Understanding the MCS Edit Report For X12 N 837 4010'A1 Submissions Only

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Understanding theMCS Edit Report For X12 N
837 4010.A1 Submissions Only
Medicare EDI Services
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What is the MCS Edit Report (MER)?

• The MCS Edit Report (MER) replaces the Submission
  Summary Report (SSR) for X12N 837 4010/4010.A1
  claim files effective December 17, 2004.
• The MCS Edit Report (MER) is a report created by
  Highmark Medicare Services approximately 24 hours
  after your claim file is accepted on the
  Functional Acknowledgement.
• The report is generated after electronic edits
  have been applied to the claims and the file.
• It may also be known as a 24 hour report, or
  next day report, depending on your vendors
  terminology.
• NOTE If your file was rejected on the Functional
  Acknowledgement, this report will NOT be created.

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Why should I use the MER?

• To see if there were any errors in the file that
  need to be corrected. (Any errors on this report
  must be corrected and resubmitted, except for
  duplicate file rejections.)
• To see if the claims will be processed by
  Medicare.
• NOTE This report is also available for test
  file transmissions however, the claims will NOT
  be forwarded for processing.

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When is the MER Available?

• The MER is created approximately 24 hours (1
  business day) after your HIPAA claim file was
  accepted on the Functional Acknowledgement.
• The MER is available for you to retrieve for five
  (5) business days only. It can be reset for you
  as often as needed within those 5 days.

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How do I get the MER?

• Your vendor may have programmed your software to
  automatically retrieve the MER for you. If you
  are unsure, you should contact your vendor.
• If your software is not programmed to
  automatically retrieve the MER, you must enter
  the following command on our Bulletin Board a
• (All commands are case sensitive.)
• This should be done at least 24 hours later (1
  business day), but within 5 business days after
  your claims were accepted on the Functional
  Acknowledgement.

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What does the MER look like?

• The MER is a text file, so it requires no vendor
  programming to read.You must print the MER in
  portrait format at 17 characters per inch.
• You should see the Error Number and Error Message
  on the report. If you are unable to view the
  Error Message, contact your vendor. (They may
  need to change the settings on your computer.)
• The report appearance may vary, depending on
  these things
• Whether there were rejected claims
• How many batches of claims were sent
• Your vendors programming
• You must read each level of the report. The
  first level is the Provider Summary Report
  (H99RAR03). The second level is the Batch Detail
  Control Listing (H99RAR04). If there are any
  deleted (rejected) claims, the details will be
  reported at the second level.

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How do I read the H99RAR03 Report?

• The H99RAR03 Report summarizes the entire file of
  claims by provider.
• This report provides the process date, which is
  the date the report was generated.
• The summary includes total claims, total
  accepted and deleted claims, error rate and
  delete rate.
• Rejected claims are now referred to as deleted
  claims.
• This report includes a Banner Message that
  contains important EDI announcements.
• An example of an H99RAR03 is on the next slide.

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H99RAR03

• H99RAR03
  HIGHMARK MEDICARE SERVICES
  
  PAGE 1
• 
  PROFESSIONAL EMC
  PROGRAM
• PRODUCTION
  MEDICARE-B EMC INPUT
• 
  PROVIDER SUMMARY
  REPORT
• SUBMITTER ID
  00009002 SUBMITTER NAME JOHN DOE
• 
  ADDRESS 100
  ELM STREET
• 
  CITY CAMP HILL
  
• 
  STATE/ZIP PA
  17089
• 
  PROCESS DATE 07/03/2006
• 
  TOTAL TOTAL CLAIMS ERROR
  DELETE
• PROVIDER CLAIMS
  ACCEPTED DELETED RATE RATE
• ---------------
  -------- --------
  ----------- --------- -------
  The next 2 slides will explain
• 999999 43
  43 0
  0 0
  how to interpret the H99RAR03
• 
  
  by using a Road Map and
  
  
  corresponding field
  descriptions.
  
  
• UNDERSTANDING ERROR MESSAGES
  
• 
  

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How Do I Read an Accepted H99RAR04 Report?

• The H99RAR04 report is a Batch Detail Control
  Listing. This report lists claims, batch, and
  file level information.
• An accepted H99RAR04 contains three sections
  (claim, batch, and file).
• The header information indicates the process
  date, the submitter, the providers number who
  submitted the claims, and the batch number.

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How Do I Read an Accepted H99RAR04 Report (cont)?

• The body of Page 1 shows
• Provider Number (999999)
• Batch Status (Accepted)
• Total Claims Received (43)
• Total Claims Accepted (43)
• Total Claims Deleted (0)
• Total Claims with Errors (0)
• Total Charges Accepted (9,210.00)
• An example of Page 1 of a H99RAR04 with the
  above data and no deletions/rejections
  is on the next slide.

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Accepted H99RAR04 Page 1

• H99RAR04
  HIGHMARK MEDICARE SERVICES
  
  Page 1
• 
  PROFESSIONAL EMC PROGRAM
• PRODUCTION
  MEDICARE-B EMC INPUT
• 
  BATCH DETAIL CONTROL LISTING
• SUBMITTER ID
  0009002 SUBMITTER NAME JOHN DOE
• 
  ADDRESS 100 ELM STREET
• 
  CITY CAMP HILL
• 
  STATE/ZIP PA 17089
• 
  PROCESS DATE 07/03/2006
• 
  
• EMC PROVIDER 999999 BATCH NUMBER
  000000000001
• PROV REFERENCE REC TYPE DTL
  FIELD IN FIELD ERR
  MESSAGE ERROR
• NUM NUMBER
  NUM ERROR CONTENTS
  NUM SEVERITY
• ---------- --------------------
  ----------- --------- ---------------
  ------------------- -------
  ---------------- --------------
• EMC PROVIDER 999999 BATCH STATUS
  ACCEPTED

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How Do I Read an Accepted H99RAR04 Report (cont)?

• The body of Page 2 shows
• Totals For This File (000000702)
• Total Claims Received (43)
• Total Claims Accepted (43)
• Total Claims Deleted (0)
• Total Claims with Errors (0)
• Total Batches Received (1)
• Total Batches Accepted (1)
• Total Batches Deleted (0)
• File Total Charged (9,210.00)
• An example of Page 2 of a H99RAR04 with the above
  data and no deletions/rejections is on the next
  slide.

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Accepted H99RAR04 Page 2

• H99RAR04
  HIGHMARK MEDICARE SERVICES
  
  PAGE 2
• 
  PROFESSIONAL EMC PROGRAM
• PRODUCTION
  MEDICARE-B EMC INPUT
• 
  BATCH DETAIL CONTROL LISTING
•  
• SUBMITTER ID
  0009002 SUBMITTER NAME JOHN DOE
• 
  ADDRESS
  100 ELM STREET
• 
  CITY
  CAMP HILL
• 
  STATE/ZIP PA
  17089
•  
• 
  PROCESS DATE 07/03/2006
• 
  
• 
  TOTALS FOR THIS FILE 000000702
•  
• TOTAL CLAIMS RECEIVED 43
  
• TOTAL CLAIMS ACCEPTED 43
  
• TOTAL CLAIMS DELETED 0
  
• TOTAL CLAIMS WITH ERRORS 0

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How Do I Read an Accepted H99RAR04 Report (cont)?

• The body of Page 3 shows
• Totals For This Submitter
• Total Claims Received (43)
• Total Claims Accepted (43)
• Total Claims Deleted (0)
• Total Claims with Errors (0)
• Total Batches Received (1)
• Total Batches Accepted (1)
• Total Batches Deleted (0)
• Total Files Received (1)
• Total Files Accepted (1)
• Total Files Deleted (0)
• Submitter Total Charged (9,210.00)
• An example of Page 3 of a H99RAR04 with the above
  data and no deletions/rejections is on the next
  slide.

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Accepted H99RAR04 Page 3

• H99RAR04
  HIGHMARK MEDICARE SERVICES PAGE 3
• 
  PROFESSIONAL EMC PROGRAM
• PRODUCTION
  MEDICARE-B EMC INPUT
• 
  BATCH DETAIL CONTROL LISTING
•  
• SUBMITTER ID
  0009002 SUBMITTER NAME
  JOHN DOE
• 
  ADDRESS
  100 ELM STREET
• 
  CITY CAMP
  HILL
• 
  STATE/ZIP
  PA 17089
•  
• 
  PROCESS DATE 07/03/2006
• 
  
• 
  TOTALS FOR THIS SUBMITTER
•  
• TOTAL CLAIMS RECEIVED 43
  
• TOTAL CLAIMS ACCEPTED 43
  
• TOTAL CLAIMS DELETE 0
  
• TOTAL CLAIMS WITH ERRORS 0
  

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How Do I Read an H99RAR04 Report with Deletions
(Rejections)?

• This report lists all claim, batch and file level
  deletions (rejections) that occurred within an
  entire file.
• The header information indicates the process
  date, the submitter, the providers number who
  submitted the claims, and the batch number.
• The deleted claims must be corrected and
  resubmitted. They will NOTbe processed in the
  Medicare System.
• If all Claims within a batch are deleted
  (rejected), the entire batch will be deleted
  (rejected).
• If all the batches within the file are deleted
  (rejected), the entire file will be deleted
  (rejected).
• Even though you may have deleted (rejected)
  claims, the batch can still be accepted.

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How Do I Read an H99RAR04 with Deletions (Cont)?

• The body of Page 1 shows
• EMC Provider (999999)
• Batch Status (ACCEPTED)
• Provider Number (999999)
• Reference Number (123456789A)
• Rec Type (2400 SV1)
• DTL Num (01)
• Field in Error (PLACE OF SVC)
• Field Contents (A1)
• Error Num (0733)
• Message (INVALID VALUE)
• Error Severity (CLAIM DELETED)
• HIC for Above Claim in Error (123456789A)
• ICN (0000000000000)
• Total Claims Received (87)
• Total Claims Accepted (86)
• Total Claims Deleted (1)
• Total Claims with Errors (1)
• Total Charges accepted (12,340.00)

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H99RAR04 (Page 1) with Deletions

• H99RAR04 HIGHMARK MEDICARE SERVICES
  
  PAGE 1
• 
  PROFESSIONAL EMC PROGRAM
• PRODUCTION
  MEDICARE-B EMC INPUT
• 
  BATCH DETAIL CONTROL
  LISTING
• SUBMITTER ID
  0009002 SUBMITTER NAME JOHN DOE
• 
  ADDRESS 100 ELM STREET
  
• 
  CITY CAMP HILL
  
• 
  STATE/ZIP PA 17089
• 
  PROCESS DATE 07/03/2006
• 
  
• EMC PROVIDER 999999 BATCH NUMBER
  000000000001
• PROV REFERENCE REC TYPE DTL
  FIELD IN FIELD ERR
  MESSAGE ERROR
• NUM NUMBER
  NUM ERROR CONTENTS
  NUM SEVERITY
• ---------- --------------------
  -------------- -----------
  ------------ ------------ ---------
  ----------------- -------------
  
• EMC PROVIDER 999999 BATCH STATUS
  ACCEPTED

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How Do I Read an H99RAR04 Report with Deletions
(Rejections) Cont?

• The body of Page 2 shows

• Totals For This File (007144500)
• Total Claims Received (87)
• Total Claims Accepted (86)
• Total Claims Deleted (1)
• Total Claims with Errors (1)
• Total Batches Received (1)
• Total Batches Accepted (1)
• Total Batches Deleted (0)
• File Total Charged (12,340.00)
• An example of Page 2 of a H99RAR04 with the above
  data and a claim level deletion (rejection) is
  on the next slide.

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H99RAR04 (Page 2) with Deletions

• H99RAR04
  HIGHMARK MEDICARE SERVICES
  PAGE 2
• 
  PROFESSIONAL EMC PROGRAM
• PRODUCTION
  MEDICARE-B EMC INPUT
• 
  BATCH DETAIL CONTROL LISTING
•  
• SUBMITTER ID
  0009002 SUBMITTER NAME JOHN DOE
• ADDRESS 100
  ELM STREET
• 
  CITY
  CAMP HILL
• 
  STATE/ZIP
  PA 17089
•  
• 
  PROCESS DATE 07/03/2006
• 
  
• 
  TOTALS FOR THIS FILE 007144500
•  
• TOTAL CLAIMS RECEIVED
  87
• TOTAL CLAIMS ACCEPTED 86
  
• TOTAL CLAIMS DELETED
  1
• TOTAL CLAIMS WITH ERRORS 1
  

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How Do I Read an H99RAR04 Report with Deletions
(Rejections) Cont?

• The body of Page 3 shows
• Totals For This Submitter
• Total Claims Received (87)
• Total Claims Accepted (86)
• Total Claims Deleted (1)
• Total Claims with Errors (1)
• Total Batches Received (1)
• Total Batches Accepted (1)
• Total Batches Deleted (0)
• Total Files Received (1)
• Total Files Accepted (1)
• Total Files Deleted (0)
• Submitter Total Charged (12,340.00)
• An Example of Page 3 of a H99RAR04 with the above
  data and a claim level deletion (rejection) is
  on the next slide.

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H99RAR04 (Page 3) with Deletions

• H99RAR04
  HIGHMARK MEDICARE SERVICES
  
  PAGE 3
• 
  PROFESSIONAL EMC
  PROGRAM
• PRODUCTION
  MEDICARE-B EMC INPUT
• 
  BATCH DETAIL CONTROL
  LISTING
•  
• SUBMITTER ID
  0009002 SUBMITTER NAME
  JOHN DOE
• ADDRESS 100 ELM
  STREET
• CITY CAMP HILL
  
• 
  STATE/ZIP
  PA 17089
•  
• 
  PROCESS DATE 07/03/2006
• 
  
• 
  TOTALS FOR THIS SUBMITTER
•  
• TOTAL CLAIMS RECEIVED 87
  
• TOTAL CLAIMS ACCEPTED
  86
• TOTAL CLAIMS DELETED
  1
• TOTAL CLAIMS WITH ERRORS
  1

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How Can I Identify which claim, batch, or file is
in error?

• A Reference Number is provided on Page 1 of the
  H99RAR04 section of the MCS Edit Report.
• The Reference Number contains different values
  depending on where the error occurred in the file
  (claim, batch, or file level).
• The chart on the next slide will help you
  determine, based on the value in the Reference
  Number field, which claim, batch, or file was
  deleted (rejected).
• NOTE In order to use this chart, refer back to
  the H99RAR04 section where the errors are listed.

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What if I do not Understand the Error Message on
the H99RAR04?

• If you do not understand the error message(s),
  please refer to the appropriate User Guide
• http//www.hgsa.com/edi/pdf/x12ntransactionuse
  rguide_mcs.pdf
• Beginning on page 28 of the User Guide, you will
  find a listing of the loops and segments, the
  error message that you see on the H99RAR04 report
  and an explanation of that error message.
• The following page corresponds to the rejected
  claim in our example.

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Interpreting the MER

• REC TYPE DTL FIELD IN
  FIELD ERR MESSAGE
  
• NUM ERROR
  CONTENTS NUM
• BATCH STATUS ACCEPTED
• 2400 SV1 01 PLACE OF SVC A1
  0733 INVALID
  VALUE

• Starting on Page 28 of the X12N Transaction User
  Guide
• Locate the Loop ID in the chart that is
  referenced on the H99RAR04. Then,
• Locate the Segment ID in the chart that is
  referenced on the H99RAR04. Then,
• Locate the Err Num and the Error Message in the
  chart that was referenced on the H99RAR04.
  Follow across the row and youll see the
  requirements for the particular information that
  caused the rejection.
• The following slide shows an example of where to
  locate the above error in the user guide.

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Interpreting the MER
Example of a Claim Level Rejection on the
H99RAR04
REC TYPE DTL FIELD IN
FIELD ERR MESSAGE
NUM
ERROR CONTENTS NUM
BATCH STATUS ACCEPTED 2400 SV1
01 PLACE OF SVC A1
0733 INVALID VALUE
Excerpt from Page 68 of the X12N Transaction User
Guide TIP Use the find icon (binocular) to
locate loop and segment.
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How do I Track EDI Claim Submissions?

• The Process Date is contained in both the
  H99RAR03 and H99RAR04.
• The Process Date listed on the MCS Edit Report is
  the date that Medicare generated the MCS Edit
  Report, not the date the claims were submitted.
• To better understand when Medicare typically
  generates this report, please refer to the
  following schedule

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Whats next?

• After your file is accepted at this level, the
  accepted claims will be sent to the Medicare
  claims processing system where Medicare policy
  edits will be applied.
• The claims will be paid or denied, based on
  policy guidelines. Clean claims that are HIPAA
  compliant, submitted electronically, and meet
  policy criteria will be processed in as early as
  14 days.
• To obtain payment information promptly, be sure
  to retrieve your Electronic Remittance Advice
  (ERA). If you are not set-up, check with your
  vendor to see if they offer a program to retrieve
  the ERA.