Subset of HIPAA 837 Institutional Version 5010 Errata Production Claims Not
Crossing Over
Description of the Problem
As part of the Tuesday, July 5, 2011 Medicare Part A quarterly systems release,
the Part A shared system (FISS) inadvertently included an invalid character
('{') within a line of code for HIPAA (Health Insurance Portability &
Accountability Act) 837 institutional version 5010 Errata claims that it sends
to the Coordination of Benefits Contractor (COBC) for crossover purposes. The
issue appears to only be affecting claims that our Part A system must force
balance in accordance with HIPAA 5010 claim transaction requirements (roughly
an average of 200 per day, out of the entire universe of claims crossed over on
a daily basis).
Currently, when the COBC receives claims with the invalid character, it rejects
them and returns edit H10041 to the A/B Medicare Administrative Contractor
(MAC) or fiscal intermediary (FI). That entity, in turn, would normally issue
and mail supplemental notices to the affected provider(s) that:
§ List the affected claims, by Document Control Number (DCN) and patient, that
cannot be crossed over; and
§ Include the error message (in this case H10041), along with error
description, to explain why Medicare cannot cross over the affected claims.
On Friday, July 8, 2011 CMS asked its A/B MAC and FI crossover staffs to
temporarily suspend issuance of the letters containing error code H10041 while
a resolution to the current problem was sought. CMS, the Part A shared system
maintainer, and the A/B MACs and FIs have now determined that efforts to
complete repairs/corrections to affected claims that received error H10041 may
take several weeks beyond Monday, August 8, 2011 the projected date on which
the fix the correct the current problem will be elevated to production.
What This Means to You
When providers receive special notification letters containing error code
H10041 from their servicing A/B MAC or FI, they will need to bill their
affected patients' supplemental payers. The claims denoted within the letters
cannot be crossed over.
Current Status
The Part A shared system has projected Monday, August 8, 2011 as the fix date
for the described problem. Therefore, any claims that A/B MACs or FIs send to
the COBC on and after that date should no longer receive error code H10041.
Additional questions can be direct to your local servicing A/B MAC or FI.
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