Understanding the CA Claims Novitas Solutions Inc

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Understanding the CA Claims Novitas Solutions Inc Powered By Docstoc
					For X12N 837 5010 Submissions Only

   The 277CA Claims Acknowledgement is a report created by Novitas
    Solutions, Inc. after your claim file has been received.

   The report is generated after electronic edits have been applied to the
    transaction sets and groups via the Implementation Acknowledgement

   A 277CA will acknowledge all accepted or rejected claims in the file.

   A 277CA for an accepted claim will contain the claim number. Use returned
    claim numbers for future claim status inquiries.

   Files will be accepted on the 999 even if there are errors in some of the
    claims. This approach allows the return of individual claims as opposed to
    entire transactions sets when an error is not a syntactical structure issue.
    See the 999 training module for more information on the 999 report.

   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 Novitas
    Solutions, Inc.

    NOTE: This report is also available for test file
    transmissions; however, the accepted claims will NOT
    be forwarded for processing.

   The 277CA is created after your claim file generates the

   The 277CA is available for you to retrieve for 45
    business days only.

   Your vendor may have programmed your software to
    automatically retrieve the 277CA for you. If you are
    unsure, you should contact your vendor.

   If your software is not programmed to automatically
    retrieve the 277CA, you must enter the following
    command on our bulletin board: 2.

   This should be done after your claims were received by
    Novitas Solutions, Inc. to verify the claims were sent to

   The 277CA is a transaction file, so it requires understanding of the
    transaction or vendor programming to read. Contact your vendor to see if
    they offer a reader friendly version of this report.
   You should see the Claim Status Codes* and Claim Status Category Codes*
    in the STC segments on the report explaining the rejections The Centers for
    Medicare & Medicaid Services (CMS) has developed an edit spreadsheet*
    that details all edits that are on the claims.
   The report appearance may vary, depending on these things:
    ◦ Whether there were rejected claims.
    ◦ How many batches of claims were sent.
    ◦ Your vendor’s programming.
   You must read the entire report. There may be rejections on multiple claims.

* An asterisk denotes a web site that is external to Novitas Solutions, Inc.
  These links will open in new browser windows.

   Look for the STC segments in the file. There are multiple STC segments sent in the
    277CA report.
   Locate the Claim Status code and/or Claim Status Category code.
   Verify the code’s definition on the Washington Publishing Company (WPC) Web site
    mentioned on the previous page.
   Locate the QTY segment to determine the total rejected claims or total rejected
    segment quantity.
                   90 = Acknowledged Quantity
                   AA = Unacknowledged Quantity
                   QA = Quantity Approved
                   QC = Quantity Disapproved

   Locate the Entity Identifier Code in the NM1 segment located just above the STC
    segment. This will identify which Entity has an error. Examples of the Entity Identifier
    code are listed below:
                    AY = Clearinghouse
                    41 = Billing Service
                    85 = Billing Provider
                    IL = Subscriber

                    Example of a Claim Level Rejection

This is an example of a file that rejected a claim for invalid total charge. View
the explanations on the next few pages for help in interpreting this report.

   After your file is accepted at this level, the accepted claims
    will be sent to the Novitas Solutions, Inc. claims processing
    system where policy edits will be applied.

   The claims will be paid or denied, based on policy guidelines.
    “Clean claims” that are Health Insurance Portability and
    Accountability Act (HIPAA) compliant, submitted electronically,
    and meet policy criteria will be processed in as early as 14

   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.

   Currently each Medicare Administrative Contractor (MAC) produces
    custom error reports that vary by jurisdiction.

   By moving to the use of standardized edits, and Electronic Data
    Interchange (EDI) error and acknowledgement transactions, it
    enables the production of standardized reports across all

   Clearinghouses and software vendors can use these transactions to
    produce reports tailored to their customers.

   If you have any questions on this transaction, contact the EDI Help
    Desk or your vendor.


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