indicates that the name of the facilitywhere arterial blood gas or oximetry tests wereperformed is missing.

GX0-25.0



MessageCode Text


516 Test Facilit Invalid 226-258 This error indicates that the name of the facilitywhere arterial blood gas or oximetry tests wereperformed is incorrectly formatted. See Section 3for Company Names Data Entry Instructions.

GX0-25.0

517 Ord Prv UPINInvalid

266-280 The Ordering physician UPIN numberis entered inan incorrect format. See Section 3 for IdentificationNumbers Data Entry Instructions. Ensure that noalphas �Os� or �Ls� have been used as numericzeros or ones and that there are no spaces within orbefore the UPIN number.

GX0-29.0

518 Test Cond Invalid 259 The code describing conditions under which patientwas tested for oximetry is invalid. Valid codes are:

1 = At Rest2 = During Exercise3 = During Sleep

GX0-26.0

519 Ord Prv TeleInvalid

281-290 The telephone number for the ordering physicianhas been entered in an invalid format. See Section 3for Telephone Data Entry Instructions.

GX0-30.0

520 Clinic Find Invalid 260-262 If the patient�s arterial PO2 is 56-59 mm Hg orarterial blood saturation is 89 percent, a codedescribing the clinical findings must be entered.This error indicates that the code is invalid.Positions include:Pos 1= Dependent edema suggesting congestive

heart failure.Pos 2= �P� pulmonate on EKG (P wave greater

than 3 mm in standard leads II, III, orAVF)

Pos 3= Erythrocythemia with a hematocrit greaterthan 56 percent

Valid codes are:Y = YesN = NoD = Does not apply

GX0-27.0

521 Port Ox RateMissing

263-265 If you entered a �P� (for Portable) in the �Type ofSystem� field (GX0-05.0), this field must becompleted. The oxygen flow rate of the portableoxygen system must be entered in liters per minute.This error indicates that the flow rate has not beenentered.

Note: If you have entered a �P� in the �Type ofSystem� (GX0-05.0) field and a value in this field,the medical therapeutic purpose served by theportable system (which cannot be met by astationary system) must be entered in the �ExerciseRoutine� field.

Not currently used for DMERC version 00301.

GX1-01.0



MessageCode Text



291-295 This error indicates that the first (#1) diagnosis codeentered on the oxygen CMN (GX0.31) is either aninvalid code or is entered in an invalid format.Things to remember about diagnosis codes:♦ The code must be the most specific diagnosis




GX0.31


296-300 This error indicates that the second (#2) diagnosiscode entered on the oxygen CMN (GX0-32.0) iseither an invalid code or is entered in an invalidformat. Things to remember about diagnosis codes:♦ The code must be the most specific diagnosis




GX0-32.0


301-305 This error indicates that the third (#3) diagnosiscode entered on the oxygen CMN (GX0-33.0) iseither an invalid code or is entered in an invalidformat. Things to remember about diagnosis codes:♦ The code must be the most specific diagnosis




GX0-33.0

525 Cert on FileMissing

311 A code indicating whether or not a certificationsigned by the ordering physician is on file at thesupplier�s office must be entered. This errorindicates that a code is missing. Valid codes are:

Y = Yes, on fileN = No, not on file

GX0-35.0

526 Sequence Error -GX1

1-3 The GX1 record(s) (Oxygen Certification records) isout of sequence in the file. It (they) must come aftera GX0 record and before a GA0, GX2, HA0, orXA0 record. Contact your software vendor if youreceive this error.

GX1



MessageCode Text



4-5 A sequence number (matching the preceding FA0-02.0) must be submitted with the GX1 record (GX1-02.0) This error indicates that there is no sequencenumber in the GX1-02.0. Contact your softwarevendor if you receive this error.

GX1-02.0


� The sequence number in the GX1 record is invalid.This sequence number must be between 01 and 99and be identical to positions 4-5 of previous GX0and subsequent GX2 records. Contact your softwarevendor if you receive this error.

GX1-02.0



GX1-03.0


6-22 The patient control number is in an invalid format.You must enter (or your software mustautomatically generate) a patient control number (or�patient account number�) that identifies the patientto the provider. This number is carried throughoutyour system and must be the same in the CA0through XA0 record. If you get this error, ensurethat you have assigned a Patient Control Number toeach patient. If your software automaticallygenerates this number and you receive this error,contact your software vendor. See Section 3 forPatient Control Number Data Entry Instructions ifyou enter these numbers manually.

GX1-03.0

531 Test ResultsMissing

23-112 If the patient was on oxygen when tests wereperformed and this was indicated by the entry of acode �O� in the �Test Conditions� field (GX0-22.0),a free-form description of the test results, informationnecessary for interpreting the tests and why the testswere performed while the patient was on oxygen isrequired in the �Test Results� field (GX1-04.0). Thiserror indicates that test result information was notentered.Not currently used for DMERC Version 00301.

GX1-05.0



MessageCode Text


532 Medical FindMissing

113-202 Medical findings justifying the need for oxygenmust be entered (free form) if PO2 levels (alsocalled Arterial Blood Gasses) are 60 mm Hg orabove, or arterial blood oxygen saturation (alsocalled Oximetry) is 90 percent or above.Not currently used for DMERC Version 00301.

533 Exercise RTNMissing

203-292 If a portable oxygen system is being used (and thisis indicated with a �P� in the �Oxygen SystemType� field [GX0-05.0] and a response in the�Oxygen Flow Rate� field (GX0-24.0]), adescription of activities or the exercise routine thepatient performs on a regular basis and for which aportable oxygen system is required must be entered(free form). This error indicates that the exerciseroutine has not been entered.Not currently used for DMERC Version 00301.

GX1-06.0

534 Sequence Error -GX2

1-3 The GX2 record (Oxygen Certification FacilityInformation) is out of sequence in the file. The GX2record must come after GX0 or GX1 record andbefore FA0, HA0, or XA0 record. Contact yoursoftware vendor if you receive this error.

GX2


4-5 A sequence number, which must be the same as thepreceding FA0-02.0, must be entered in the GX2-02.0. This error indicates that the sequence number ismissing. Contact your software vendor if youreceive this error.

GX2-02.0


4-5 The sequence number on the GX2 record is invalid.The sequence number must be between 01 and 99and be identical to positions 4-5 of previous GX0and subsequent GX2 record. Contact your softwarevendor if you receive this error.

GX2-02.0



GX2-03.0



MessageCode Text



6-22 The patient control number is in an invalid format.You must enter (or your software must automaticallygenerate) a patient control number (or �patientaccount number�) that identifies the patient to theprovider. This number is carried throughout yoursystem and must be the same in the CA0 throughXA0 record. If you get this error, ensure that youhave assigned a Patient Control Number to eachpatient. If your software automatically generates thisnumber and you receive this error, contact yoursoftware vendor. See Section 3 for a Patient ControlNumber Data Entry Instruction if you enter thesenumbers manually.

GX2-03.0

539 Test Fac AddInvalid

23-113 The complete address of the test facility whereoxygen tests were performed must be entered. Thiserror indicates that the address is missing or enteredin an invalid format. See Section 3 for AddressesData Entry Instructions.

GX2-04.0

540 GX1 Fields AllBlank

23-292 If a GX1 (Oxygen Certification Record - NarrativeInformation) record is included in the submission itmust have information in the GX1-04.0 (TestResults), the GX1-05.0 (Additional MedicalFindings), or the GX1-06.0 (Exercise Routine). Thiserror indicates that the record is blank. Enterinformation in one of these fields to resolve theerror.

GX1-04.0,05.0, 06.0

541 Sequence Error -HA0

1-3 The HA0 (Provider Narrative) record is out ofsequence in the file. It must come after an FA0,FB0, FB1, GA0, GC0, GD0, GE0, GP0, GX0, GX1,or GX2 record and before an XA0 record. Contactyour software vendor if you receive this error.

HA0


4-5 A sequence number, which must be the same as thesequence number in the preceding FA0-02.0, mustbe entered. This error indicates that the sequencenumber is missing. Contact your software vendor ifyou receive this error.

HA0-02.0


4-5 The sequence number entered in the HA0-02.0 isinvalid. The sequence number must be between 01and 99 and be identical to positions 4-5 of theassociated FA0 record.

HA0-02.0



MessageCode Text




HA0-03.0



HA0-03.0

546-547 Not Used548 Extra Narrat

Missing40-320 Somewhere in your claim you specified that

additional information (free-form narrative) wouldbe entered to assist in adjudication of the serviceline item in the preceding FA0 (Claim) record. Thiserror indicates that none has been entered.

HA0-05.0

549 Sequence Error -XA0

1-3 The XA0 (Claim Trailer) record is out of sequencein the file. It must come after an FA0, FB0, FB1,FD0, GA0 (Cert Records), or HA0 record andbefore a CA0 or YA0 record. Contact your softwarevendor if you receive this error.

XA0



XA0-03.0



MessageCode Text




XA0-03.0

552 CXX Rcrd CntMissing

23-24 The total number of all CXX (Claim Header)records included in this claim must be entered. Thiserror indicates that the total has not been entered.Contact your software vendor if you receive thiserror.

XA0-04.0

553 CXX Rcrd Cnt NotNum

23-24 The total number of all CXX (Claim Header)records included in this claim must be numeric. Thiserror indicates that the total is not numeric. Contactyour software vendor if you receive this error.

XA0-04.0

554 CXX Rcrd CntInvalid

23-24 The CXX (Claim Header) record count is invalid. Itmust equal the total number of all CXX records forthis claim. Contact your software vendor if youreceive this error.

XA0-04.0

555 DXX Rcrd CntMissing

25-26 The total number of all DXX (InsuranceInformation) records included in this claim must beentered. This error indicates that the total has notbeen entered. Contact your software vendor if youreceive this error.

XA0-05.0

556 DXX Rcrd Cnt NotNum

25-26 The total number of all DXX (InsuranceInformation) records included in this claim must benumeric. This error indicates that the total is notnumeric. Contact your software vendor if youreceive this error.

XA0-05.0

557 DXX Rcrd CntInvalid

25-26 The DXX (Insurance Information) record count isinvalid. It must equal the total number of all DXXrecords for this claim. Contact your software vendorif you receive this error.

XA0-05.0

558 EXX Rcrd CntMissing

27-28 The total number of all EXX (Claim Data) recordsincluded in this claim must be entered. This errorindicates that the total has not been entered. Contactyour software vendor if you receive this error.

XA0-06.0

559 EXX Rcrd Cnt NotNum

27-28 The total number of all EXX (Claim Data) recordsincluded in this claim must be numeric. This errorindicates that the total is not numeric. Contact yoursoftware vendor if you receive this error.

XA0-06.0



MessageCode Text


560 EXX Rcrd CntInvalid

27-28 The EXX (Claim Data) record count is invalid. Itmust equal the total number of all EXX records forthis claim. Contact your software vendor if youreceive this error.

XA0-06.0

561 FXX Rcrd CntMissing

29-30 The total number of all FXX (Line Detail) recordsincluded in this claim must be entered. This errorindicates that the total has not been entered. Contactyour software vendor if you receive this error.

XA0-07.0

562 FXX Rcrd Cnt NotNum

29-30 The total number of all FXX (Line Detail) recordsincluded in this claim must be numeric. This errorindicates that the total is not numeric. Contact yoursoftware vendor if you receive this error.

XA0-07.0

563 FXX Rcrd CntInvalid

29-30 The FXX (Line Detail) record count is invalid. Itmust equal the total number of all FXX records forthis claim. Contact your software vendor if youreceive this error.

XA0-07.0

564 GXX Rcrd CntMissing

31-32 The total number of all GXX (Certification) recordsincluded in this claim must be entered. This errorindicates that the total has not been entered. Contactyour software vendor if you receive this error.

XA0-08.0

565 GXX Rcrd Cnt NotNum

31-32 The total number of all GXX (Certification) recordsincluded in this claim must be numeric. This errorindicates that the total is not numeric. Contact yoursoftware vendor if you receive this error.

XA0-08.0

566 GXX Rcrd CntInvalid

31-32 The GXX (Certification) record count is invalid. Itmust equal the total number of all GXX records forthis claim. Contact your software vendor if youreceive this error.

XA0-08.0

567 HXX Rcrd CntMissing

33-34 The total number of all HXX (Extra Narrative)records included in this claim must be entered. Thiserror indicates that the total has not been entered.Contact your software vendor if you receive thiserror.

XA0-09.0

568 HXX Rcrd Cnt NotNum

33-34 The total number of all HXX (Extra Narrative)records included in this claim must be numeric. Thiserror indicates that the total is not numeric. Contactyour software vendor if you receive this error.

XA0-09.0

569 HXX Rcrd CntInvalid

33-34 The HXX (Extra Narrative) record count is invalid.It must equal the total number of all HXX recordsfor this claim. Contact your software vendor if youreceive this error.

XA0-09.0

570 Clm Rcrd CntMissing

35-37 The total number of records submitted for eachclaim (excluding the XA0 record) must be enteredin the Claim Trailer record. This error indicates thatthe total has not been entered in the Claim Trailerrecord. Contact your software vendor if you receivethis error.

XA0-10.0



MessageCode Text


571 Clm Rcrd Cnt NotNum

35-37 This error indicates that the claim record count inthe Claim Trailer record (XA0) is not numeric. Theclaim record count must be numeric. Contact yoursoftware vendor if you receive this error.

XA0-10.0

572 Clm Rcrd CntInvalid

35-37 This error indicates that the claim record count inthe Claim Trailer record (XA0) is invalid. The claimrecord count must equal the total number of recordssubmitted for this claim, excluding this record(XA0). Contact your software vendor if you receivethis error.

XA0-10.0

573 Tot Clm ChgsInvalid

78-84 The sum of all line item charges (FA0-13.0)included within each claim must be entered for eachclaim. This error indicates that the sum is missing, isnot numeric, or does not balance. If your softwaretotals the line charges for you, contact your softwarevendor if you receive this error. If not, check yourfigures and correct the error.

XA0-12.0

574 Tot AllowedInvalid

99-105 The sum of all allowed amount fields (FB0-06.0)must be entered. This error indicates that theallowed amount is missing, is not numeric, or doesnot balance. Contact your software vendor if youreceive this error.

XA0-15.0

575 Tot Dis CC Invalid 78-84 The sum of all disallowed cost containment chargesincluded in the claim (FA0-27.0) must be entered.This error indicates that the sum is missing, is notnumeric, or does not balance. Contact your softwarevendor if you receive this error.

XA0-13.0

576 Tot Dis Ot Invalid 106-112 The sum of all the disallowed charges (FA0-28.0)included in this claim is missing or does notbalance. Contact your software vendor if youreceive this error.

XA0-14.0

577 Tot Ded Amt NotNum

106-112v The sum of all the deductible amount fields (FB0-07.0) must be entered. This error indicates that thetotal is not numeric. Contact your software vendor ifyou receive this error.

XA0-16.0

578 Tot Ded AmtInvalid

106-112 The sum of all the deductible amount fields (FB0-07.0) must be entered. This error indicates that thetotal is missing or does not balance. Contact yoursoftware vendor if you receive this error.

XA0-16.0

579 Tot Coin AmtMissing

113-119 The sum of all the coinsurance amount fields (FB0-08.0) must be entered. This error indicates that thesum is missing. Contact your software vendor if youreceive this error.

XA0-17.0

580 Tot Coin Amt NotNum

113-119 The sum of all the coinsurance amount fields (FB0-08.0) must be numeric. This error indicates that thesum is not numeric. Contact your software vendor ifyou receive this error.

XA0-17.0



MessageCode Text


581 Tot Coin AmtInvalid

113-119 The total coinsurance amount must equal the sum ofall the coinsurance amount fields (FB0-08.0). Thiserror indicates that it does not. Contact yoursoftware vendor if you receive this error.

XA0-17.0

582 Tot Amt PaidInvalid

120-126 The sum of all payer amount paid fields (DA1-14.0)included in the claim must be numeric and mustbalance. This error indicates that the total is missing,is not numeric, is not equal to the sum of all payeramount paid fields included in the claim, and/orexceeds total claim charges. Contact your softwarevendor if you receive this error.

XA0-18.0

583 Tot Pat PaidInvalid

127-133 The total amount the provider has received from thepatient must be a positive, unsigned numeric valueand it must not exceed the total claim charges. Thiserror indicates that the total is not entered as apositive, unsigned numeric value and/or it exceedsthe total claim charges. Contact your softwarevendor if you receive this error.

XA0-19.0

584 Tot Prch SvcInvalid

134-140 Not applicable to DMEPOS claims submissions.

585 Sequence Error -YA0

1-3 The Batch Trailer (YA0) record is out of sequencein the file. It must come after an XA0 record andbefore a BA0 or ZA0 record. Contact your softwarevendor if you receive this error.

YA0-01.0

586 EMC Prov IDMissing

4-18 This error indicates that your Supplier number hasnot been carried to the YA0 record. Contact yoursoftware vendor if you receive this error.

YA0-02.0

587 EMC Prov IDInvalid

4-18 This error indicates that your Supplier number hasbeen entered in an invalid format in the YA0 record.Contact your software vendor if you receive thiserror.

YA0-02.0

588 EMC Prov ID Not= BA0

4-18 The Supplier number in the YA0 record is not thesame Supplier number entered in the BA0 (BatchHeader) record. Contact your software vendor if youreceive this error.

YA0-02

589 Batch NumberMissing

22-25 The batch number must be entered in the BatchTrailer (YA0) record and must be identical to thebatch number in BA0-04.0. This error indicates thatthe batch number is not entered in the Batch Trailerrecord. Contact your software vendor if you receivethis error.

YA0-04.0

590 Batch Nbr Not =BA0

22-25 The batch number must be numeric and identical tothe batch number in BA0-04.0. This error indicatesthat it is not numeric and/or that it does not matchthe batch number in the Batch Header (BA0) record.Contact your software vendor if you receive thiserror.

YA0-04.0



MessageCode Text


591 Batch NumberInvalid

22-25 This error indicates that the batch number in theBatch Trailer (YA0) is invalid. It must be between�0001� through �9999�; the first batch number mustbe �0001�; and it must match the batch number(positions 22-25) of the Batch Header (BA0) record.Contact your software vendor if you receive thiserror.

YA0-04.0

592 Batch Ln CntMissing

47-53 This error indicates that the batch service line countis missing. Contact your software vendor if youreceive this error.

YA0-08.0

593 Batch Ln Cnt NotNum

47-53 This error indicates that the batch service line countis not numeric. Contact your software vendor if youreceive this error.

YA0-08.0

594 Ln Cnt Not = SumFA0

47-53 This error indicates that the batch service line countdoes not equal the sum of all record type FA0�swithin this batch. Contact your software vendor ifyou receive this error.

YA0-08.0

595 Bat Rcrd CntMissing

54-60 This error indicates that the batch record count hasnot been entered. Contact your software vendor ifyour receive this error.

YA0-09.0

596 Bat Rcrd Cnt NotNum

54-60 This error indicates that the batch record count isnot numeric. Contact your software vendor if youreceive this error.

YA0-09.0

597 Bat Rcrd CntInvalid

54-60 This error indicates that the batch record count doesnot equal the sum of all record types BA0 throughYA0. Contact your software vendor if you receivethis error.

YA0-09.0

598 Bat Clm CntMissing

61-67 This error indicates that the batch claim count hasnot been entered. Contact your software vendor ifyou receive this error.

YA0-10.0

599 Bat Clm Cnt NotNum

61-67 This error indicates that the batch claim count is notnumeric. Contact your software vendor if youreceive this error.

YA0-10.0

600 Clm Ct Not = SumCA0

61-67 This error indicates that the batch claim count doesnot equal the sum of all record type CA0�s includedbetween this batch trailer record (YA0) and thepreceding batch header record (BA0). Contact yoursoftware vendor if you receive this error.

YA0-10.0

601 Bat Tot ChgMissing

68-76 This error indicates that the batch total charges havenot been entered. Contact your software vendor ifyou receive this error.

YA0-11.0

602 Bat Tot Chg NotNum

68-76 This error indicates that the batch total charges arenot numeric. Contact your software vendor if youreceive this error.

YA0-11.0

603 Tot Chg Not SumXA0

68-76 This error indicates that the batch total charges donot equal the sum of all the total claim charges(positions 78-84 of Claim Trailer (XA0) records)included in this batch. Contact your software vendorif you receive this error.

YA0-11.0



MessageCode Text


604 Sequence Error -ZA0

1-3 This error indicates that the File Trailer (ZA0)record is out of sequence in the file. It must comeafter a YA0 record and must be the last record in thefile.

ZA0-01.0

605 Submitter IDMissing

4-19 This error indicates that your SubmitterIdentification number as defined by the carrier ismissing from the File Trailer (ZA0) record. Contactyour software vendor if you receive this error.

ZA0-02.0

606 Subm ID Not =AA0 ID

4-19 This error indicates that the submitter identificationnumber does not match the submitter ID (positions4-19) in the File Header (AA0) record. Contact yoursoftware vendor if you receive this error.

ZA0-02.0

607 Recv ID Not =AA0 ID

29-44 The receiver identification number in the FileTrailer (ZA0) record does not match the receiver ID(positions 227-242) in the File Header (AA0)record. Contact your software vendor if you receivethis error.

ZA0-04.0

608 File Lin Cnt Invalid 45-51 The service line count does not equal the total of allbatch service line count fields and/or it is notnumeric. Contact your software vendor if youreceive this error.

ZA0-05.0

609 Lin Ct Not = SumYA0

45-51 The service line count does not equal the sum of allbatch service line counts (positions 47-53) in theBatch Trailer (YA0) records. Contact your softwarevendor if you receive this error.

ZA0-05.0

610 File Rec CntMissing

52-58 The number of records included in this file ismissing. Contact your software vendor if youreceive this error.

ZA0-06.0

611 File Rec CntInvalid

52-58 This error indicates that the number of records in theFile Trailer (ZA0) record is invalid. The number ofrecords included in this file must be numeric andshould not include any count of the AA0 or the ZA0records. Contact your software vendor if you receivethis error.

ZA0-06.0

612 Rec Ct Not = SumYA0

52-58 The number of records in the file must equal thesum of all batch record counts (positions 54-60) inthe Batch Trailer (YA0) records. Contact yoursoftware vendor if you receive this error.

ZA0-06.0

613 File Clm CntMissing

59-65 The number of claims included in the file is missing.Contact your software vendor if you receive thiserror.

ZA0-07.0

614 File Clm CntInvalid

59-65 This error indicates that the number of claimsincluded in the file is not numeric and/or does notequal the total of all batch claim count fieldsincluded in the file. Contact your software vendor ifyou receive this error.

ZA0-07.0



MessageCode Text


615 Clm Ct Not = SumYA0

59-65 This error indicates that the number of claimsincluded in the file does not equal the sum of allbatch claim counts (positions 61-67) in the BatchTrailer (YA0) records. Contact your softwarevendor if you receive this error.

ZA0-07.0

616 File Bat CntInvalid

66-69 This error indicates that the number of batchesincluded in the file is not numeric and/or does notequal the total of all YA0 record types within thisfile. Contact your software vendor if you receivethis error.

Note: Only submissions using the same submitterID# (AA0-02.0) are able to transmit more than onebatch per AA0 through ZA0.

ZA0-08.0

617 Bch Ct Not = SumYA0

66-69 This error indicates that the number of batchesincluded in the file does not equal the sum of allBatch Trailer (YA0) records in this file. Contactyour software vendor if you receive this error.

ZA0-08.0

618 File Tot ChgInvalid

70-80 This error indicates that the total of all batch chargesincluded in the claim is not entered as a positive,unsigned numeric value. Contact your softwarevendor if you receive this error.

ZA0-09.0

619 Record NotRequired

� A CB0 record is not allowed/required when CA0-25.0 Legal Representative Indicator equals �N�(no), indicating that there is not a responsible party(legal rep payee). Contact your software vendor ifyou receive this error.

CB0

620 Clm File IndMissing

23 A Claim Filing Indicator must be entered to indicatewhether or not payment is being requested of thepayer. Valid codes are:

P = Payment is being requested of this payer(enter �P� on the Primary Record)

I = Payment is not being requested of this payer(enter �I� on Secondary records)

DA0-04.0

621 Clm File IndInvalid

23 The Claim Filing Indicator entered to indicatewhether or not payment is being requested of thepayer is invalid. Valid codes are:

P = Payment is being requested of this payer(enter �P� on the Primary Record)

I = Payment is not being requested of this payer(enter �I� on Secondary records)

DA0-04.0

622 Clm Fl Ind PInvalid

23 A claim-filing indicator of �P� has been entered andis invalid. There can be only one DA0 record with�P.�

DA0-04.0

623 CLM Fl Ind MInvalid

23 A claim filing indicator of �M� has been enteredand is invalid. �M� cannot be used with Medicareclaims.

DA0-04.0

624 Clm Fl Ind I Invalid 23 A claim-filing indicator of �I� has been entered andis invalid. There cannot be more than two DA0(Insurance Information) records with an �I�indicator.

DA0-04.0



MessageCode Text


625 Sourc of PayInvalid

24 A code indicating the source of payment must beentered (DA0-05.0) and may be either user enteredor entered by software in conjunction with the entryof an insurance type code (DA0-06.0). This errorindicates that the source of payment indicatorentered is an invalid code. The code may be invalidbecause it is not an acceptable code or because itdoes not match information about the source ofpayment (insurer) entered in the system. ValidDMEPOS source of payment codes for MedicarePrimary claims are:

C = Medicare (primary record)D = Medicaid (secondary record)Z = Medigap (secondary record)

Valid DMEPOS source of payment codes for theprimary insurance record on MSP claims are:

B = Worker�s CompensationE = Other Federal ProgramF = Commercial Insurance CompanyG = Blue Cross Blue ShieldH = TRICAREI = HMOJ = FEP (Federal Employee�s Program)K = Central Certification

DA0-05.0

626 Tot Chg Not =Sum YA0

70-80 The total of all batch charges in this file does notequal the sum of all Batch Total Charges fields inthe file. Contact your software vendor if you receivethis error.

YA0-11.0

627-632 Not Used633 Delivery Typ

Invalid312 A code indicating the delivery system type must be

entered in the Oxygen CMN. This error indicatesthat the code entered for delivery system type isinvalid. Valid codes are:

A = Nasal CannulaB = O2 Conserving DeviceC = O2 Conserving Device with Pulse O2 SystemD = O2 Conserving Device with Reservoir

SystemE = Transtracheal CatheterO = Other

GX0-36.0



MessageCode Text



306-311 This error indicates that the fourth (#4) diagnosiscode entered on the oxygen CMN (GX0-34.0) iseither an invalid code or is entered in an invalidformat. Things to remember about diagnosis codes:♦ The code must be the most specific diagnosis


zeros. For example, if the code is �123,� enter�123,� not �12300.�


GX0-34.0

635 Receiver IDInvalid

227-242 The Receiver Identification number must be enteredto indicate which DMERC is to receive the claimsbeing transmitted. This error indicates that the IDentered is invalid. A five position DMERC CarrierID must be entered. The Receiver IDs for eachDMERC are:Region A = 00811Region B = 00635Region C = 00885Region D = 05655

All claims submitted to Palmetto GBA must contain�00885� in this field.

AA0-17.0

636 Loc Vers CdeInvalid

249-253 The Local version code is entered in an invalidformat.

AA0-20.0

637 Payer CL OffInvalid

32-35 See explanation for the next error code (638).

638 Payer ID Invalid 27-31 Either or both of these errors (637 and 638) indicatethat the OCNA (Other Carrier Name and Address)number is missing or invalid. Important notes aboutOCNA numbers:♦ OCNA numbers are required only for Medigap

secondary payers.♦ Medicaid payers are not required to have an

OCNA number. A list of OCNA numbers for allMedigap insurers can be found in Appendix E ofthe Region C Supplier Manual and the DMERCAdvisories.

♦ If you believe you have a beneficiary with aMedigap policy and you cannot find an OCNAnumber for the insurer, contact your DedicatedWork Team for assistance (See Section 2 forDedicated Work Team telephone directory.)

DA0-08.0

639 Review CodeInvalid

140 A review code describes extenuating circumstancesor justification that may assist in a review ofmedical necessity for a particular service. This fieldmay be left blank, but do not enter an �N� toindicate �no.� This will cause an error. Valid codesare:

FA0-29.0



MessageCode Text


A = Case turned over to a consultantB = Pre-Admission testingC = X-ray/Lab procedure related to a covered

surgeryD = Provider/Supplier determined the service is

not covered, but the patient is requesting aformal review by the payer

E = Beneficiary was notified that the item mightnot be considered medically necessary andhas agreed in writing to pay for the item. Asigned waiver is on file with the provider

F = Beneficiary was notified that the item mightnot be considered medically necessary andhas not agreed to pay for the item. No signedwaiver is on file with the provider

640 Patient GenInvalid

56-58 The patient generation indicator is invalid. Somesoftware does not allow for patient generationindicators. Check with your software vendor to seeif your software allows for this field.

A patient generation indicator is to be used only ifshown on the patient�s Medicare Health Insurancecard. Valid patient generation indicators are II, III,JR, and SR. If you use a patient generationindicator, do not use any punctuation.

CA0-07.0

641 Group NameInvalid

89-121 The insurer Group Name is entered in an invalidformat. See Section 3 for Company Names DataEntry Instructions. The Group Name is not requiredon the Medicare primary insurance record.

DA0-11.0

642 Sign SourceInvalid

154 The code indicating the patient signature source isinvalid. Valid signature source code values are:

C = Signed 1500 claim form on fileS = Signed signature authorization form for

Block 12 is on fileM = Signed signature authorization form for

Block 13 is on fileB = Signed signature authorization form or forms

for both Block 12 and Block 13 are on fileP = Signature generated by provider because the

patient was not physically present forservices

DA0-16.0

643 Insured GenInvalid

215-217 The insured generation indicator is invalid. Somesoftware does not allow for insured generationindicators. Check with your software vendor to seeif your software allows for this field.

An insured generation indicator is to be used only ifshown on the patient�s Medicare Health Insurancecard. Valid insured generation indicators are II, III,JR, and SR. If you use a patient generationindicator, do not use any punctuation.

CA0-07.0



MessageCode Text


644 Insured SexInvalid

218 The code indicating the sex of the insured is invalid.This error occurs primarily on secondary insurancerecords. The Insured�s sex is required only if thepatient and the insured are not the same person (asindicated by a value other than �01� in the �PatientRelationship to Insured� field [DA0-17.0]). Codevalues for insured�s sex are:

M = MaleF = FemaleU = Unknown

Remember: This field is looking for the sex of theinsured. The insured and the patient may not be thesame. If you indicated in the �Patient Relationshipto Insured� field (DA0-17.0) that the patient is notthe insured (i.e., a value other than �01�), be sure toenter the sex of the insured and not the sex of thepatient.

DA0-23.0

645 Ins Birth Dt Invalid 219-226 The insured�s date of birth is either entered in aninvalid format (see Section 3 for Dates Data EntryInstructions) or is incorrect. This error occursprimarily on secondary insurance records. Theinsured�s date of birth is only required if the patientand the insured are not the same person (asindicated by a value other than �01� in the �PatientRelationship to Insured� field [DA0-17.0]).

Remember: This field is looking for the birthdateof the insured. The insured and the patient may notbe the same. If you indicated in the �PatientRelationship to Insured� field (DA0-17.0) that thepatient is not the insured (i.e., a value other than�01�), be sure to enter the birthdate of the insuredand not of the patient.

DA0-24.0

646 Insd Emp StInvalid

227 The code indicating the employment status of theinsured is invalid. Valid codes are:

1 = Employed full time2 = Employed part time3 = Not employed4 = Self-employed5 = Retired6 = On active military duty9 = Unknown

DA0-25.0

647 Adjud Ind Invalid 157-158 The code indicating the Adjudication status isinvalid. Valid Adjudication indicators, derived fromthe EOB or remittance from the primary payer are:

01 = Benefits exhausted02 = Non-covered benefits03 = Insured coverage lapsed or did not exist04 = Cost containment disallowed05 = Entire amount applied to deductible06 = Charges exceeded allowance

DA1-16.0



MessageCode Text


648 Balance DueInvalid

183-189 The balance due amount for an MSP claim, which isderived from the Primary Payer EOB or remittance,is invalid.

DA1-24.0

649 No CA0 RecordFound

� No CA0 (Claim Header - Patient Data) Record wasfound for this claim. A CA0 record must besubmitted for the claim. Contact your softwarevendor if you receive this error.

CA0

650 No DA0 RecordFound

� No DA0 (Insurance Information) Record was foundfor this claim. A DA0 record must be submitted forthe claim. Contact your software vendor if youreceive this error.

DA0

651 No EA0 RecordFound

� No EA0 (Claim Data) Record was found for thisclaim. An EA0 record must be submitted for theclaim. Contact your software vendor if you receivethis error.

EA0

652 No FA0 RecordFound

� No FA0 (Line Detail) Record was found for thisclaim. An FA0 record must be submitted for theclaim. Contact your software vendor if you receivethis error.

FA0

653 Not Used654 Test/Prod Ind

Invld254-257 This error indicates that the test/production

(TEST/PROD) indicator is invalid. Contact yoursoftware vendor if you receive this error. Validtest/production indicators are:

TEST = file should be run through test systemPROD = file should be run through production

system

AA0-21.0

655 Test File in Prod 254-257 A test file has been submitted to the productionsystem. It must be run through the test system, orthe test/production indicator changed to PROD forproduction. Contact your software vendor if youreceive this error.

AA0-21.0

656 Legal Rep But noCB0

� It is indicated that there is a Legal Representativefor the patient, because a �Y� (yes) has been enteredin the CA0 (Patient Data) record field 25.0, but noCB0 (Legal Representative Data) record has beensubmitted with the claim.

CB0

657 MSP But no DA1Rec

� A DA1 record is required when Non-MedicarePrimary Insurance (MSP) policies exist for thebeneficiary and none has been submitted. Contactyour software vendor if you receive this error.

DA1

658 MSP But no DA2Rec

� A DA2 record is required for Medicare SecondaryPayer (MSP) claims and none has been submitted.Contact your software vendor if you receive thiserror.

DA2

659 No FB1 RecordFound

� No FB1 (Line Detail) record is found for this claim.FB1 record(s) is required on all claims. Contactyour software vendor if you receive this error.

FB1



MessageCode Text


660 CMN With no FB2Rec

� When a Certificate of Medical Necessity (CMN) isused, an FB2 (Physician Information) record mustbe completed. This error indicates that there is noFB2 record for this claim and one is required as aCMN has been submitted. Contact your softwarevendor if you receive this error.

FB2

661 Prov Type BInvalid

133-134 The code entered to indicate the type of provider forwhom the address information in FB2-12.0 throughFB2-16.0 applies is invalid. Valid codes are:

CP = Consulting PhysicianAP = Attending PhysicianOO= Other Ordering Physician


FB2-11.0

662 Prov B AddrInvalid

135-225 The mailing address of the physician identified inFB2-11.0 has been entered in an invalid format. SeeSection 3 for Addresses Data Entry Instructions.Not currently used for DMERC Version 00301.

FB2-12.0,13.0, 14.0,15.0, 16.0

663 Bad Date CertSigned

313-320 The date the oxygen certification was signed isinvalid or entered in an invalid format. It must bethe date the CMN was issued, re-certified, orrevised. See Section 3 for Dates Data EntryInstructions.

GX0-33.0

664 GX0 But no GX2Found

� A GX2 record (Oxygen Certification Record -Facility Information) must be submitted with everyoxygen certification.

GX2

669 Rev Date < ToDate

40-55 The �from� and/or �to� dates indicated on the claimare in the future (dates greater than the date theclaim was received). You may only bill future dates ofservice on HCPCS codes as outlined in yourSupplier Manual.

FA0-.05,.06

674 Frm Date >Receipt Date

40-47 The �from� date on the claim�s line item is greaterthan (ahead of) the date the claim was received (e.g.,the �from� date on the line is 11/1/95. The claim issent to and received by Palmetto GBA on 10/1/95.)

FA0-.05

678 Prov NotAuthorized forEMC

� This error indicates that a current and valid EDIEnrollment Form has not been sent to EDIOperations. Please call the Technology SupportCenter and request an EDI Enrollment Form. TheMonday following the week that EDI Operationsreceives a current and valid EDI Enrollment Formwith an original signature will be the date on whichyou may resubmit claims with this error.

679-697 Not Used698 ABG >4 LPM

Invalid132-134 If greater than 4 LPM is prescribed, the oxygen

saturation results taken on 4 LPM must be numericin question 7a on form 484.2.

GX0-17.0

699 OXY >4 LPMInvalid

135-137 If greater than 4 LPM is prescribed, the oxygensaturation results taken on 4 LPM must be numericin question 7b on form 484.2.

GX0-18.0



MessageCode Text


700 4 LPM Test DTMissing

� If greater than LPM is prescribed, the ABG oroxygen test date must be entered into question7c onform 484.2.

GX0-19.0

701 4 LPM Test DTInvld

138-145 The date of the ABG or oxygen saturation test hasbeen entered in an invalid format. See Dates DataEntry Instructions in Section 3 of this manual.

GX0-19.0

702 Inpat Stable Invld 146 Question 2 of the Certificate of Medical Necessity:Oxygen (Form 484.2) has invalid information. Validcodes are:

Y = YesN = No

GX0-20.0

703 Pat Mob Invld 24 Question 5 of the Certificate of Medical Necessity:Oxygen (Form 484.2) has invalid information. Validcodes are:

Y = YesN = No

GX0-05.0

704 Dependent EdemaInvld

� Question 8 of the Certificate of Medical Necessity:Oxygen (Form 484.2) has invalid information. Validcodes are:

Y = YesN = NoD = Does not apply

GX0-27.0

705 Cor PulmonaleInvld

� Question 9 of the Certificate of Medical Necessity:Oxygen (Form 484.2) has invalid information. Validcodes are:


GX0-27.0

706 Hematrocit Invalid 262 Question 10 of the Certificate of Medical Necessity:Oxygen (Form 484.2) has invalid information. Validcodes are:


GX0-27.0

707 Edema/Cor/HematMiss

260-262 Question 8, 9, and/or 10 of the Certificate ofMedical Necessity: Oxygen (Form 484.2) ismissing. Valid codes are:


GX0-27.0

708 ABG/SAT>4Missing

132-134 Question 7a or 7b of the Certificate of MedicalNecessity: Oxygen (Form 484.2) is required whenthe response to Question 6 (GX0-14.0) is greaterthan 4.

GX0-17.0,18.0

709 Form 02/Q9/GU0-33

119 Question 9 of the Certificate of Medical Necessity:Manual Wheelchairs (Form 02.03) is missing or hasinvalid information. Valid codes are:


GU0-33.0



MessageCode Text


710 Form 02/Q5/GU0-62

266-269 Question 5 of the Certificate of Medical Necessity:Manual/Motorized Wheelchairs (Form 02.03) ismissing or has invalid information; must be 0001-0024.

GU0-62.0

711 Form 02/Q6/GU0-30

116 Question 6 of the Certificate of Medical Necessity:Motorized Wheelchairs (Form 02.03) is missing orhas invalid information. Valid codes are:


GU0-30.0

712-714 Not Used715 Form 04/Q6/GU0-

31117 Question 6 of the Certificate of Medical Necessity:

Osteogenesis Stimulators (Form 04.03) is missing orhas invalid information. Valid codes are:


GU0-31.0

716 Form04/Q6b/GU0-62

266-269 Question 6b of the Certificate of Medical Necessity:Osteogenesis Stimulators (Form 04.03) is missing orhas invalid information; must be 0001-0099.

GU0-62.0

717 Form04/Q7a/GU0-32

118 Question 7a of the Certificate of Medical Necessity:Osteogenesis Stimulators (Form 04.03) is missing orhas invalid information. Valid codes are:


GU0-32.0

718 Form04/Q7b/GU0-63


GU0-63.0

719 Form04/Q9b/GU0-34

120 Question 9a of the Certificate of Medical Necessity:Osteogenesis Stimulators (Form 04.03) is missing orhas invalid information. Valid codes are:


GU0-34.0

720 Form04/Q9b/GU0-64


GU0-64.0

721 Form04/Q10a/GU0-35

121 Question 10a of the Certificate of MedicalNecessity: Osteogenesis Stimulators (Form 04.03) ismissing or has invalid information. Valid codes are:


GU0-35.0

722 Form04/Q10b/GU0-65

278-281 Question 10b of the Certificate of MedicalNecessity: Osteogenesis Stimulators (Form 04.03) ismissing or has invalid information; must be 0001-0099.

GU0-65.0



MessageCode Text


723 Form04/Q10c/GU0-66

282-285 Question 10c of the Certificate of MedicalNecessity: Osteogenesis Stimulators (Form 04.03) ismissing or has invalid information; must be 0001-0099.

GU0-66.0

724 Form04/Q11a/GU0-36

122 Question 11a of the Certificate of MedicalNecessity: Osteogenesis Stimulators (Form 04.03) ismissing or has invalid information. Valid codes are:


GU0-36.0

725 Form04/Q11b/GU0-67

286-289 Question 11b of the Certificate of MedicalNecessity: Osteogenesis Stimulators (Form 04.03) ismissing or has invalid information; must be 0001-0099.

GU0-67.0

726 Form 02/Q7/GU0-31

117 Question 7 of the Certificate of Medical Necessity:Motorized Wheelchairs (Form 02.03 ) is missing orhas invalid information. Valid codes are:


GU0-31.0

727 Form 02/Q8/GU0-32

118 Question 8 of the Certificate of Medical Necessity:Manual Wheelchairs (Form 02.03) is missing or hasinvalid information. Valid codes are:


GU0-32.0

729 DA1-11 Allwd AmtInv

128-134 This error indicates that the allowed amount isentered in an invalid format. The allowed amountmust be entered as a positive, unsigned amount.Zero fill, may not be blank

DA1-11.0

730 FA0-35 Primr PdInv

179-185 This error indicates that the primary paid amount isentered in an invalid format. The primary paidamount must be entered as a positive, unsignedamount. Zero fill, may not be blank

FA0-35.0

731 FB0-06 Allwd AmtInv

47-53 This error indicates that the allowed amount isentered in an invalid format. The allowed amountmust be entered as a positive, unsigned amount.Zero fill, may not be blank

FB0-6.0

732 FA0-48 OTA AmtInvld

224-230 This error indicates that the obligated to acceptamount is entered in an invalid format. Theobligated to accept amount must be entered as apositive, unsigned amount. Zero fill, may not beblank

FA0-48.0

DMERC EDI User�s Manual Section 6 � Electronic Claims Report � Error Message Abbreviations


SECTION 6 � ELECTRONIC CLAIMS REPORTERROR MESSAGE ABBREVIATIONS

Abbreviation TranslatedA

ABG Arterial BloodGas

ADD AddressADDR AddressALLOW AllowedAMT AmountASSN AssignmentAUTH Authorization

BBAT Batch

CCD CodeCDE CodeCERT CertificationCH ChargeCHG ChargeCHGS ChargesCLINIC ClinicalCLM ClaimCNT CountCNTL ControlCOIN CoinsuranceCOINS CoinsuranceCOND ConditionCNT CountCST CostCT Count

DDED DeductibleDELIV DeliveryDOB Date of BirthDT DateDTE Date

EEMC Electronic

Media ClaimsEMP EmployerEMPL EmploymentEQUIP Equipment

Abbreviation TranslatedF

FAC FacilityFACILITY FacilityFIND FindingsFL FileFREQ FrequencyFRM From

GGEN GenerationGRP Group

IID IdentificationIND IndicatorINIT InitialINS InsuranceINSD InsuredINV Invalid

LLIN LineLEN LengthLN LineLOCAT Location

MMED MedicareMISS Missing

NNARR NarrativeNAT NationalNBR NumberNME NameNUM NumericNUMER Numeric

OORD OrderingOTH OtherOX OxygenOXY Oxygen

Abbreviation TranslatedP

PAT PatientPER PersonPERF PerformedPORT PortablePRESCRIB PrescribedPRI PriorPT PatientPROD ProductionPROV ProviderPRV Provider

RRCRD RecordREC RecertificationRECV ReceiverREL Related/

RelationREND RenderingREQ RequiredRES ResponsibleRETIR RetirementREV RevisedRC RecordRP RepresentativeRTN Routine

SSEQ SequenceSERVIC ServiceSIGN SignatureSRV ServiceST StateST StatusSUBM SubmitterSUBMISS SubmissionSVC ServiceSYS System

TTELE TelephoneTOT TotalTYP Type

VVERS Version

DMERC EDI User™s Manual · 2001-08-20 · DMERC EDI User™s Manual Section 1 Œ Getting Started...

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Transcript of DMERC EDI User™s Manual · 2001-08-20 · DMERC EDI User™s Manual Section 1 Œ Getting Started...