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									Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
                                                                        Page i
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TO:          Host sites, STC Beta site, SSMs, and CMS
FROM:        Christopher Sheridan
DATE:        July 3, 2008
SUBJECT:     R2008300 Final Quarterly Release Document

The R2008300 Final Quarterly Release Document is being sent to Host sites, STC
Beta site, SSMs, and CMS today, July 3, 2008.

This release is scheduled to be in production on July 7, 2008. Vinay Vuyyuru is
the Release Coordinator, and Eileen Dill is the Assistant Release Coordinator.
They are working with Kathy Woytan, who is coordinating this release for CMS.

Special Notes:

   1. This release has been approved by CMS to be installed into the production
      environment by Monday July 7, 2008.

   2. CR 00025654 involved updates to the EDITCONS, EDITUTIL, and EDITLIST
      sections of the CWF User Documentation to replace edits 2217/5711 with
      2206/5700 for VA project due to Problem 00026061. However, these
      documentation updates were not completed in time to be delivered with the
      R2008300 version of the CWF User Documentation. Entries were added to Doc
      only CR 00025924 for October, and the updates will be made with the
      R2008400 version of the documentation.

If you have any questions regarding this document, contact Vinay Vuyyuru at
(443) 436-6719, or Eileen Dill at (443) 436-6741.

Thank you.




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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
                                                                       Page ii
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TABLE OF CONTENTS


I.    RELEASE OVERVIEW .......................................................1

      A.   RELEASE DOCUMENT STRUCTURE........................................1

      B.   DOCUMENTATION UPDATES AND REVISIONS...............................3

      C.   NSC (NO SYSTEM CHANGES) CHANGE REQUESTS...........................6

      D.   RE-ASSIGNED CHANGE REQUESTS.......................................7

      E.   COMBINED CHANGE REQUESTS..........................................8

II.   SPECIAL INFORMATION ....................................................9

      A.   CWF SYSTEMS DOCUMENTATION CHANGES.................................9

      B.   CHANGES REQUIRING SATELLITE SYSTEM MODIFICATIONS.................10

      C.   EDIT MODIFICATIONS BY CHANGE REQUEST.............................11

      D.   SYSTEMS MODIFICATIONS TO HIMR....................................16

III. TECHNICAL INFORMATION .................................................17

      A.   IMPACT TEST......................................................17

      B.   ADDED/ARCHIVED MODULES...........................................18

IV.   PRE-PRODUCTION ACTIVITY ...............................................19

      A.   HOST PRE-PRODUCTION ACTIVITY.....................................19

      B.   SPECIAL INSTALLATION INSTRUCTIONS................................20

      C.   SPECIAL NOTES....................................................21

V.    CONNECT:DIRECT CONTENTS - FILE STATISTICS .............................22

VI.   TESTING DATA IN CURRENT RELEASE .......................................24



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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
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VII. DETAILED DESCRIPTION OF CHANGES .......................................28

      A.     HOST CHANGE REQUEST..............................................28
           1.  00025734 BENE XREF DID NOT MERGE ESRD AUX FILE WHEN INDICATOR 328
           2.  00025756 5864-MODIFICATIONS TO THE UPDATING ROUTINE OF CWF DATA
                          MART ...............................................31
           3. 00025791 XREF MERGE IS REDUCING LRSV AND LPSY DAYS AGAIN AFTER
                          MERGE ..............................................35
           4. 00025822 HICR TRANSACTION FOR HCBR IS RETURNING IO ERRORS ....38

      B.   SATELLITE CHANGE REQUESTS........................................40
           1.00024543 UR5601 SHOULD BE BYPASSED AS WERE 7270/7271 FOR CR338940
           2.00025321 5613 REJECT CWF ISSUE ...............................49
           3.00025654 5783-NEW INPATIENT SPELL & ADJUSTMENT PROCESS FOR VA
                        CLAIMS .............................................52
         4. 00025713 5828-CREATE USER ACCOUNT FOR NEXT GENERATION DESKTOP ON
                        CWF ...............................................109
         5. 00025723 UTILITY TO CORRECT DATA ON SMOKING CESSATION AUX FILE123
         6. 00025739 MODIFICATIONS NEEDED FOR DATA POSTED TO SMOK AUXILIARY
                        FILE ..............................................126
         7. 00025740 5855-SYSTEMS CHANGES FOR PRESCRIPTION ORDER NUMBERS FOR
                        CAPS ..............................................138
         8. 00025747 5210 REC'D IN ERROR ................................143
         9. 00025753 UR5703/UR5704 ISSUES ...............................148
         10. 00025755 A/B EDIT 7251 SETTING INCORRECTLY ..................152
         11. 00025764 5880-MODIFICATION OF PAYMENT WINDOW EDITS IN CWF ...154
         12. 00025765 5878-SMOKING AND TOBACCO USE CESSATION COUNSELING UPDATE
                         ..................................................188
         13. 00025773 5877 CORRECTION TO LOW UTILIZATION PAYMENT ADJUSTMENT
                        ADD-ON ............................................199
         14. 00025774 77X1 SHOULD BYPASS WHEN THE CLAIM OR LINE ITEM IS DENIED
                         ..................................................203
         15. 00025789 COBC PROCESS MUST BE RE-WRITTEN TO PROCESS BASED ON
                        LIDOS .............................................208
         16. 00025800 5907-UPDATE TO CWF EDITS 7284 AND 7548 .............211
         17. 00025801 5916-ADJUDICATING CLAIMS FOR IMMUNOSUPPRESSIVE DRUGS219
         18. 00025803 7259 INCORRECTLY RECD WHEN OVERRIDE CODE IS PRESENT 224
         19. 00025804 5872-UPDATE TO CWF TO ALLOW POSTING OF SNF/SB TO SPELL
                         ..................................................227
         20. 00025805 IUR INCORRECTLY GENERATED WHEN DOS EQUAL FROM OR THRU
                        DATE ..............................................231
         21. 00025815 DOCUMENTATION CHANGES FOR RELEASE R2008300 .........233
         22. 00025816 R2008300 INSTALLATION INSTRUCTION - ONE-TIMER CONTROL CR
                         ..................................................239
         23. 00025817 EXTERNAL COPYBOOK CHANGES FOR R2008300 .............253
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2020 Company, LLC                                          Baltimore, Maryland
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Final Quarterly Release Document                                  July 3, 2008
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           24. 00025818     ARCHIVE MAINTENANCE FOR RELEASE R2008300 ...........255
           25. 00025824     5888- AMBULANCE SERVICES CWF BYPASS WHEN DOS GREATER DOD
                              ..................................................256
           26.   00025858   524Q & 524P SETTING INCORRECTLY ....................261
           27.   00025878   6009 - JULY 2008 QUARTERLY UPDATE OF HCPCS FOR SNF CB267
           28.   00025937   6060 - NEW WAIVED TESTS ............................309
           29.   00025950   6087 - JULY 2008 MPFSDB UPDATES ....................314
           30.   00025960   6095 - JULY 2008 UPDATE TO THE ASC PAYMENT SYSTEM
                             SUMMARY ...........................................320

      C.        ANALYSIS CHANGE REQUESTS........................................325
           1.     00025650 6001/5767 MEDICARE ACUTE CARE EPISODE (ACE)
                             DEMONSTRATION .....................................325

APPENDIX A:       INSTALLATION INSTRUCTIONS ....................................367

APPENDIX B:       CICS TABLE UPDATES ...........................................392

APPENDIX C:       SOFTWARE RELEASE FILES .......................................393




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section I. Release Overview                                             Page 1
______________________________________________________________________________

I.   RELEASE OVERVIEW

     The Host Quarterly Release was NDMd on Tuesday, June 3, 2008, and is
     scheduled to go into production on July 7, 2008.

A.   RELEASE DOCUMENT STRUCTURE

     SECTION I, RELEASE OVERVIEW - contains information describing the
     structure of this document, and distinguishes the sections that are
     included in the Final Release version from those included in the Pre
     Release versions. It also includes CWF Systems Documentation changes,
     Change Requests that were closed, or re-assigned, after being assigned to
     the Release, a list of changes that are cross-referenced to CRs that were
     developed for this Release, and changes that were made to the Release
     inventory. This section is started for the Pre Release Document, but is
     not completed until the Final Release Document.

     SECTION II, SPECIAL INFORMATION - includes changes that have been made to
     the CWF Systems Documentation, CWF modifications to HIMR, a list of
     changes requiring Satellite System Modifications, and a list of new,
     modified, and deleted edits related to the Change Requests within the
     Release. This section is started for the Pre Release Document, but is
     not completed until the Final Release Document.

     SECTION III, TECHNICAL INFORMATION - provides specific Impact Test
     results, which are provided by the CWF Beta Site. If available, the
     results will be included in the Host Release Document. However, if it is
     not available at the time the Host Release is sent, it will be sent in a
     separate letter. This section also contains elements that were added, or
     archived, for the Release.

     SECTION IV, PRE-PRODUCTION ACTIVITY - provides a high-level summary of
     steps that should be taken to verify the installation of the Release
     software in the Test region. Further detail is located in SECTION VI.
     The SPECIAL NOTES section contains technical information that is unique
     to the installation, and testing, of this Release. This section is
     started for the Pre Release Document, but is not completed until the
     Final Release Document.

     SECTION V, CONNECT:DIRECT CONTENTS - FILE STATISTICS - groups the
     datasets, including file statistics, that are included in the Host
     Release delivery. Chapter INSTALL of the CWF Systems Documentation
     contains a full description of the contents of the shipment, and the
     instructions for installing the CWF software. This section is provided
     with the Beta, Host, and Final Release Documents.

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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section I. Release Overview                                             Page 2
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    SECTION VI, TESTING DATA IN CURRENT RELEASE - provides information that is
    used by the Host Sites to verify the installation of the Release, along
    with the information required to duplicate the CWFM environment. This
    section is updated when CWFM sends input transactions, and response files,
    for Host Sites to use to verify the installation of the Host Release
    software.

    SECTION VII, DETAILED DESCRIPTION OF CHANGES - includes detailed
    descriptions of each Change Request. It is divided into three sections:
    one is specific to Host Site changes, another is specific to Satellite
    Site changes, and the last is specific to Analysis CRs in RESE (research)
    status.

    APPENDIX A, INSTALLATION INSTRUCTIONS - provides all of the necessary
    Installation Instructions for the Release. This section is not completed
    until the Final Release Document.

    APPENDIX B, CICS TABLE UPDATES - includes a complete listing of CICS Table
    updates for the current Release. This Appendix is under development
    throughout the Release, and the first version will not be included until
    the Beta version of the Release Document.

    APPENDIX C, SOFTWARE RELEASE FILES - lists the Software Release files that
    relate to this Release. This Appendix is under development throughout the
    system test period. The first version is available for the Beta Release
    Document.

    APPENDIX D, CUSTOMER REQUEST CROSS-REFERENCE REPORT - contains a Customer
    Request/Element Cross-Reference list. The Appendix shows the information
    in two different formats for easy use. The first lists the information by
    CR number, the second lists the information by element name. This
    Appendix is under development throughout the system test period. The
    first version will be available for the Beta Release Document.

    Additional appendices are present if documentation associated with a
    Release-specific CR is included with the Release Document. Further
    explanation of the content of these appendices can be found in the SPECIAL
    NOTES section of the Release Memo in Section IV, Part C.




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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section I. Release Overview                                             Page 3
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B.   DOCUMENTATION UPDATES AND REVISIONS

CWF Systems Documentation changes result from system changes occurring because
of the Change Requests included with the Release. The Release production date
is placed in the header at the top of each page. If using the mainframe
version of the documentation, changes are noted with a carat in the left
margin; if using the web site (http://cwf.2020llc.com/cwf), changes are noted
in red. The reason for each documentation change is indicated in the CWF
SYSTEMS DOCUMENTATION AFFECTED sub-section of the CR, or in the Documentation
only CR. A copy of the updated CWF Systems Documentation is provided with the
Host Quarterly Release and Final Quarterly Release.

The CWF Systems Documentation is available via the web site, as well as, via a
Connect:Direct transmission. The complete CWF Systems Documentation is
included in both deliveries. In the Connect:Direct version, the documentation
is located in the library entitled DOCUMENT, and this library is divided into
two members as follows:

*     DOCUMENT -   This member contains all CWF Systems Documentation volumes.
                   It can be used to print/search all documentation at one time.

*     PRODDOCO -   This member contains the CWF Systems Documentation as it
                   existed prior to the promotion of the current Release into
                   production.

The DOCUMENT library contains all of the individual files that make up the CWF
Systems Documentation. The files are used to search/print specific volumes of
the CWF Systems Documentation. The following chart describes the different
documentation sections:




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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section I. Release Overview                                             Page 4
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MEMBER            CONTENT
___________________________________________________________________________

OVERCWF           Overview of the CWF System - General Information Manual:
                  Medicare; CWF History; CMS

OVERELGA          Overview of the Part A Eligibility System

OVERELGB          Overview of the Part B Eligibility System

OVERHIHO          Overview of the HIHO System - HIHO Training Manual

OVERHIMR          Overview of the HIMR System

OVERINFO          Overview of the INFOMAN Change Control System

ACRONYMS          List of Acronyms and Abbreviations Used Throughout the
                  Documentation

COPYINPR          Inter-program Communications Copybooks

COPYINTL          CWF Internal Record Specifications

COPYXTNL          CWF External Record Specifications

CWFMACRO          CWF Macro Specifications

DATAFLOW          Data Flow and Storage Manual

DATAMODL          Entity Relationship Model Diagram, Conceptual Data Model
                  Diagram

DESCLVL1          CWF Software Data

DESCLVL2          CWF Data Maintenance

DESCLV3B          Satellite Data

DISPCODE          CWF Disposition Codes

EDITABX           CWF A/B Crossover Edits

EDITALRT          CWF Alert Edits

EDITCONS          CWF Consistency Edits

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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section I. Release Overview                                             Page 5
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MEMBER            CONTENT
___________________________________________________________________________

EDITLIST          Listing of CWF Edits

EDITMNTS          CWF Maintenance Edits

EDITUTIL          CWF Utilization Edits

HCPCS             HCPCS-By-Category Report

HIMRNAV           HIMR Navigational Document

HIMRPROM          HIMR Screen Prompts

HOSTJCL           Procedures

INSTALL           Procedures for Installation of CWF Software

LAYBENE           Beneficiary Database File Layouts

LAYSUPP           CWF Support File Layouts

OVERINPA          Overview of CWF Inpatient Processing

PROGDTL           Computer Programming Detail

PURGE             Purge Record Formats

REPTPROD          Production Reports by Job name

SCRHOST           Host Screen Transactions

SYSDEF            Glossary of Terms; Definitions

TABLECO           Table of Codes

TBLEMANT          Overview and Process Descriptions

TRANSCLM          CMS Claim Transactions

TRANSINT          CWF Internal Transactions; Record Layouts

TRANSMNT          CMS Maintenance Record Layouts

XREF              XREF II Processing Information
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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section I. Release Overview                                             Page 6
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C.   NSC (NO SYSTEM CHANGES) CHANGE REQUESTS

The Change Requests listed in this section were assigned to this Release.
During requirements gathering, they were changed to an NSC status. Refer to
INFOMAN for more detailed closure information.

     CR
     Number       Description
     ______       ___________

     00020386     PROV SUFFIX DROPPED ON RESP WHEN CLAIM BYPASSES ER DISPOS

     00025627     5725-MEDICARE FRAUD EDIT MODULE

     00025763     5866 - MODIFICATIONS TO COBA CROSSOVER

     00025806     CWF IS NOT SETTING 7261 ON HUBC ADJUST RECORD

     00025912     CWF IS AUTO CANCELLING INPATIENT RECORDS WHEN ADJUST
                  RECEIVE




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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section I. Release Overview                                             Page 7
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D.   RE-ASSIGNED CHANGE REQUESTS

The Change Requests listed here require further evaluation. They have been
removed from R2008300. Refer to INFOMAN for up-to-date, re-assignment
information.

     CR
     Number       Description
     ______       ___________

     00025825     5914-REMOVAL OF CWF EDITS THAT DENY PEN HCPCS IF NOT
                  RECERT




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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section I. Release Overview                                             Page 8
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E.   COMBINED CHANGE REQUESTS

Change Requests that are being developed under other CRs are in COMB
(Combined) status. The CRs listed in the left column contain all of the
information, and will appear in SECTION VII, DETAILED DESCRIPTION OF
CHANGES. The CRs in COMB status will only be mentioned here.

     CR
     NUMBER       ORIGIN        DESCRIPTION
     ______       ______        ___________

     None to report




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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section II. Special Information                                         Page 9
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II.   SPECIAL INFORMATION

A.    CWF SYSTEMS DOCUMENTATION CHANGES

As a result of CR 00025654 - 5783-NEW INPATIENT SPELL & ADJUSTMENT PROCESS FOR
VA CLAIM, a new chapter/section has been added to the CWF User Documentation
with the R2008300 release. This chapter is titled OVERINPA, and it is an
overview of CWF Inpatient processing. The new chapter was made available with
the Host delivery on June 3, 2008, and it is also included in the website
version of the documentation (http://cwf.2020llc.com/cwf). This section will
be included in all subsequent deliveries of the CWF User Documentation going
forward.




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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section II. Special Information                                        Page 10
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B.      CHANGES REQUIRING SATELLITE SYSTEM MODIFICATIONS

Each CR that contains Satellite Systems Modifications is specified below,
followed by the name of the record layout that is being modified. Please
refer to CR 00025817 for the specific updates.

CR 00025654 - 5783-NEW INPATIENT SPELL & ADJUSTMENT PROCESS FOR VA CLAIMS

     Copybook Name: CIOCBENE


CR 00025739 - MODIFICATIONS NEEDED FOR DATA POSTED TO SMOK AUXILIARY FILE

     Copybook Name: CABEHUQA


CR 00025765 - 5878-SMOKING AND TOBACCO USE CESSATION COUNSELING UPDATE

     Copybook Name: CABEHUQA




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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section II. Special Information                                        Page 11
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C.   EDIT MODIFICATIONS BY CHANGE REQUEST

   1. 00024543 UR5601 SHOULD BE BYPASSED AS WERE 7270/7271 FOR CR3389
   IMPACT:
 (X) Host
 (X) Satellite Part A Inpatient
 a. Error Code: 5601 ( )New (X)Modified ( )Deleted


   2. 00025321 5613 REJECT CWF ISSUE
   IMPACT:
 (X) Host
 (X) Satellite Part A Outpatient
 a. Error Code: 5613 ( )New (X)Modified ( )Deleted


   3. 00025654 5783-NEW INPATIENT SPELL & ADJUSTMENT PROCESS FOR VA CLAIMS
   IMPACT:
 (X) Host
 (X) Satellite Part A Inpatient
 a. Error Code: 0018 ( )New (X)Modified ( )Deleted
 b. Error Code: 6001 ( )New (X)Modified ( )Deleted
 c. Error Code: 6002 ( )New (X)Modified ( )Deleted
 d. Error Code: 6004 ( )New (X)Modified ( )Deleted
 e. Error Code: 6006 ( )New (X)Modified ( )Deleted
 f. Error Code: 6040 ( )New (X)Modified ( )Deleted
 g. Error Code: 8001 ( )New (X)Modified ( )Deleted
 h. Error Code: 8002 ( )New (X)Modified ( )Deleted
 i. Error Code: 8003 ( )New (X)Modified ( )Deleted
 j. Error Code: 8004 ( )New (X)Modified ( )Deleted
 k. Error Code: 8005 ( )New (X)Modified ( )Deleted
 l. Error Code: 8006 ( )New (X)Modified ( )Deleted
 m. Error Code: 8007 ( )New (X)Modified ( )Deleted
 n. Error Code: 8008 ( )New (X)Modified ( )Deleted
 o. Error Code: 8009 ( )New (X)Modified ( )Deleted
 p. Error Code: 2217 (X)New ( )Modified ( )Deleted
 q. Error Code: 5711 (X)New ( )Modified ( )Deleted
 r. Error Code: 0020 ( )New (X)Modified ( )Deleted
 s. Error Code: 5800 ( )New (X)Modified ( )Deleted
 t. Error Code: 6000 ( )New (X)Modified ( )Deleted




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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section II. Special Information                                        Page 12
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   4. 00025713 5828-CREATE USER ACCOUNT FOR NEXT GENERATION DESKTOP ON CWF
   IMPACT:
 (X) Host
 (X) Satellite Part A Inpatient
 (X) Satellite Part A Outpatient
 (X) Satellite Part B
 (X) Hospice
 (X) Home Health
 (X) DMERC
 a. Error Code: SP20 ( )New (X)Modified ( )Deleted
 b. Error Code: SP37 ( )New (X)Modified ( )Deleted
 c. Error Code: SP50 ( )New (X)Modified ( )Deleted
 d. Error Code: SP57 ( )New (X)Modified ( )Deleted
 e. Error Code: SP59 ( )New (X)Modified ( )Deleted
 f. Error Code: SP73 ( )New (X)Modified ( )Deleted


   5. 00025739 MODIFICATIONS NEEDED FOR DATA POSTED TO SMOK AUXILIARY FILE
   IMPACT:
 (X) Host
 (X) Satellite Part A Outpatient
 (X) Satellite Part B
 a. Error Code: 5A#2 ( )New (X)Modified ( )Deleted
 b. Error Code: 66x8 ( )New (X)Modified ( )Deleted
 c. Error Code: 539E ( )New (X)Modified ( )Deleted


   6. 00025740 5855-SYSTEMS CHANGES FOR PRESCRIPTION ORDER NUMBERS FOR CAPS
   IMPACT:
 (X) Host
 (X) Satellite Part B
 a. Error Code: 5711 (X)New ( )Modified ( )Deleted


   7. 00025747 5210 REC'D IN ERROR
   IMPACT:
 (X) Host
 (X) Satellite Part A Inpatient
 a. Error Code: 5210 ( )New (X)Modified ( )Deleted




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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section II. Special Information                                        Page 13
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  8. 00025753 UR5703/UR5704 ISSUES
  IMPACT:
(X) Host
(X) Satellite Part B
a. Error Code: 5703 ( )New (X)Modified ( )Deleted
b. Error Code: 5704 ( )New (X)Modified ( )Deleted


  9. 00025764 5880-MODIFICATION OF PAYMENT WINDOW EDITS IN CWF
  IMPACT:
(X) Host
(X) Satellite Part A Inpatient
(X) Satellite Part A Outpatient
a. Error Code: 7109 ( )New (X)Modified ( )Deleted
b. Error Code: 7112 ( )New (X)Modified ( )Deleted
c. Error Code: 7113 ( )New (X)Modified ( )Deleted
d. Error Code: 7114 ( )New (X)Modified ( )Deleted
e. Error Code: 7115 ( )New (X)Modified ( )Deleted
f. Error Code: 7119 ( )New (X)Modified ( )Deleted
g. Error Code: 7120 ( )New (X)Modified ( )Deleted
h. Error Code: 7121 ( )New (X)Modified ( )Deleted
i. Error Code: 7122 ( )New (X)Modified ( )Deleted


  10. 00025765 5878-SMOKING AND TOBACCO USE CESSATION COUNSELING UPDATE
  IMPACT:
(X) Host
(X) Satellite Part A Outpatient
(X) Satellite Part B
a. Error Code: 5A#2 ( )New (X)Modified ( )Deleted
b. Error Code: 66x8 ( )New (X)Modified ( )Deleted
c. Error Code: 539E ( )New (X)Modified ( )Deleted


  11. 00025773 5877 CORRECTION TO LOW UTILIZATION PAYMENT ADJUSTMENT ADD-ON
  IMPACT:
(X) Host
(X) Home Health
a. Error Code: 539H (X)New ( )Modified ( )Deleted




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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section II. Special Information                                        Page 14
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   12. 00025774 77X1 SHOULD BYPASS WHEN THE CLAIM OR LINE ITEM IS DENIED
   IMPACT:
 (X) Host
 (X) Satellite Part B
 (X) DMERC
 a. Error Code: 77x1 ( )New (X)Modified ( )Deleted (Pt. B Carrier)
 b. Error Code: 77x1 ( )New (X)Modified ( )Deleted (DMEPOS)


   13. 00025800 5907-UPDATE TO CWF EDITS 7284 AND 7548
   IMPACT:
 (X) Host
 (X) Satellite Part A Outpatient
 a. Error Code: 7284 ( )New (X)Modified ( )Deleted
 b. Error Code: 7548 ( )New (X)Modified ( )Deleted


   14. 00025801 5916-ADJUDICATING CLAIMS FOR IMMUNOSUPPRESSIVE DRUGS
   IMPACT:
 (X) Host
 (X) DMERC
 a. Error Code: D910 ( )New (X)Modified ( )Deleted
 b. Error Code: 5514 ( )New (X)Modified ( )Deleted


   15. 00025824 5888- AMBULANCE SERVICES CWF BYPASS WHEN DOS GREATER DOD
   IMPACT:
 (X) Host
 (X) Satellite Part A Outpatient
 (X) Satellite Part B
 a. Error Code: 5211 ( )New (X)Modified ( )Deleted (Pt. B Carrier)
 b. Error Code: 5211 ( )New (X)Modified ( )Deleted (Hospital, SNF, HHA,
                                                       Hospice, OUTP)


   16. 00025858 524Q & 524P SETTING INCORRECTLY
   IMPACT:
 (X) Host
 (X) Home Health
 a. Error Code: 524P ( )New (X)Modified ( )Deleted
 b. Error Code: 524Q ( )New (X)Modified ( )Deleted




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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section II. Special Information                                        Page 15
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   17. 00025878 6009 - JULY 2008 QUARTERLY UPDATE OF HCPCS FOR SNF CB
   IMPACT:
 (X) Host
 (X) Satellite Part A Inpatient
 (X) Satellite Part A Outpatient
 (X) Satellite Part B
 (X) DMERC
 a. Error Code: 7252 ( )New (X)Modified ( )Deleted




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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section II. Special Information                                        Page 16
______________________________________________________________________________

D.    SYSTEMS MODIFICATIONS TO HIMR

These are the system modifications to HIMR for CR 00025739:

 Requirement 7
 Modify the HIMR SMOK screen to display the SMOK Initial Date.
 This is the date of the first Smoking Cessation Training
 claim and is used to derive the 5 subsequent training periods.

 Note:   This new field will only display information for
         a Beneficiary that has a processed claim with a
         service date after 07/01/2008.

 Note:   Only 10 years of Smoking Cessation data will be
         processed after the Initial Date. The claim will
         post to the SMOK Auxiliary File, but will not accumulate
         units for editing purposes.

 EXAMPLE SMOK AUX FILE:

 INITIAL DATE: 10/01/2010        <<<<<       New Field added in HIMR
                                             for Benes with claims after
                                             7/1/2008

 COUNSELING PERIOD:    1    2      3     4     5
    TOTAL SESSIONS:    1    0      0     0     0
                                                              CLM
     HCPCS      FROM    -        THRU      PERIOD       QTY   TYPE     ICN/DCN
     G0375     10/01/2010       10/01/2010    1          1     O        TEST-10




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section III. Technical Information                                     Page 17
______________________________________________________________________________

III. TECHNICAL INFORMATION

A.   IMPACT TEST

     This section will be supplied by the STC Beta Site.




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section III. Technical Information                                     Page 18
______________________________________________________________________________

B.   ADDED/ARCHIVED MODULES

     1.     ADDED ELEMENTS

            The following SOURCE modules are new to the CWF system:

            HABWUHST
            HUIPVSPL
            UTLS83A1


            The following COPYBOOK module is new to the CWF system:

            CABCVSPL


            The following UTILITY module is new to the CWF system:

            UTLJ83A1


            The following CONTROL CARD module is new to the CWF system:

            UTLC83A1


     2.     ARCHIVED ELEMENTS

            None to report.




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section IV. Pre-Production Activity                                    Page 19
______________________________________________________________________________

IV.    PRE-PRODUCTION ACTIVITY

A.     HOST PRE-PRODUCTION ACTIVITY

Host Sites should use the following procedure to verify the installation of
the Release software in the test region.

 1. Establish Test Region:
    a.   Perform INIT
         - Initialize test region

      b.   Run REGRLOAD
           - Load history claims, Beneficiary, and Auxiliary file

      c.   Run CABMNSCW utility
           - Load NSC file to establish DMEPOS Supplier Number Table

      d.   Run test cycles
           - Bring in benchmark input

      e.   Compare response file output




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section IV. Pre-Production Activity                                    Page 20
______________________________________________________________________________

B.   SPECIAL INSTALLATION INSTRUCTIONS

CR 00025816 is the installation instruction/one-timer control CR for this
release. This CR is used to document all the one-timers and installation
instructions for each CR in the release. The Instructions are not listed in
any particular order within this CR.

For the order in which the one-timers should be run, refer to Appendix A.
Appendix A is divided into eight sections: Host/Satl Pre-Pre Installation,
Host/Satl Pre-Installation, Host/Satl Installation, and Host/Satl Post-
Installation. These instructions should be performed in the order specified.




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section IV. Pre-Production Activity                                    Page 21
______________________________________________________________________________

C.    SPECIAL NOTES

     1. This release has been approved by CMS to be installed into the
        production environment by Monday July 7, 2008.

     2. CR 00025654 involved updates to the EDITCONS, EDITUTIL, and EDITLIST
        sections of the CWF User Documentation to replace edits 2217/5711 with
        2206/5700 for VA project due to Problem 00026061. However, these
        documentation updates were not completed in time to be delivered with
        the R2008300 version of the CWF User Documentation. Entries were added
        to Doc only CR 00025924 for October, and the updates will be made with
        the R2008400 version of the documentation.




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section V. Connect:Direct Contents - File Statistics                   Page 22
______________________________________________________________________________

V.      CONNECT:DIRECT CONTENTS - FILE STATISTICS

 The track estimate was based on 3390 DASD.

 Host files:
 -----------
                                      NO. OF                                 DIR
 FILE    DSName                       MEMBERS DSORG RECFM LRECL BLKSZE TRKS BLKS
 ____    _______________________      _______ _____ _____ _____ ______ ____ _____
  1.     *.RCCYYQST.H.SW.BTCH.LD        204     PO     U      0 23200 312     100
  2.     *.RCCYYQST.H.SW.CARTBL         N/A     PS    VB   7716 23476     1   N/A
  3.     *.RCCYYQST.H.SW.CICS.TAB       16      PO   FBA    133 23408    27     5
  4.     *.RCCYYQST.H.SW.CNTLCARD       122     PO    FB     80   6160    6    50
  5.     *.RCCYYQST.H.SW.COPYLIB        575     PO    FB     80   6160 151    200
  6.     *.RCCYYQST.H.SW.EDIT.TBL       N/A     PS    VB   4551 24498     2   N/A
  7.     *.RCCYYQST.H.SW.HCPCS          N/A     PS    VB    529 27598    48   N/A
  8.     *.RCCYYQST.H.SW.IDCMCARD       545     PO    FB     80   6160   25   100
  9.     *.RCCYYQST.H.SW.JCLLIB         139     PO    FB     80   6160    9    50
 10.     *.RCCYYQST.H.SW.ONL.LD         545     PO     U      0 23200 198     100
 11.     *.RCCYYQST.H.SW.PROCLIB        174     PO    FB     80   6160   27    50
 12.     *.RCCYYQST.H.SW.PROG.LST       731     PO   FBA    133 23408 4795    200
 13.     *.RCCYYQST.H.SW.RPT.TITLES     N/A     PS    FB     34   3400    1   N/A
 14.     *.RCCYYQST.H.SW.UTILLIB        203     PO    FB     80   6160   31    50
 15.     *.RCCYYQST.H.TD.BENEDATA       N/A     PS    VB 32004 32008     65   N/A
 16.     *.RCCYYQST.H.TD.BENES          4       PO    VB 13322 27998 128       10
 17.     *.RCCYYQST.H.TD.MISC           6       PO    VB 26142 27998 705       10
 18.     *.RCCYYQST.H.TD.SITE.CLM       3       PO    VB 19800 27998 2198      50
 19.     *.RCCYYQST.H.TD.SITE.RESP      3       PO    VB 26327 27998 251       10
 20.     *.RCCYYQST.H.TX.DOCUMENT       45      PO   FBA    110 27500 856      20
 21.     *.RCCYYQST.H.TX.RLSE.DOC       N/A     PS   FBA     90 27000    26   N/A

 Note:     Asterisk denotes prefix used at each Host site, RCCYYQST denotes the
            Release number of the current release.




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section V. Connect:Direct Contents - File Statistics                   Page 23
______________________________________________________________________________

 Satellite files:
 ----------------
                                     NO. OF                                 DIR
 FILE    DSName                      MEMBERS DSORG RECFM LRECL BLKSZE TRKS BLKS
 ____    _______________________     _______ _____ _____ _____ ______ ____ _____
  1.     *.RCCYYQST.S.SW.BTCH.LD       14      PO     U     0   23200    6    50
  2.     *.RCCYYQST.S.SW.CARTBL        N/A     PS    VB 7716    23476    1    NA
  3.     *.RCCYYQST.S.SW.CICS.TAB      6       PO   FBA   133   23408    3     5
  4.     *.RCCYYQST.S.SW.COPYLIB       205     PO    FB    80    6160   48    50
  5.     *.RCCYYQST.S.SW.IDCMCARD      13      PO    FB    80    6160    1    15
  6.     *.RCCYYQST.S.SW.ONL.LD        162     PO     U     0   23200   23    50
  7.     *.RCCYYQST.S.SW.PROCLIB       4       PO    FB    80    6160   50    50
  8.     *.RCCYYQST.S.SW.PROG.LIST     166     PO   FBA   133   23408 1217   200
  9.     *.RCCYYQST.S.SW.UTILLIB       11      PO    FB    80    6160    1    15
 10.     *.RCCYYQST.S.TX.DOCUMENT      44      PO   FBA   110   27500 601     20
 11.     *.RCCYYQST.S.TX.RLSE.DOC      N/A     PS   FBA    90   27000   26    NA

 Note:     Asterisk denotes prefix used at each Host site, and RCCYYQST denotes
            the Release number of the current release.

 The DOCUMENT Library Members should be printed using the same characteristics
 that have always been used.




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section V. Connect:Direct Contents - File Statistics                   Page 24
______________________________________________________________________________

VI.   TESTING DATA IN CURRENT RELEASE

 Input and output files have been provided for Host Sites to use to verify
 the correct installation of this Release. Specifically, the input consists
 of:

 1. A 'base' of test data made up of prior input from previous Releases.
 2. Site 3 file for Run 02, containing input related to this Release.

 This input/output may also be used in regression testing of the CWF system.
 The following actions must be taken in order to create the same response
 files, with 95% accuracy, contained on the current Release files:

 1. Delete/define all VSAM files once (only) before running the test sequence
    outlined below. (See instructions in Chapter INSTALL of the CWF Systems
    Documentation - Create CWF VSAM Datasets.)

 2. If there are test history files in existence from previous CWF Releases,
    delete the existing test history files and run the HISTINIT utility.
    (Described in CWF Systems Documentation Chapter INSTALL - Create CWF VSAM
    Datasets.)

 3. Run the 'REGRLOAD' Utility before beginning the test cycles.

 The characteristics and environment that existed when the test cycles were
 run for this Release are listed in this section.

 1. Enter transactions using the HISU transaction:
     Record 1 - Maximum tasks for sites '--', '00', '01', '02', and '03'
                were set to '1'.
     Record 3 - Transactions per batch were set to '5'.

 2. The Contractor File Maintenance (HIIN) for Contractor Number '00000'
    contained the following characteristics:

      SITE INDICATOR          KS
      PROCESS TYPE            O
      MULTI SWITCH            Y
      5% DUPE EDITS:          ACTIVE
      SKELETON CMN:           ACTIVE
      CONTRACTOR EDIT:        TEST
      PART A DATE CHECKING:   INACTIVE
      PART B DATE CHECKING:   INACTIVE
      MSP DATE CHECKING:      INACTIVE
      ESRD DATE CHECKING:     INACTIVE
      CMN DATE CHECKING:      INACTIVE
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VI. Testing Data in Current Release                            Page 25
______________________________________________________________________________

 3. Production files that directly affect the results of the cycles include:

     CLIA
     Carrier Table
     Edit Table
     HCPCS

 4. Chapter INSTALL contains instructions for executing CMS Maintenance OSA
    Claims Cycles, and Claims Processing Cycles.

 5. The data should be input using the sequence listed in this section.

   Note:   Asterisk denotes prefix used at each Host site and the Release
           number of the current release

     HCFA 01 - 21,488 CMS MAINTENANCE TRANSACTIONS TO SET UP
           Types: HIID, HIHO, HIHR, HIBR, HIPA, HIPB, HIXR, HIAR, HICA,
                    HINT, HISP, HHMO, HICB, etc.

            INPUT FILES: *.RCCYYQST.H.TD.BENES(HCFA01)
                    Input to CABHCFA Step (CABLIN DD) in CABMDC06
                           Header Date 2008151

     HCFA 03 - 50,443 MISCELLANEOUS CMS MAINTENANCE TRANSACTIONS
           Types: HIHO, HIPA, HIPB, HIID, and HHMO

            INPUT FILE: *.RCCYYQST.H.TD.BENES(HCFA03)
                    Input to CABHCFA Step (CABLIN DD) in CABMDC06
                         Header Date 2008152

     HCAL 03 - 171 HCAL HICR MAINTENANCE TRANSACTIONS
           Types: HCAL

            INPUT FILE: *.RCCYYQST.H.TD.BENES(HCAL03)
                    Input to REPRHICR Step (INFILE DD) in CABMDC06

            OUTPUT FILE:   Response output is not created for this run; no
                            expected results are included.

     NOTE: HCFA01 and 03 can be concatenated and executed in one RUN.
           HCAL03 can also be taken into same run for HICR process.




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VI. Testing Data in Current Release                            Page 26
______________________________________________________________________________

        RUN 02 - ONLINE SITE PROCESSING WITH A TOTAL OF 92,180 CLAIMS IN 3 FILE
                 SETS:

              INPUT FILES:    *.RCCYYQST.H.TD.SITE.CLM(RUN02S01)
                               - Site location is 00080 (PF 1)
                               - Header Date is 2008151
                               - Contains 6,826 transactions
                               Types: HUIP, HUOP, HUHC, HUHH, HUSP, HUBC, and HURD

                              *.RCCYYQST.H.TD.SITE.CLM(RUN02S02)
                              - Site location is 00190 (PF 2)
                              - Header Date is 2008151
                              - Contains 158 transactions
                              Types: HUIP, HUHC, HUSP, and HURD

                              *.RCCYYQST.H.TD.SITE.CLM(RUN02S03)
                              - Site location is 00210 (PF 3)
                              - Header Date is 2008151
                              - Contains 85,196 transactions
                              Types: HUIP, HUOP, HUBC, HUSP, HURD, HUDC, HUCM,
                              HUHC, HUBO, and HUHH

              OUTPUT FILES:   Expected Satellite response files, which should
                              match 95% with actual results received after the
                              input files, above, have been processed.

                              *.RCCYYQST.H.TD.SITE.RESP(RUN02R01)
                              - Response file for input file 'RUN02S01'
                              - Site location is 00080

                              *.RCCYYQST.H.TD.SITE.RESP(RUN02R02)
                              - Response file for input file 'RUN02S02'
                              - Site location is 00190

                              *.RCCYYQST.H.TD.SITE.RESP(RUN02R03)
                              - Response file for input file 'RUN02S03'
                              - Site location is 00210

Special Testing Instructions:      None


Note:     The asterisks above denote prefix used at each Host site, and RCCYYQST
           denotes the Release number of the current release.



______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VI. Testing Data in Current Release                            Page 27
______________________________________________________________________________

TESTING INFORMATIONAL UNSOLICITED RESPONSES THROUGH THE CABBUMP PROCESS.

In the event that it is necessary to test Informational Unsolicited Responses
through CABBUMP as part of release testing, the following jobs must be
executed as part of the CABBUMP process to generate and send Information
Unsolicited Responses to Satellites.

C05 _ CABBUMP _         Processes HHMO transaction and writes CWF Cancel Only
                        claims to CWFHOST.TRANS(+1).

HRCV _ Receive OSA _    Reads the CWFHOST.TRANS and write to Site 97.

H05 _                   Load OSA Site 97 queries.

HISC for Site 97 _      Processes CWF Cancel Only claims and generates
                        Informational Unsolicited Responses. These Responses
                        will be written to the CABNS97 file by H10, below.
                        (Note: CABOT* files may be empty if no regular OSA
                        queries exist).

H10 _                   Sorts and Backups OSA CABOT97 file. It copies CABNS97
                        from a VSAM file to a QSAM file, which is input to
                        HXMT.

HXMT _                  Split OSA Reply records. It reads the QSAM CABNS97
                        and creates Host Transmission files.

HRCV _                  Takes in Host transmission files (created by HXMT) and
                        creates Satellite Response files including OSA, if
                        any. The Satellite Response files are transmitted to
                        the appropriate Satellite.




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 28
______________________________________________________________________________

VII. DETAILED DESCRIPTION OF CHANGES

A.        HOST CHANGE REQUEST

     1.     00025734   BENE XREF DID NOT MERGE ESRD AUX FILE WHEN INDICATOR 3

     REQUESTOR ID: CWFM2000

   IMPACT:
 (X) Host
 ( ) Satellite Part A Inpatient
 ( ) Satellite Part A Outpatient
 ( ) Satellite Part B
 ( ) Hospice
 ( ) Home Health
 ( ) DMERC

   REASON FOR CHANGE:
 CWF is not merging the ESRD Auxiliary file during the XREF process
 when the ESRD indicator is equal to '3'.

     NEW BUSINESS REQUIREMENTS:

 Requirement 1
 CWF will need to modify HCDL/HIDL processing to transfer the ESRD
 Aux file data from the Inactive Beneficiary record to the
 Active Beneficiary record when the ESRD indicator is '3'.

 Requirement 2
 CWF will need to modify HCDL/HIDL processing to ensure correct
 processing if the Active Beneficiary has an ESRD Auxiliary indicator
 of '3' and Inactive Beneficiary has no ESRD data.

 Requirement 3
 CWF will need to modify HCDL/HIDL processing to merge the ESRD
 Aux file data when both the Active and Inactive Beneficiary
 records contain ESRD data. Do not merge duplicate or overlapping
 ESRD occurrences.

     EVENT-RESPONSE LIST:

 Event 1.1
 Submit an HCDL/HIDL transaction on an Inactive Beneficiary
 with an ESRD Aux file (3) that is merged to an Active Beneficiary
 with no ESRD Aux file.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 29
______________________________________________________________________________

 Response
 The Active HIC number reflects an ESRD Auxiliary Indicator of
 '3', and the ESRD Auxiliary file reflects the ESRD data from the
 Inactive HIC's record once the merge is finalized.
 If an HCDL was processed, ensure transaction was posted to HICR
 Audit Report.

 Event 2.1
 Submit an HCDL/HIDL transaction on an Active Beneficiary
 with an ESRD Aux file (3). The Inactive Beneficiary has
 no ESRD Aux file.

 Response
 The Active HIC number reflects an ESRD Auxiliary Indicator of
 '3', and the ESRD Auxiliary file reflects the ESRD data from the
 Active HIC's record once the merge is finalized.
 If an HCDL was processed, ensure transaction was posted to HICR
 Audit Report.

 Event 3.1
 Submit an HCDL/HIDL transaction on an Inactive Beneficiary
 with an ESRD Aux file that is merged to an Active Beneficiary
 with an ESRD Aux file.

 Response
 The ESRD Auxiliary file of the Active Beneficiary contains
 ESRD data from both the Active and Inactive Beneficiary.
 ESRD occurrences that are duplicate or overlapping
 should not be merged.
 If an HCDL was process, ensure transaction was posted to HICR
 Audit Report.

 The Entity List includes only NEW acronyms and terminology
 that is currently not in use in CWF.

 Entity List: N/A

 Areas Affected by the Problem.
   1. X-REF Processing

 Solution Criteria: N/A

   EDITS AFFECTED:   None

   INSTALLATION INSTRUCTIONS:     None

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 30
______________________________________________________________________________

   SYSTEMS DOCUMENTATION AFFECTED:   None

   SATELLITE SYSTEM MODIFICATIONS:   None




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 31
______________________________________________________________________________

   2.   00025756   5864-MODIFICATIONS TO THE UPDATING ROUTINE OF CWF DATA MART

   REQUESTOR ID: CWFM2000

   IMPACT:
 (X) Host
 ( ) Satellite Part A Inpatient
 ( ) Satellite Part A Outpatient
 ( ) Satellite Part B
 ( ) Hospice
 ( ) Home Health
 ( ) DMERC

   REASON FOR CHANGE:
 Currently, the Common Working File (CWF) system sends extracts
 of its data to a common CWF data mart to facilitate the
 customer service needs of 1-800-Medicare staff through the
 Next Generation Desktop (NGD) application and to update the
 Medicare Beneficiary Database. At present, updates from the
 CWF Auxiliary files are only made through the initiation of
 four events: submission of a Beneficiary claim; through HICR
 update; through a CWF cross-reference update; and through
 HIID transaction. The Center for Medicare & Medicaid Services
 (CMS) has determined that these events are not sufficient for
 ensuring that the CWF data mart is kept in synch with CWF's
 auxiliary files as they are updated. Therefore, CMS is making
 a modification to this process through this instruction.

 Effective, with this instruction, as the Coordination of
 Benefits Contractor (COBC) sends its HUBO updates to CWF
 on a bi-weekly or monthly basis, CWF shall immediately
 transmit all such update actions to both the MBD and NGD.

   NEW BUSINESS REQUIREMENTS:

 Requirement 1
 When the Coordination of Benefits Contractor (COBC) '11120'
 sends an HUBO update (add, update or delete) to CWF, CWF
 will generate an extract record for the Medicare Beneficiary
 Database (MBD).




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 32
______________________________________________________________________________

 BOI DATA FROM CABEMBD COPYBOOK:
 ------------------------------
 10 :XX:-BOI-DATA
      OCCURS 0 TO 40 TIMES
      DEPENDING ON :XX:-BOI-COUNT.
     15 :XX:-BOI-QUALIFIER           PIC   X(04).
     15 :XX:-BOI-COBC                PIC   X(05).
     15 :XX:-BOI-EFF-DATE            PIC   9(07).
     15 :XX:-BOI-TERM-DATE           PIC   9(07).
     15 :XX:-BOI-POLICY              PIC   X(17).
     15 :XX:-BOI-INSR-NAME           PIC   X(32).
     15 :XX:-BOI-INSR-ADDR1          PIC   X(32).
     15 :XX:-BOI-INSR-ADDR2          PIC   X(32).
     15 :XX:-BOI-INSURER-CITY        PIC   X(15).
     15 :XX:-BOI-INSURER-STATE       PIC   X(02).
     15 :XX:-BOI-INSURER-ZIP         PIC   X(09).

 Note: The record generated by CWF will be a complete overlay.

 Requirement 2
 When the Coordination of Benefits Contractor (COBC) '11120'
 sends an HUBO update (add, update or delete) to CWF, CWF
 will generate an extract record for the Next Generation
 Desktop (NGD).

 BOI DATA FROM CABENGD COPYBOOK:
 ------------------------------
 10 :XX:-BOI-DATA
      OCCURS 0 TO 40 TIMES
      DEPENDING ON :XX:-BOI-COUNT.
     15 :XX:-BOI-QUALIFIER         PIC X(04).
     15 :XX:-BOI-COBC              PIC X(05).
     15 :XX:-BOI-ACTION-TYPE       PIC X(01).
     15 :XX:-BOI-DELETE-IND        PIC X(01).
     15 :XX:-BOI-COBA-NUMBER       PIC 9(10).
     15 :XX:-BOI-EFF-DATE          PIC 9(07).
     15 :XX:-BOI-TERM-DATE         PIC 9(07).
     15 :XX:-BOI-POLICY            PIC X(17).
     15 :XX:-BOI-INSR-NAME         PIC X(32).
     15 :XX:-BOI-INSR-ADDR1        PIC X(32).
     15 :XX:-BOI-INSR-ADDR2        PIC X(32).
     15 :XX:-BOI-INSURER-CITY      PIC X(15).
     15 :XX:-BOI-INSURER-STATE     PIC X(02).
     15 :XX:-BOI-INSURER-ZIP       PIC X(09).
     15 :XX:-BOI-CREATION-DATE     PIC 9(07).
     15 :XX:-BOI-DELETION-DATE     PIC 9(07).
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 33
______________________________________________________________________________

    15   :XX:-BOI-DOCUMENT-CNTL     PIC   X(15).
    15   :XX:-BOI-UPDATE-DATE       PIC   9(07).
    15   :XX:-BOI-INSURER-CODE      PIC   X(01).
    15   :XX:-BOI-IDENTIFIER-NUMBER
                                    PIC   X(10).
    15   :XX:-BOI-PLAN-ID           PIC   X(10).
    15   :XX:-BOI-OTHER-INSURER-NUM
                                    PIC   X(10).

 Note: The record generated by CWF will be a complete overlay.

   EVENT-RESPONSE LIST:

 Event 1.1
 COBC (11120) submits an Add through the HUBO transaction that
 is accepted and updates the Beneficiary's BOI Auxiliary File.

 Response
 The MBD extract record is generated and overlays the existing
 record.

 Event 1.2
 COBC (11120) submits an Update through the HUBO transaction that
 is accepted and updates the Beneficiary's BOI Auxiliary File.

 Response
 The MBD extract record is generated and overlays the existing
 record.

 Event 1.3
 COBC (11120) submits a Delete through the HUBO transaction that
 is accepted and updates the Beneficiary's BOI Auxiliary File.

 Response
 The MBD extract record is generated and overlays the existing
 record.

 Event 2.1
 COBC (11120) submits an Add through the HUBO transaction that
 is accepted and updates the Beneficiary's BOI Auxiliary File.

 Response
 The NGD extract record is generated and overlays the existing.
 record.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 34
______________________________________________________________________________

 Event 2.2
 COBC (11120) submits an Update through the HUBO transaction that
 is accepted and updates the Beneficiary's BOI Auxiliary File.

 Response
 The NGD extract record is generated and overlays the existing.
 record.

 Event 2.3
 COBC (11120) submits an Delete through the HUBO transaction that
 is accepted and updates the Beneficiary's BOI Auxiliary File.

 Response
 The NGD extract record is generated and overlays the existing
 record.

 The Entity List includes only NEW acronyms and terminology
 that is currently not in use in CWF.

 Entity List: N/A

 Areas Affected by the Problem.
   1. MBD Extract Record
   1. NGD Extract Record

 Solution Criteria: N/A

   EDITS AFFECTED:   None

   INSTALLATION INSTRUCTIONS:     None

   SYSTEMS DOCUMENTATION AFFECTED:       None

   SATELLITE SYSTEM MODIFICATIONS:       None




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 35
______________________________________________________________________________

   3.   00025791   XREF MERGE IS REDUCING LRSV AND LPSY DAYS AGAIN AFTER MERGE

   REQUESTOR ID: CWFM2000

   IMPACT:
 (X) Host
 ( ) Satellite Part A Inpatient
 ( ) Satellite Part A Outpatient
 ( ) Satellite Part B
 ( ) Hospice
 ( ) Home Health
 ( ) DMERC

   REASON FOR CHANGE:
 XREF merges are incorrectly reducing the LRSV (lifetime reserve
 days) and LPSY (lifetime psychiatric days).

   NEW BUSINESS REQUIREMENTS:

 Requirement 1
 CWF will modify the XREF merge process to ensure that LRSV
 (lifetime reserve days) and LPSY (lifetime psychiatric days)
 are not incorrectly reduced for Beneficiaries where the
 inactive HIC has reduced LRSV or LPSY days and the active
 Beneficiary does not. CWF should rebuild the days if both
 the active and inactive Beneficiary have reduced days.
 Beneficiaries that are currently incorrect in production,
 will need to be corrected via HICR.

   EVENT-RESPONSE LIST:

 Event 1.1
 Submit an HIDL/HCDL transaction that will initiate a merge for
 an inactive Beneficiary that has reduced LSRV days. The
 active Beneficiary has all allotted LSRV days available.

 Response
 The LSRV days after the merge for the active Beneficiary is
 equal to the LSRV days for the inactive Beneficiary prior to the
 merge.

 Event 1.2
 Submit an HIDL/HCDL transaction that will initiate a merge for
 an inactive Beneficiary that has all allotted LSRV days. The
 active Beneficiary has a reduced amount of LSRV days available.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 36
______________________________________________________________________________

 Response
 The LSRV days after the merge for the active Beneficiary is
 equal to the LSRV days for the active Beneficiary prior to the
 merge.

 Event 1.3
 Submit an HIDL/HCDL that will initiate a merge for an
 inactive Beneficiary that has reduced LSRV days. The
 active Beneficiary also has reduced LSRV days.

 Response
 The LSRV days after the merge for the active Beneficiary is
 rebuilt using the remaining days for both Beneficiaries.

 Event 1.4
 Submit an HIDL/HCDL transaction that will initiate a merge for
 an inactive Beneficiary that has reduced LPSY days. The
 active Beneficiary has all allotted LPSY days available.

 Response
 The LPSY days after the merge for the active Beneficiary is
 equal to the LPSY days for the inactive Beneficiary prior to the
 merge.

 Event 1.5
 Submit an HIDL/HCDL transaction that will initiate a merge for
 an inactive Beneficiary that has all allotted LPSY days. The
 active Beneficiary has a reduced amount of LPSY days available.

 Response
 The LPSY days after the merge for the active Beneficiary is
 equal to the LPSY days for the active Beneficiary prior to the
 merge.

 Event 1.6
 Submit an HILD/HCDL transaction that will initiate a merge for
 an inactive Beneficiary that has reduced LPSY days. The
 active Beneficiary also has reduced LPSY days.

 Response
 The LPSY days after the merge for the active Beneficiary is
 rebuilt using the remaining days for both Beneficiaries.




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 37
______________________________________________________________________________

 The Entity List includes only NEW acronyms and terminology
 that is currently not in use in CWF.

 Entity List: N/A

 Areas Affected by the Problem.
   1. X-Ref Processing

 Solution Criteria: N/A

   EDITS AFFECTED:   None

   INSTALLATION INSTRUCTIONS:   None

   SYSTEMS DOCUMENTATION AFFECTED:     None

   SATELLITE SYSTEM MODIFICATIONS:     None




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 38
______________________________________________________________________________

  4.   00025822   HICR TRANSACTION FOR HCBR IS RETURNING IO ERRORS

  REQUESTOR ID: CWFM2000

  IMPACT:
(X) Host
( ) Satellite Part A Inpatient
( ) Satellite Part A Outpatient
( ) Satellite Part B
( ) Hospice
( ) Home Health
( ) DMERC

  REASON FOR CHANGE:
CWF is incorrectly generating 60 I/O errors when an HCBR transaction
(IP SUMMARY HISTORY ACCRETE/UPDATE TRANS) is submitted for an
Inpatient claim that was auto-canceled due to an XREF merge.

  NEW BUSINESS REQUIREMENTS:

Requirement 1
CWF will no longer return an I/O error when processing an HCBR
transaction on an Inpatient claim that was canceled due to
an XREF merge.

Requirement 2
CWF will ensure the accepted HCBR is present on the HICR Audit
Report.

  EVENT-RESPONSE LIST:

Event 1.1
An HCBR transaction is submitted for a claim that was
auto-canceled due to an XREF merge.

Response
The HCBR transaction is accepted.

Event 1.1
An HCBR transaction is submitted for a claim that was
not auto-canceled due to an XREF merge.

Response
The HCBR transaction is accepted.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 39
______________________________________________________________________________

 Event 2.1
 An HCBR transaction is submitted and accepted.

 Response
 The accepted HCBR is present on the HICR Audit Report.

 The Entity List includes only NEW acronyms and terminology
 that is currently not in use in CWF.

 Entity List: N/A

 Areas Affected by the Problem.
   1. HICR

 Solution Criteria: N/A

   EDITS AFFECTED:   None

   INSTALLATION INSTRUCTIONS:     None

   SYSTEMS DOCUMENTATION AFFECTED:       None

   SATELLITE SYSTEM MODIFICATIONS:       None




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 40
______________________________________________________________________________

B.        SATELLITE CHANGE REQUESTS

     1.     00024543   UR5601 SHOULD BE BYPASSED AS WERE 7270/7271 FOR CR3389

     REQUESTOR ID: EMBCBS1000

   IMPACT:
 (X) Host
 (X) Satellite Part A Inpatient
 ( ) Satellite Part A Outpatient
 ( ) Satellite Part B
 ( ) Hospice
 ( ) Home Health
 ( ) DMERC

   REASON FOR CHANGE:
 Effective 01/01/2004, change request (CR) 2716
 (Transmittal A-03-065) established CWF edits to ensure
 accurate payment for Beneficiaries readmitted to the same
 Inpatient Prospective Payment System (IPPS) Provider on
 the same day. These edits rejected subsequent claims with
 the same Provider on the same day. Fiscal Intermediaries
 (FIs) were also instructed to return claims to the IPPS
 Provider for adjustment. This instruction created a new
 Condition Code 'B4' to not allow edits, '7270' (Inpatient
 PPS claim with Admit equal to Inpatient PPS Discharge
 Date in history for same Provider and Patient Status is
 not '30') and '7271' (Inpatient PPS claim with Discharge
 Date equal to Inpatient PPS Admit Date in history for same
 Provider and Patient Status is not '30') to set if present.

 Modifications were made to A/B Crossover edits '7270' and
 '7271' in CWF CR 23522/CMS CR 3389 to not set if Condition
 Code 'B4' is present.

 Modifications to utilization edit '5601' (Services on the
 claim overlap covered services on a previously accepted
 claim) are needed to bypass for the same conditions when
 overlapping the Admit Date for the same IPPS Provider
 (Provider Range 0001-0999).

 Spell processing modifications are also needed to only
 utilize one day when Condition Code 'B4' is present on
 the incoming or history record for the same day and IPPS
 Provider (Provider Range 0001-0999).

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 41
______________________________________________________________________________

   NEW BUSINESS REQUIREMENTS:

 Requirement 1
 Modify utilization edit '5601' to bypass if Condition Code
 'B4' is present on the incoming or history record and the
 overlap is the Admit Date only for the same IPPs Provider
 (Provider Range 0001-0999). Continue to set the edit if DOS
 are within the From and Thru Date.

 Requirement 2
 Modify the CWF software to not count the same utilization
 day twice in a benefit period. If an incoming Inpatient
 IPPS record for the same IPPS Provider (Provider Range 0001-
 0999) is received with Condition Code 'B4' and the Admit
 Date is already been utilized in a benefit period do not
 count the day in again.

 Example:
 Incoming record has Dates of Service 11/17/2004 thru 11/19/2004
 with Condition Code 'B4'. In history for the same Provider
 with Dates of Service 11/17/2004 thru 11/17/2004 has posted a
 utilization day in the benefit period.

 Modify the CWF software to not count the same utilization
 day twice in a benefit period. If a history Inpatient
 record is posted with Condition Code 'B4' and the Admit
 Date has already been utilized in a benefit period do not
 count the day in utilization again.

 Example:
 Incoming record has Dates 11/17/2004 thru 11/17/2004. In
 history for the same Provider is claim with Dates of
 Service 11/17/2004 thru 11/19/2004 and Condition Code 'B4'
 is present and posted utilization in the benefit period.

 If an adjustment to non-cover or cancel the above scenario,
 and another claim has already utilized the day, DO NOT
 back out the one day from the benefit period.

 If no subsequent claim is posted in history CWF should
 back out the utilization day.




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 42
______________________________________________________________________________

   EVENT-RESPONSE LIST:

 Event 1.1
 An HUIP Inpatient IPPS (Provider Range 0001-0999) '11x'
 Type of Bill is received with Dates of Service overlapping
 the Admit Date only of a previously accepted IPPS record
 for the same Provider and Condition 'B4' is present.

 Response
 The record is accepted, and utilization edit '5601' is not set.

 Event 1.2
 An HUIP Inpatient IPPS (Provider Range 0001-0999) '11x'
 Type of Bill is received with Dates of Service overlapping
 the Admit Date only of a previously accepted IPPS record
 for the same IPPS Provider and Condition Code 'B4' is not
 present.

 Response
 The record is rejected, and utilization edit '5601' is set.

 Event 1.3
 An HUIP Inpatient IPPS (Provider Range 0001-0999) '11x'
 Type of Bill is received with Dates of Service within the
 Admit Date or Discharge Date of a previously accepted record
 for the same IPPS Provider and Condition Code 'B4' is
 present.

 Response
 The record is rejected, and utilization edit '5601' is set.

 Event 1.4
 An HUIP Inpatient IPPS (Provider Range 0001-0999) '11x'
 Type of Bill is received with Dates of Service within the
 Admit Date or Discharge Date of a previously accepted record
 for the same IPPS Provider and Condition 'B4' is not present.

 Response
 The record is rejected, and utilization edit '7271' is set.

 Event 2.1
 An IPPS (Provider Range 0001-0999) HUIP record for   a one
 covered day stay is in history. An HUIP record for   the
 same IPPS Provider is received with Condition Code   'B4'
 and the Admit Date is equal to the history one day   stay.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 43
______________________________________________________________________________

 Response
 The Admit date is not counted in utilization again.

 Event 2.2
 An IPPS (Provider Range 0001-0999) HUIP record with
 Condition Code 'B4' is in history and posted utilization
 days. An HUIP one day stay record for the same IPPS Provider
 is received with an Admit Date equal to the history record.

 Response
 The Admit date is not counted in utilization again.

 Event 2.3
 An IPPS (Provider Range 0001-0999) HUIP record for a one-day
 stay is in history and the one day was not utilized since
 the day was already counted due to same IPPS Provider with
 Condition Code 'B4'. An HUIP record for the same IPPS
 Provider with Condition Code 'B4' and the Admit Date equal
 to the history one day stay is posted. An adjustment to
 non-cover or cancel the record with Condition Code 'B4'
 is received.

 Response
 The same day Admit Date is not backed out from the benefit
 period, however, the days should be backed out.

 Event 2.4
 An IPPS (Provider Range 0001-0999) HUIP record with Condition
 Code 'B4' is in history and an additional HUIP one day stay
 record for the same IPPS Provider is posted with an Admit
 Date equal to the history record. An adjustment to non-cover
 or cancel the record with Condition Code 'B4' is received.

 Response
 The one day is not backed out from the benefit period.

 The Entity List includes only NEW acronyms and terminology
 that is currently not in use in CWF.

 Entity List: N/A

 Areas Affected by the Problem.
   1. Utilization HUIPCUT
   2. Part A inpatient/SNF

 Solution Criteria: N/A
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 44
______________________________________________________________________________


   EDITS AFFECTED:

 a. Error Code:      5601   ( )New (X)Modified ( )Deleted
 Disposition: UR

 Type of Record: Hospital, SNF

 Error Message:
 Services on the claim overlap covered services on a previously
 accepted claim.

 Set Condition for edit '5601':

 Hospital
 When the claim stay From Date is less than the history stay
 From Date, and the claim stay Thru Date is greater than the
 history stay From Date, set the '5601' error code.

 When the claim stay From Date is greater than the history stay
 From Date, and the claim stay From Date is less than the
 history stay Thru Date, set the '5601' error code.

 When the claim Admission Date is equal to the claim stay Thru
 Date, and the claim utilization days are greater than zero,
 and the history stay From Date is equal to the claim stay Thru
 Date, and the history stay Thru Date is greater than the
 history stay From Date, and the claim patient status is not
 equal to '7', set the '5601' error code.

 When the history Admission Date is equal to the history stay
 Thru Date, and the history full days plus the history co-
 insurance days plus the history lifetime reserve days are
 greater than zero, and the history stay Thru Date is equal to
 the claim stay From Date, and the claim stay Thru Date is
 greater than the claim stay From Date, and the history patient
 status is not equal to '7', set the '5601' error code.

 When the claim patient status is equal to '30' and the history
 Admission Date is not equal to the claim Admission Date or the
 history Provider Number is not equal to the claim Provider
 Number, and the history stay From Date is greater than the
 claim stay Thru Date, and the elapsed days from '66001' to the
 history stay From Date minus the total days from '66001' to
 the history stay Thru Date is equal to '1', set the '5601'
 error code.
______________________________________________________________________________
2020 Company, LLC                                           Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 45
______________________________________________________________________________


 When the history patient status is equal to '30' and the
 history Admission Date is equal to the claim Admission Date,
 and the claim stay From Date is equal to the history stay Thru
 Date, set the '5601' error code.

 When the claim Provider Number is equal to the history
 Provider Number, and the claim patient status is equal to '30'
 and the claim Admission Date is equal to the history Admission
 Date and the claim stay From Date is equal to the history stay
 Thru Date, set the '5601' error code.

 When the history Provider Number is equal to the claim
 Provider Number and the history patient status is equal to
 '30' and the history Admission Date is equal to the claim
 Admission Date, and the history stay From Date is equal to the
 claim stay Thru Date, set the '5601' error code.

 When the patient status on the claim is equal to '30', and the
 claim stay Thru Date is equal to the history Admission Date,
 set the '5601' error code.

 When the history patient status is equal to '30', and the
 history stay Thru Date is equal to the claim Admission Date,
 set the '5601' error code.

 When Condition Code '69' is present, and an IME/GME claim
 already exists on history with a stay From Date that is less
 than the history From Date, and a stay Thru Date that is greater
 than the history stay From Date, set the '5601' error code.

 When Condition Code '69' is present, and an IME/GME claim
 already exists on history with a stay From Date that is less
 than the history From Date, and a stay Thru Date is greater
 than the history stay From Date, set the '5601' error code.

 When Condition Code '69' is present and an IME/GME claim
 already exists on history with a stay From Date that is less
 than the history stay Thru Date, and a stay Thru Date that is
 greater than the history stay Thru Date, set the '5601' error
 code.

 When the claim From Date is not equal to the history From
 Date, or the claim Thru Date is equal to the history Thru
 Date, and the claim Admission Date is equal to the history
 Admission Date, set the '5601' error code.
______________________________________________________________________________
2020 Company, LLC                                           Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 46
______________________________________________________________________________


When claim patient status is not equal to '7', or the claim
patient status equals '7' but the claim stay From Date is
not equal to the claim stay Thru Date,

AND

When history patient status is not equal to '7', or the
history patient status equals '7' but the history stay From
Date is not equal to the history stay Thru Date, set the
'5601' error code.

AND

When CA-SPAN   is less than the claim utilization days plus the
history full   days plus the history co-insurance days plus the
history life   time reserve days, and the history No-Pay Code is
not equal to   'B', 'C', 'E', or 'N', set the '5601' error code.

When the Utilization Days on the claim are equal to zero,
bypass this edit.

When the claim stay Thru Date is less than the spell Date of
Earliest Billing Activity (DOEBA), or the claim Stay From Date
is greater than the spell Date of Latest Billing Activity
(DOLBA), bypass this edit.

When the claim stay Thru Date is greater than the claim stay
From Date, and the bill Discharge Date is equal to the spell
DOEBA, bypass this edit.

When the spell the claim links to shows full benefits
remaining for hospital full days, hospital co-insurance days,
Skilled Nursing Facility (SNF) full days, SNF co-insurance
days, and Inpatient deductible as indicated on the rule table,
bypass this edit.

When there are no spells on history, and there is no Inpatient
summary history present, bypass this edit.

 When the claim stay From Date is greater than the history stay
 Thru Date, and the claim Admission Date is greater than, or
 equal to, the history Admission Date, and the claim Admission
 Date is greater than, or equal to, the history stay Thru Date,
 and the history patient status is not equal to '30', bypass
 this edit.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 47
______________________________________________________________________________


 When the claim stay Thru Date is less than the   history   stay
 From Date, and the claim Admission Date is not   greater   than
 the history Admission Date, and the claim Thru   Date is   less
 than the history Admission Date, and the claim   patient   status
 is not equal to '30', bypass this edit.

 When the first two characters of the claim bill type are equal
 to '18', '21', or '28', and the claim No-Pay Code is 'C' or
 'N', and there is an Occurrence Span Code '22', bypass this
 edit.

 When the first two positions of the claim bill type are '11',
 '21', or '41', and the claim Provider Number is not equal to
 the history Provider Number and the claim Non-Covered days is
 greater than zero, and a Occurrence Span Code '74' is on the
 claim, bypass this edit.

 When the claim patient status is '30' and the claim span Thru
 Date is equal to the claim Thru Date and the history Admission
 Date is greater than, or equal to, the claim span From Date
 and the history Admission Date is less than, or equal to, the
 claim span Thru Date, bypass this edit.

 When the claim span From Date is less than, or equal to, the
 history Admission Date, and the Inpatient Span Code '74' Thru
 Date plus '1' greater than, or equal to, the history stay Thru
 Date, bypass this edit.

 When the claim span From Date is less than, or equal to, the
 history Admission Date, and the Inpatient Span Code '74' Thru
 Date plus '1' greater than, or equal to, the history stay
 From Date, bypass this edit.

 When the History Transaction Code Indicator is equal to '1',
 '2', '3', or '4', and the claim Provider Number is not
 equal to the history Provider Number, and history Non-Covered
 days are greater than zero, and a Occurrence Span Code '74' is
 on history claim, bypass this edit.

 When the history patient status is '30' and the history span
 Thru Date is equal to the history Thru Date and the claim
 Admission Date is greater than, or equal to, the history span
 From Date and the claim Admission Date is less than, or equal
 to, the history span Thru Date, bypass this edit.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 48
______________________________________________________________________________

 When the history span From Date is less than, or equal to, the
 claim Admission Date, and the history span Thru Date plus '1'
 is greater than, or equal to, the claim stay Thru Date, bypass
 this edit.

 When Condition Code 'B4' is present with overlapping admit date,
 bypass this edit.

 Hospice
 When the DUPE-9SW is not equal to 'D', but is equal to zero,
 set the '5601' error code.

 When the Beneficiary Hospice summary history indicator is not
 equal to '1', and the bill type on the Outpatient claim is not
 equal to '815' or '825', bypass this edit.

 If DONE is not true, bypass this edit.

 When the DUPE-SW is equal to 'N', bypass this edit.

 Trailer Information: 08

   INSTALLATION INSTRUCTIONS:   None

   SYSTEMS DOCUMENTATION AFFECTED:

     EDITUTIL              MODIFY UR EDIT '5601' TO NOT SET IF
                           CONDITION CODE 'B4' IS PRESENT WITH
                           OVERLAPPING ADMIT OR DISCHARGE DATE.

   SATELLITE SYSTEM MODIFICATIONS:     None




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 49
______________________________________________________________________________

   2.   00025321   5613 REJECT CWF ISSUE

   REQUESTOR ID: TRANSO1000

   IMPACT:
 (X) Host
 ( ) Satellite Part A Inpatient
 (X) Satellite Part A Outpatient
 ( ) Satellite Part B
 ( ) Hospice
 ( ) Home Health
 ( ) DMERC

   REASON FOR CHANGE:
 CWF is currently setting utilization edit '5613' incorrectly when
 multiple medical visits are billed with the same Date of Service,
 the same Revenue Code center, and Condition Code 'G0' is present.
 The services are submitted on separate claims.

 '5613':   Duplicate Claim Being Processed with Different ICN.

   NEW BUSINESS REQUIREMENTS:

 Requirement 1
 CWF should not set utilization edit '5613' when an Outpatient claim
 is submitted with Condition Code 'G0' and posted to history is an
 Outpatient claim with the same Revenue Code center and the same Date
 of Service. Utilization edit '5613' should also be bypassed when the
 claim posted to history is an Outpatient claim with the same Revenue
 Code center and the same date of service as the incoming Outpatient
 claim and contains Condition Code 'G0'.

   EVENT-RESPONSE LIST:

 Event 1.1
 Submit an Outpatient claim with Condition Code 'G0' and the
 same Revenue Code center and Date of Service as a posted
 Outpatient claim.

 Response
 Utilization edit '5613' is not set.

 Event 1.2
 Submit an Outpatient claim with the same Revenue Code center and
 Date of Service as a posted Outpatient claim. The incoming claim
 does not contain Condition Code 'G0'.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 50
______________________________________________________________________________


 Response
 The Outpatient claim is rejected.      Utilization edit '5613' is set.

 Event 1.3
 Submit an Outpatient claim that has the same Revenue Code center
 and Date of Service as a posted Outpatient claim. The outpatient
 claim posted to history has a 'G0' Condition Code.

 Response
 Utilization edit '5613' is not set.

 The Entity List includes only NEW acronyms and terminology
 that is currently not in use in CWF.

 Entity List: N/A

 Areas Affected by the Problem.
   1. Part A Utilization

 Solution Criteria: N/A

   EDITS AFFECTED:

 a. Error Code: 5613        ( )New (X)Modified ( )Deleted
 Disposition: UR

 Type of Record:     OUTP

 Error Message:
 Duplicate Claim Being Processed with Different ICN.

 Set Condition for edit '5613':
 This edit will only set due to a 5% sample, which at
 this time applies only to the GL and PA Host sites.

 When the first two positions of the incoming claim bill type
 are equal to the first two positions of the Master/Delta
 History bill type, and the incoming claim From Date is equal
 to the Master/Delta History From Date, and the incoming claim
 Thru Date is equal to the Master/Delta History Thru Date, and
 the number of line items on the incoming claim matches the
 number of line items on the Master/Delta History claim, and
 the following is also true:


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 51
______________________________________________________________________________

The incoming claim and Master/Delta history Intermediary HIC
Numbers are equal, and the incoming claim and Master/Delta
history Provider HIC Numbers are equal, and the incoming claim
and Master/Delta history total charges are equal, and the
incoming claim and Master/Delta History Revenue Codes are
equal, and the incoming claim and Master/Delta history HCPCS
codes are equal, and the incoming claim and Master/Delta
History financial units are equal, and the incoming claim and
Master/Delta History financial charges are equal, and the
incoming claim and Master/Delta History HCPCS Modifier are
equal, and the incoming claim and Master Delta History Zip
code, (derived from the associated Value Amount for Value Code
'AO') are equal, and DUP-DELT-4 is equal to '3', set the '5613'
error code.

If the Span Code '72' From Date in history is not equal to the
claim From Date, or if the Span Code '82' Thru Date in history
is not equal to the claim Thru Date, bypass this edit.

When an Outpatient claim is submitted with Condition Code 'G0'
and the posted Outpatient history claim with the same Revenue
Code center and the same Date of Service, bypass this edit.

Trailer Information:   06, 08

  INSTALLATION INSTRUCTIONS:    None

  SYSTEMS DOCUMENTATION AFFECTED:

    EDITUTIL              ADD 'G0' TO BYPASS CRITERIA FOR EDIT
                          '5613'.

  SATELLITE SYSTEM MODIFICATIONS:      None




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 52
______________________________________________________________________________

   3.   00025654   5783-NEW INPATIENT SPELL & ADJUSTMENT PROCESS FOR VA CLAIMS

   REQUESTOR ID: CWFM2000

   IMPACT:
 (X) Host
 (X) Satellite Part A Inpatient
 ( ) Satellite Part A Outpatient
 ( ) Satellite Part B
 ( ) Hospice
 ( ) Home Health
 ( ) DMERC

   REASON FOR CHANGE:
 The Veterans Administration (VA) desires to fully implement
 the processing of Informational Unsolicited Responses (IUR)
 for VA claims and adjustments to Part A and B VA Medicare
 Advice (MRA) claim in the Common Working File System. The
 CRs to implement these VA functions into CWF were:

 - CR 5077 - Requirements for System Changes Needed to generate
             Unsolicited Responses to the Veterans Administration
 - CR 4370 - Allowing Adjustments for Part A and Part B Veterans
             Administration Medicare Advice (MRA) Claims.

 CSC partially implemented these two CRs (00024752 and 00024818)
 in the October 2006 release. During the analysis phase it
 was discovered that some of the CR requirements for
 both CRs would not allow CWFM to fully implement
 these changes without extensive modifications to the
 existing CWF Inpatient spell construction and adjustment
 process. Analysis indicated such development is not
 feasible using current Inpatient claim processing modules and
 rules.

 CWF will analyze the existing Inpatient system spell processing
 and adjustment routines. Modifications will be made to these
 processes to allow adjustments to Inpatient claims due to
 VA processing. This change will apply for Dates of Services
 on or after 01/01/2004 for Inpatient.

 Reason for VA Requirement:
 --------------------------
 When a Medicare Beneficiary is also eligible for Veterans
 health benefits and elects to obtain his/her health care at
 a VA facility, the VA is entitled to collect from the
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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 53
______________________________________________________________________________

 Beneficiary's supplemental insurer the deductible and
 coinsurance that would have been payable had the Beneficiary
 instead received services from a Medicare provider. However,
 differences in payment methodology between the VA and Medicare
 make it difficult for the supplemental insurers to calculate the
 Medicare-equivalent deductible and coinsurance. CMS is bound
 by its interagency agreement with the VA to adjudicate these
 claims to produce Medicare-equivalent remittance advice
 notices, which the VA attaches to secondary claims sent to
 the supplemental insurers to ease their calculation of the
 Medicare-equivalent deductible and coinsurance amounts.

 However, because the VA is entitled to collect these amounts
 only if there are no true Medicare claims for which the
 insurer should instead be paying, situations sometimes arise
 where the VA claim was submitted to the insurer and paid
 before a true Medicare claim was submitted to that insurer.
 In the spirit of the mutual support of the two Agencies
 represented in their interagency agreement, CMS has agreed
 to extend its aid to the VA by helping that Agency determine
 when they may need to refund deductible and/or coinsurance
 erroneously paid to them by Medicare supplemental insurers.

 CWF will implement changes that will update Medicare Part A
 spells due to Inpatient VA claims. The information from the
 VA claims will also contain sufficient data that will
 generate an Informational Unsolicited Response when a
 true Medicare claim is received that will impact the spell
 of the VA claims.

 As part of this CR, CWFM will do the following:

 (1) Simplify the CWF spell processing system by processing
     incoming and history claims only after the catastrophic
     (1989) period. CWF will capture all lifetime
     utilization values up to 1990 as a starting point for
     reprocessing any utilization for Beneficiaries
     with the simpler spell process.

 (2) Restructure CWF Inpatient Processing system.
     - Remove catastrophic logic to simply spell processing
       so that VA spells can be implemented. Perform
       streamlining of code.
     - Remove redundant processes and de-activated processes
       from the Inpatient modules.
     - Restructure to improve ease of maintenance of the
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2020 Company, LLC                                           Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 54
______________________________________________________________________________

        Inpatient modules and cancels, IUR processing,
        and other technical standard structuring.

(3) Create a structured spell processing system for VA processing
    that will read history and build spell periods and
    perform adjustments and unsolicited processing without
    actually canceling or adjusting claims in history.

(4) Create a consistency edit '2217' for the following reasons:
    - Inpatient claims with Dates of Service prior to 1990
      will not process in CWF. Such claims will have to be
      processed manually by the contractors.
    - Inpatient VA demo claims with Dates of Service prior
      to 2004 will not process in CWF.

(5) Create a utilization edit '5711' to not allow incoming claims
    with Dates of Service that are after the catastrophic period
    that will link back to spell of illness prior to 1990.
    Such claims will have to be processed manually by the
    contractors.

(6) Allow VA adjustment claims to be processed in CWF.

(7) Allow Informational Unsolicited Records (IUR)s to be
    generated for VA claims.

NOTE:    The catastrophic claims data and Beneficiary spell
         data will still be displayed on the HIMR Beneficiary
         master record inquiry.

GENERAL SCENARIOS
-----------------
Below are some scenarios for the VA business requirements:

 Scenario 1 for combining VA Spell of Illness:
 ----------
 Currently CWF does not combine two regular spells
 when the dates on the VA claim link to both spells
 but applies utilization from the Earliest Spell for
 processing and this should continue. However, if
 the incoming VA claim would link two VA spells the
 spell should be combined and CWF should accept the
 claim without deductible. An Informational
 Unsolicited Response will be generated on the
 over applied deductible on the already posted VA
 claim. Trailer '20' applies the same process for
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 55
______________________________________________________________________________

 regular claims, except an IUR will apply for VA
 claim and will not be auto cancelled in CWF.

 Scenario 2 for Prior Year same VA Spell of Illness:
 ----------
 When a VA claim is received and the dates are during
 the previous year, and the VA Spell of Illness on the
 Beneficiary Master Record is for the following year,
 but the Earliest and Latest Date are within 60 days of
 the incoming VA claim, CWF should accept the claim
 without deductible. An Informational Unsolicited Response
 will be generated to reduce the amount of the
 over-applied amount. Trailer '15' applies the same
 process for regular claims, except an IUR will apply
 for VA claims and will not be auto adjusted in CWF.

 Scenario 3 for No Spell of Illness within 60 days:
 ----------
 If the Beneficiary does not have a regular or VA claim
 present or not within 60 days, then the VA claim
 will process with Full Utilization and return the
 Trailer '09' from the VA claim when accepted (UR AAAA).

 Scenario 4 for Regular Spell of Illness present:
 ----------
 When the dates of the VA claim are within a regular
 spell and not during a VA spell the VA will process
 based on the regular spell. If the VA claim is
 accepted, the utilization will include the VA claim
 in the Trailer '09'.

 Scenario 5 for VA Spell of Illness Present:
 ----------
 When the dates of the VA claim are not within a regular
 spell but during posted VA claims that are within 60 days,
 CWF will process based on the on the VA spell. If the VA
 claim is accepted, the utilization will include the VA
 claim in the Trailer '09'.

 Scenario 6 for both regular and VA Spell of Illness:
 ----------
 When the dates of the VA claim are during both a
 regular and VA spell the VA will consider both
 and combine the spells to process the VA claim.
 If the VA claim is accepted, the utilization will
 include the VA claim in the Trailer '09'.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 56
______________________________________________________________________________


   NEW BUSINESS REQUIREMENTS:

 Requirement 1
 Modify consistency edit '0018' for Inpatient VA claim to
 allow Action Code '3' (Debit Adjust) and Action Code '4'
 (Cancel) when the Dates of Service are on or after
 01/01/2004. If the dates are prior to 01/01/2004, continue
 to set the edit.

 ER '0018' - Claim is submitted with Demonstration Number
             '31' and the Action is not equal to '1'.

 Requirement 2
 Modifications will be required to UR '6001' to not set on
 VA Inpatient adjustments (Action Code 3) or cancels (Action
 Code 4) since VA claims do not fall within a Spell of Illness
 on the Beneficiary Master Record.

 UR '6001' - The Cancel/Credit claim Service Dates do not fall
             within a Spell of Illness on the Beneficiary Master
             Record.

 Requirement 3
 Modifications will be required to UR '6002' to not set on
 VA Inpatient adjustments (Action Code 3) or cancels (Action
 Code 4) since VA claims do not partially overlap a Spell of
 Illness on the Beneficiary Master Record.

 UR '6002' - The Cancel/Credit claim Service Dates that partially
             overlap a Spell of Illness on the Beneficiary Master
             Record.

 Requirement 4
 Modifications will be required to UR '6004' to not set on
 VA Inpatient adjustments (Action Code 3) since there is no
 history for one or both Spells of Illness on the Beneficiary
 Master Record.

 UR '6004' - A debit claim is combining two Spells of Illness and
             there is no history for one or both Spell of Illness.

 Requirement 5
 Modifications will be required to UR '6006' to set on
 VA Inpatient (Action Code 3) or Cancels (Action Code 4)
 when a Cancel Date is present on the VA original claim
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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 57
______________________________________________________________________________

on the Full Claim History. However, due to REQ 30 if
a VA Inpatient Adjustment (Action Code 3) is submitted
and the original history VA claim had been canceled and
not an adjustment with a new record CWF will not return
UR 6006 since no record is found. The edit will always set
on a Cancel (Action Code 4).

UR '6006' - Match found on ICN, but History bill contains a
            Cancel Date.

Requirement 6
Modifications will be required to UR '6040' to not set on
Part A VA Inpatient adjustments (Action Code 3) or cancels
(Action Code 4) since VA claims do not post spell and/or
catastrophic data.

UR '6040' - Master Beneficiary Record contains incorrect
            spell and/or catastrophic data.

Requirement 7A
If the VA Inpatient adjustment (action code 3)
rejects due to over-utilization or under-utilization
(AA Disposition Code) based on the regular or VA claims,
no updates are done on the Beneficiary Master Record.

Continue to return Trailer '07', '09', and '16',
however, include both the regular and VA claims that
are within the Spell of Illness.

Modifications will be required to the following
'AA' Disposition Codes to now read both the regular
and VA claims for the incoming VA Inpatient claim.

'8001'   -   Full Days over utilized
'8002'   -   Full Days under utilized
'8003'   -   Co Days under utilized
'8004'   -   Co Days over utilized
'8006'   -   Cash Deductible over applied
'8007'   -   Cash Deductible under applied

 Modifications will be required to the following
 'AA' Disposition Codes to now read both the
 regular Blood Deductible under Combined A&B
 and the VA Blood Data on the VADE file within
 the same year on the incoming VA Inpatient
 claim with Value Code '37', '38' or '39'.
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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 58
______________________________________________________________________________


 '8008' - Blood Deductible over applied
 '8009' - Blood Deductible under applied

 Modifications will be required to the following
 'AA' Disposition Code to now read both the
 regular LRSV and VADE file for the incoming VA
 Inpatient claim.

 '8005' - LTR Days over utilized

 NOTE: This requirement has been implemented for
       VA Incoming Original claims (Action code 1).

 NOTE: The processing for Inpatient VA will only apply
       to dates 01/01/2004 and after.

 Requirement 7B
 CWF will process the incoming VA claims reading the claim
 history file and include the utilization from both regular
 and VA claims and combine the Spell of Illness if the dates
 on the VA claim are within 60 days. If the VA claim is
 accepted (UR AAAA), the regular spell on the Beneficiary
 Master Record should not be updated.

 CWF will apply the over utilized and under utilized
 edits by reading the regular and VA claims to determine
 utilization.

 Include utilization from the combined claims within
 60 days in the Trailer '09'. In cases where negative
 utilization values are created due to combined spells,
 CWF will not show reduced days but will default to the
 days in the spell.

 CWF will need to read both the From and Thru Date on the
 claim and combine the regular claims and VA claims to
 determine if within the same Spell of Illness.

 No auto adjustments or auto cancels will apply
 due to the VA claim processing.

 CWF will process the incoming VA Inpatient claim reading the
 Lifetime Reserve Days from both the regular and VA claims.
 No updates to the LTR days due to the VA claim will apply on
 the Beneficiary Master Record.
______________________________________________________________________________
2020 Company, LLC                                           Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 59
______________________________________________________________________________


CWF will read both blood deductible information
from the regular and VA claims in the same year
if the incoming VA Inpatient claim has Value Code
'37' (Blood Furnished) or '38' (Blood Replaced)
or '39' (Blood Deductible) present. Blood
Replaced (Value Code 38) will also apply
towards the three pints of Blood Deductible.

No updates to the Blood Data from the VA claim
will apply on the Beneficiary Master Record.

CWF will not consider the VA Spell of Illness when
applying utilization to a regular Inpatient claim.

The regular spells will not be updated on the
Beneficiary Master Record from the VA claims.

NOTE: The processing for Inpatient VA will only apply
      to dates 01/01/2004 and after.

Requirement 8
If an incoming Inpatient VA claim would link to two
VA Spell of Illness, the spells should be combined and
CWF would accept the incoming claim without deductible.
The VA Inpatient claim that is already posted with
cash deductible from the second spell is now linked
to the previous spell, and the cash deductible is now
over applied. An Informational Unsolicited Response
will be generated due to the over applied deductible.
The Informational Unsolicited Response will be in the same
format as the existing Informational Unsolicited Response,
except the Unsolicited Indicator will be a 'V' and not an 'I'.
This will identify the Informational Unsolicited Response
for a VA claim. This is necessary for Trailblazer to
distinguish between a regular IUR and a VA IUR.

CWF will post a 'V' in the UNSOL IND field on the
VADE file for the Inpatient VA claim that generated
an IUR. The Trailer Mask '24' will indicate a 'V'.
Trailer '24' will also include code '8006' due to
over applied cash deductible.




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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 60
______________________________________________________________________________

The IUR will return the following Trailers:

'07' - Will indicate zero amount to apply to the cash
       deductible due to over applied amount.
'24' - Will identify the VA claim returning the IUR.

The same process will apply if the incoming VA claim
links a VA and also a regular Spell of Illness. Since the
posted VA claim now has over applied cash deductible
due to the cash deductible being applied on the regular
claim.

The VA claim returning the IUR will not correct the over
applied cash deductible on the VADE file.

Once the UNSOL IND is posted with a 'V', another IUR is
not generated due to VA processing.

NOTE: This IUR is generated due to incoming VA claim.

NOTE: The processing for Inpatient VA will only apply
      to dates 01/01/2004 and after.

Requirement 9
If an incoming Inpatient VA claim had dates that
are during the previous year of a posted VA Spell of
Illness that is within 60 days of the Earliest date it
should be accepted without deductible and included in
the spell for the following year. The VA Inpatient claim
that is already posted with incorrect rate is now
over applied. An Informational Unsolicited Response
will be generated due to the over applied amount.
The Informational Unsolicited Response will be in the same
format as the existing Informational Unsolicited Response,
except the Unsolicited Indicator will be a 'V' and not an 'I'.
This will identify the Informational Unsolicited Response
for a VA claim. This is necessary for Trailblazer to
distinguish between a regular IUR and a VA IUR.
CWF will post a 'V' in the UNSOL IND field on the
VADE file for the Inpatient VA claim that generated
an IUR. The Trailer Mask '24' will indicate a 'V'.
Trailer '24' will also include code '8006' due to
over applied cash deductible.



______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 61
______________________________________________________________________________

The IUR will return the following Trailers:

'07' - Will indicate reduce amount to apply to the cash
       deductible due to over applied amount.
'24' - Will identify the VA claim returning the IUR.

The VA claim returning the IUR will not correct the rate
due to over applied cash deductible on the VADE file.
Once the UNSOL IND is posted with a 'V', another IUR is not
generated due to VA processing.

NOTE: In the above situation where the incoming claim
      is a regular Inpatient claim for the previous year,
      the Cash Deductible on the VA claim would not
      return a reduce amount in Trailer '07', but follow
      the IUR due to Requirement 9 for over applied
      Cash Deductible.

NOTE: This IUR is generated due to incoming VA claim.

NOTE: The processing for Inpatient VA will only apply
      to dates 01/01/2004 and after.

Requirement 10
If an incoming regular Inpatient claim is received
with Cash Deductible and has dates that are within
60 days of a VA Inpatient claim's dates that
processed with cash deductible, CWF will generate
an Informational Unsolicited Response due to the
over applied cash deductible.
The Informational Unsolicited Response will be in the same
format as the existing Informational Unsolicited Response,
except the Unsolicited Indicator will be a 'V' and not an 'I'.
This will identify the Informational Unsolicited Response
for a VA claim. This is necessary for Trailblazer to
distinguish between a regular IUR and a VA IUR.
CWF will post a 'V' in the UNSOL IND field on the
VADE file for the Inpatient VA claim that generated
an IUR. The Trailer Mask '24' will indicate a 'V'.
Trailer '24' will also include code '8006' due to
over applied cash deductible.

The IUR will return the following Trailers:

 '07' - Will indicate the amount of cash deductible and number
        of Full, CO, and LTR days submitted and what to apply.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 62
______________________________________________________________________________

 '24' - Will identify the VA claim returning the IUR.

 The VA claim returning the IUR will not correct the over
 applied cash deductible on the VADE file.
 Once the UNSOL IND is posted with a 'V', another IUR is not
 generated due to VA processing.

 NOTE: The processing for Inpatient VA will only apply
       to dates 01/01/2004 and after.

 Requirement 11
 If an incoming regular Inpatient claim is received
 in CWF and has dates that are within 60 days of a
 VA Inpatient claim's dates and would cause the
 VA claim to over utilize the 60 Full Days, CWF will
 generate an Informational Unsolicited Response due
 to the over utilized Full days.
 The Informational Unsolicited Response will be in the same
 format as the existing Informational Unsolicited Response,
 except the Unsolicited Indicator will be a 'V' and not an 'I'.
 This will identify the Informational Unsolicited Response
 for a VA claim. This is necessary for Trailblazer to
 distinguish between a regular IUR and a VA IUR.
 CWF will post a 'V' in the UNSOL IND field on the
 VADE file for the Inpatient VA claim that generated
 an IUR. The Trailer Mask '24' will indicate a 'V'.
 Trailer '24' will also include code '8001' due to
 over utilized full days.

 The IUR will return the following Trailers:

 '07' - Will indicate the amount of cash deductible and number
        of Full, CO, and LTR days submitted and what to apply.
 '24' - Will identify the VA claim returning the IUR.

 Once the UNSOL IND is posted with a 'V', another IUR is not
 generated due to VA processing.

 NOTE: The processing for Inpatient VA will only apply
       to dates 01/01/2004 and after.

 Requirement 12
 If an incoming regular Inpatient claim is received
 in CWF and has dates that are within 60 days of a
 VA Inpatient claim's dates and would cause the
 VA claim to over utilize the 30 CO Days, CWF will
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 63
______________________________________________________________________________

 generate an Informational Unsolicited Response due
 to the over utilized CO days.
 The Informational Unsolicited Response will be in the same
 format as the existing Informational Unsolicited Response,
 except the Unsolicited Indicator will be a 'V' and not an 'I'.
 This will identify the Informational Unsolicited Response
 for a VA claim. This is necessary for Trailblazer to
 distinguish between a regular IUR and a VA IUR.
 CWF will post a 'V' in the UNSOL IND field on the
 VADE file for the Inpatient VA claim that generated
 an IUR. The Trailer Mask '24' will indicate a 'V'.
 Trailer '24' will also include code '8004' due to
 over utilized CO days.

 The IUR will return the following Trailers:

 '07' - Will indicate the amount of cash deductible and number
        of Full, CO, and LTR days submitted and what to apply.
 '24' - Will identify the VA claim returning the IUR.

 Once the UNSOL IND is posted with a 'V', another IUR is not
 generated due to VA processing.

 NOTE: The processing for Inpatient VA will only apply
       to dates 01/01/2004 and after.

 Requirement 13
 If an incoming regular Inpatient claim is received
 in CWF that would have caused the VA claim to
 over utilize the 60 LTR days, CWF will generate an
 Informational Unsolicited Response due to the over
 utilized LTR days.
 The Informational Unsolicited Response will be in the same
 format as the existing Informational Unsolicited Response,
 except the Unsolicited Indicator will be a 'V' and not an 'I'.
 This will identify the Informational Unsolicited Response
 for a VA claim. This is necessary for Trailblazer to
 distinguish between a regular IUR and a VA IUR.
 CWF will post a 'V' in the UNSOL IND field on the
 VADE file for the Inpatient VA claim that generated
 an IUR. The Trailer Mask '24' will indicate a 'V'.
 Trailer '24' will also include code '8005' due to
 over utilized LTR days.

 The IUR will return the following Trailers:

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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 64
______________________________________________________________________________

 '07' - Will indicate the amount of cash deductible and number
        of Full, CO, and LTR days submitted and what to apply.
 '24' - Will identify the VA claim returning the IUR.

 Once the UNSOL IND is posted with a 'V', another IUR is not
 generated due to VA processing.

 NOTE: The processing for Inpatient VA will only apply
       to dates 01/01/2004 and after.

 Requirement 14
 If an incoming regular Inpatient claim is received
 with Blood Deductible (Value Code 38 or 39) in CWF
 that has dates that are within the same year of a
 VA claim with Blood Deductible, CWF will generate an
 Informational Unsolicited Response due to the over
 applied Blood Deductible.
 The Informational Unsolicited Response will be in the same
 format as the existing Informational Unsolicited Response,
 except the Unsolicited Indicator will be a 'V' and not an 'I'.
 This will identify the Informational Unsolicited Response
 for a VA claim. This is necessary for Trailblazer to
 distinguish between a regular IUR and a VA IUR.
 CWF will post a 'V' in the UNSOL IND field on the
 VADE file for the Inpatient VA claim that generated
 an IUR. The Trailer Mask '24' will indicate a 'V'.
 Trailer '24' will also include code '8008' due to
 over applied Blood Deductible.

 The IUR will return the following Trailers:

 '07' - Will indicate the amount of cash deductible and number
        of Full, CO, and LTR days submitted and what to apply.
 '16' - Will identify the Blood Deductible remaining for the
        year.
 '24' - Will identify the VA claim returning the IUR.

 Once the UNSOL IND is posted with a 'V', another IUR is not
 generated due to VA processing.

 NOTE: The processing for Inpatient VA will only apply
       to dates 01/01/2004 and after.




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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 65
______________________________________________________________________________

Requirement 15
Create a new consistency edit '2217' to not allow -
- Inpatient (TOB 11x or 41x) or SNF (TOB 21x or 18x) or
  Christian Science (TOB 51x) HUIP record with Dates
  of Service prior to 1990.
  CWF will no longer apply Catastrophic logic in CWF.
- Inpatient VA claims (demo 31) with Dates of Service
  prior to 01/01/2004.
This edit will apply to all HUIP records and Action
Codes. No bypass condition should apply.

NOTE: Due to PLOG 26061 CWF will replace the new
      consistency edit '2217' to not set but instead
      apply the above logic to the existing edit
      '2206'. CWF will make the system documentation
      updates in the October release for edit 2206.
      The new edit will be utilized at a later date.

Requirement 16
Create a new utilization edit '5711' to not allow an
Inpatient (TOB 11x or 41x) or SNF (TOB 21x or 18x)
or Christian Science (TOB 51x) HUIP record where
the Dates of Service will link back to a spell of
illness prior to 1990.
CWF will no longer apply logic that will impact Catastrophic
in CWF.
This edit will apply to all HUIP records and Action
Codes. No bypass condition should apply.

NOTE: Due to PLOG 26061 CWF will replace the new
      utilization edit '5711' to not set but instead
      apply the above logic to the existing edit
      '5700'. CWF will make the system documentation
      updates in the October release for edit 5711.
      The new edit will be utilized at a later date.

Requirement 17
Modify the Beneficiary master layout to include four
data elements required to compute the new Inpatient
and VA spell processing excluding catastrophic claims.
These data elements will be internal to the CWF
system and will not require display on HIMR.




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 66
______________________________________________________________________________

 NOTE:
 To simplify the CWF spell processing system, only
 incoming and history claims only after the catastrophic
 (1989) period will be processed by CWF. CWF will capture
 (via Requirement 18) all lifetime utilization values for
 a Beneficiary up to 1990. This will be the starting point for
 reprocessing any utilization for claims processed after
 the catastrophic period.

 (1) PRE90-CUTOFF-DATE - The pre-1990 cutoff
 date will be 01/01/1990 for Beneficiaries with no
 claims before 1990 or no claims linking to spells after
 1990; otherwise, it will be 60 days after the last spell
 linking back before 1990.

 (2) PRE90-LIFE-RSV-USED - The Pre-1990 Lifetime
 reserve days used is the starting value for Benes
 accreted before 1990 with spells prior to 1990 or
 any post 1990 spells linking back before 1990.
 This field will retain Lifetime reserve days used
 for claims with DOS from 1965 thru end of catastrophic
 period.

 (3) PRE90-LIFE-PSY-USED - The Pre-1990 Psychiatric
 days used is the starting value for Benes
 accreted before 1990 with spells prior to 1990 or
 any post 1990 spells linking back before 1990.
 This field will retain Psychiatric days used
 for claims with DOS from 1965 thru end of catastrophic
 period.

 (4) PRE90-PREENT-PSY-DAYS - The pre-1990
 pre-entitlement psych days are the days before the
 Beneficiary entitlement date based on claim dates before
 1990 or linking back before 1990. This field will be
 used in the computation of the Bene's psychiatric days.

 Initialize the data elements in the HBMP process
 for incoming Beneficiary accretion and overlay
 transactions (HIIDs and the HIAB test transaction).

 Note: The Beneficiary Master record will continue
 to hold the catastrophic spell data to be in sync
 with catastrophic claims history records.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 67
______________________________________________________________________________

COPYBOOK CIOCBENE

==>C25654   10   :XXXX:-PRE90-DATA.
==>C25654        15 :XXXX:-PRE90-CUTOFF-DATE
                       PIC S9(07)      COMP-3       VALUE   ZERO.
==>C25654        15 :XXXX:-PRE90-life-RSV-USED
                       PIC S9(03)      COMP-3       VALUE   ZERO.
==>C25654        15 :XXXX:-PRE90-life-PSY-USED
                       PIC S9(03)      COMP-3       VALUE   ZERO.
==>C25654        15 :XXXX:-PRE90-PREENT-PSY-DAYS
                       PIC S9(03)      COMP-3       VALUE   ZERO.
==>C25654        15 FILLER
                       PIC X(05)           VALUE SPACE.

Requirement 18
Create a one-timer utility UTLJCATX that will compute the
initial values for the new Pre90 data elements
required for the revised spell processing. The one-timer
will read all the claims in history for a Beneficiary
and determine the PRE90-CUTOFF-DATE, PRE90-LIFE-RSV-USED,
PRE90-LIFE-PSY-USED, and PRE90-PREENT-PSY-DAYS.
These Pre90 data elements will be utilized to determine
the starting point for CWF Inpatient and VA spell calculation.

The PRE90-CUTOFF-DATE will be determined as follows:

(1) The date will be set to 01/01/1990 if there are no
    regular or Catastrophic Spells and no Claims History
    qualifying for Spell processing starting before 1990.

(2) If there are regular or Catastrophic Spells or Claims on
    History starting before 1990, the PRE90-CUTOFF-DATE
    will still be 01/01/1990 if the last DOLBA for these
    Spells is more than 60 days before 01/01/1990.

(3) If there is a DOLBA for a regular or Catastrophic Spell
    that is within 60 days of any post catastrophic
    spell, then the PRE90-CUTOFF-DATE will be the date
    60 days from that DOLBA.

The PRE90-LIFE-RSV-USED will be computed based on the
claims in history prior to the PRE90-CUTOFF-DATE.

 The PRE90-LIFE-PSY-USED and PRE90-PREENT-PSY-DAYS-USED
 will be computed based on the claims in history prior
 to the PRE90-CUTOFF-DATE.
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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 68
______________________________________________________________________________


 The one-timer can be executed in prod, test and audit
 mode. The parameters will be as follows:

      PARM='0,PROD'    WRITE BENE MASTER OUTPUT;
                       ONLY REPORT BENES WITH CUTOFF DATES
                       AFTER 1990 OR NEGATIVE PRE-1990 VALUES.

      PARM='0,TEST'    WRITE BENE MASTER OUTPUT;
                       REPORT ALL NON-DEFAULT PRE-1990 VALUES.

      PARM='0,AUDIT'   SUPPRESS BENE MASTER OUTPUT;
                       ONLY REPORT BENES WITH CUTOFF DATES
                       AFTER 1990 OR NEGATIVE PRE-1990 VALUES.

 Requirement 19
 Create new VA Inpatient Spell processing module
 HUIPVSPL to recompute spells of illness from claims
 in history. These spells of illness will be maintained
 internally within CWF during VA claims processing.

 Spell processing will read claims history where Dates
 of Service are after PRE90-CUTOFF-DATE established
 on the Beneficiary master. The computation
 of lifetime and psychiatric days will start with the
 days used on the pre-1990 lifetime and psychiatric
 data elements. Each regenerated spell will add to
 pre-1990 days used to compute the latest days
 remaining for the Beneficiary's lifetime and
 psychiatric days.

 The new module will also process edits and spell
 posting logic within CWF and will be utilized
 for adjustments and Unsolicited processing for
 VA claims. The new module will only flag records
 in history without actually deleting them when
 claims are determined to be auto-adjusted or
 auto-cancelled in order to send an unsolicited
 response back to VA.

 Requirement 20
 Revise the regular Inpatient spell processing
 modules to include history claims with DOS after the
 catastrophic period. The regular Inpatient Spell
 processing logic will be modified to re-compute
 spells of illness from claims in history starting
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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 69
______________________________________________________________________________

 with PRE90-CUTOFF-DATE established by the
 one-timer UTLJCATX utility. These spells of illness
 will be maintained internally within CWF during
 regular claims processing.

 Spell processing will read claims history where
 Dates of Service are after the PRE90-CUTOFF-DATE
 established on the Beneficiary master. The computation of
 lifetime and psychiatric days will start with the days used
 on the pre-1990 lifetime and psychiatric data elements.
 Each regenerated spell will add to pre-1990 days
 used to compute the latest days remaining for the
 Beneficiary's lifetime and psychiatric days.

 Requirement 21
 Modify the HICR transaction 'HCPA' to allow
 corrections to be made to the new Pre90 data
 elements. CWF will no longer obtain days prior
 to 1990 in the spell of illness process.

 The Pre90 fields can be corrected if needed after
 the execution of the one-timer UTLJCATX in production.
 The one-timer will populate data in the new
 fields. The data in these field will apply to
 Dates of Service prior to 1990.

 PRE90-LIFETIME DAYS
 When Beneficiary is entitled prior to the
 01/01/1990 then allow adjustments to
 the PRE90-LIFETIME DAYS Used field.
 This field will indicate the number of
 Lifetime days used and not remaining prior
 to 01/01/1990.

 PRE90-PSYC Days
 When Beneficiary is entitled prior to the
 01/01/1990 then allow adjustments to
 the PRE90-PSYC Days Used field.
 This field will indicate the number of
 psychiatric days used and not remaining prior
 to 01/01/1990.

 PRE90-PRE-ENTITLEMENT Days
 When Beneficiary is entitled prior to the
 01/01/1990 then allow adjustments to
 the PRE90-PRE-ENTITLEMENT days field.
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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 70
______________________________________________________________________________

 This field is required for computing Pre90
 PSYC days used for claims prior to 01/01/1990.

 NOTE: This field will only need to be corrected
 if the calculated one-timer data for Pre90
 pre-entitlement Psyc days is determined to be
 incorrect for the Beneficiary.

 PRE90-CUTOFF Date
 When a Beneficiary is adjusted via HICR, and
 if any of the Pre90 Days Used Field are adjusted,
 then the Pre90 Spell Cutoff Date cannot be zeros.
 This field will determine if claims have
 processed prior to 1990.
 When Beneficiary is entitled after 01/01/1990,
 then allow the PRE90-CUTOFF-DATE on HCPA to be set
 to 01/01/1990 only.

 The Cutoff Date cannot be prior to 01/01/1990 and will
 highlight the field on the HCPA screen if a prior date
 is present.

 (a) The date will be set to 01/01/1990 if there are no
     regular or Catastrophic Spells and no Claims History
     qualifying for Spell processing starting before 1990.

 (b) If there are regular or Catastrophic Spells or Claims on
     History starting before 1990, the PRE90-CUTOFF-DATE
     will still be 01/01/1990 if the last DOLBA for these
     Spells is more than 60 days before 01/01/1990.

 (c) If there is a DOLBA for a regular or Catastrophic Spell
     that is within 60 days of any post catastrophic
     spell, then the PRE90-CUTOFF-DATE will be the date
     60 days from that DOLBA.

 NOTE: Claims that process after the HICR updates will
       compute the correct utilization for the Beneficiary.

 SCREEN HCPA CHANGES
 HICR / HICRC00        CWF BENEFICIARY CORRECTION FACILITY     99/99/9999
                                 PART A SPELL DATA

  BENE NR: 999999999X   NAME: XXXX      INIT: X   DOB: MMDDCCYY SEX: M
  XREF CLAIM NR:             TYPE OF ACTION:     0=ADD 1=DEL 2=OVERLAY
  LIFETIME: RESERVE DAYS:    60    PSYCHIATRIC DAYS: 190
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2020 Company, LLC                                           Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 71
______________________________________________________________________________

 ==> PRE90 LIFETIME DAYS USED: 00 PRE90 PSYC DAYS USED: 000
 ==> PRE90 PRE-ENTITL DAYS:    000 PRE90 CLAIM CUTOFF DATE: MM/DD/CCYY

  SPELL 1: DAYS: FULL: 00 CO: 00 SNF: FULL: 00 CO: 00 INP DED: 000000
    BLOOD DED: 00 DOEBA: 000000 DOLBA: 000000 IND: DATA: 00 AS-IS 00

  SPELL 2: DAYS: FULL: 00 CO: 00 SNF: FULL: 00 CO: 00 INP DED: 000000
    BLOOD DED: 00 DOEBA: 000000 DOLBA: 000000 IND: DATA: 00 AS-IS 00

  SPELL 3: DAYS: FULL: 00 CO: 00 SNF: FULL: 00 CO: 00 INP DED: 000000
    BLOOD DED: 00 DOEBA: 000000 DOLBA: 000000 IND: DATA: 00 AS-IS 00

  SPELL 4: DAYS: FULL: 00 CO: 00 SNF: FULL: 00 CO: 00 INP DED: 000000
    BLOOD DED: 00 DOEBA: 000000 DOLBA: 000000 IND: DATA: 00 AS-IS 00

  SPELL 5: DAYS: FULL: 00 CO: 00 SNF: FULL: 00 CO: 00 INP DED: 000000
    BLOOD DED: 00 DOEBA: 000000 DOLBA: 000000 IND: DATA: 00 AS-IS 00

 Modify the HICR Audit Report to display the new fields from
 the HCPA:
 PRE90 LIFETIME DAYS USED: 00 PRE90 PSYC DAYS USED: 000
 PRE90 PRE-ENTITL DAYS:    000 PRE90 CLAIM CUTOFF DATE: MM/DD/CCYY

 Requirement 22
 Modify the XREF processing to merge the
 Beneficiary Pre90 fields as follows:

 (1) When Active Beneficiary has no history claims
 prior to 1990, but the Inactive Beneficiary has
 history claims prior to 1990, then move the inactive
 Beneficiary PRE90-CUTOFF-DATE,
 PRE90-LIFE-RSV-USED, PRE90-LIFE-PSY-USED
 And PRE90-PREENT-PSY-DAYS to the active
 Beneficiary master record.

 (2) When Active Beneficiary has history claims
 prior to 1990, but the Inactive Beneficiary has no
 history claims prior to 1990, then do not overlay
 Beneficiary PRE90-CUTOFF-DATE,
 PRE90-LIFE-RSV-USED, PRE90-LIFE-PSY-USED
 And PRE90-PREENT-PSY-DAYS on the active
 Beneficiary master record.

 (3) When both the Active and Inactive Beneficiaries
 have history claims prior to 1990, then compute the
 PRE90-CUTOFF-DATE, PRE90-LIFE-RSV-USED,
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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 72
______________________________________________________________________________

PRE90-LIFE-PSY-USED, and PRE90-PREENT-PSY-DAYS
after merging the claims for the active Beneficiary.

Requirement 23
Modify CWF Inpatient system to remove
catastrophic code and processing. CWF will process
Claims that will affect only spells of illness that have
no attachment to any catastrophic periods.
CWF will not process the following claims:

Spell-Catastrophic - Claims that will affect Spells
starting before 1989 and the catastrophic period.

Catastrophic only - Claims that will affect the
catastrophic period only - 1989.

Catastrophic-Spell - Claims that will affect the
catastrophic period and a spell that starts after 1989.

Spell-Catastrophic-Spell - Claims that will
affect both a spell starting before 1989 and
ending after 1989 along with the catastrophic
period.

Pre-and-Post-Catastrophic - Claims that start
before 1989 and end after 1989. These claims
will affect multiple spells starting before 1989
and ending after 1989 along with the catastrophic
period. Both dates and benefits will be affected
on such spells of illness.

Note: Requirement 15 set consistency edit and Requirement
16 set utilization edit to disable pre-1990 claims from
processing in CWF.

This activity will largely consist of removing
code for catastrophic process from COBOL
modules and restructuring the modules to
eliminate data fields, work-areas and subroutines
that are used by catastrophic processing.

 Requirement 24
 Renovate and modularize the CWF Inpatient
 modules using CWFM Module COBOL
 Coding Standards. Renovation will include
 restructuring, streamlining and improving ease
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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 73
______________________________________________________________________________

of maintenance of the modules. The functionality
of the Inpatient system should remain the same.
Modify programs based on the following criteria:

(1)   If there are three or more levels of "nested IFs"
      - analyze each occurrence to determine if a more
      efficient method can be employed.

(2)   Unused Paragraphs - analyze each occurrence and
      remove where applicable.

(3)   Inefficient internal table processing - analyze each
      occurrence to determine if a more efficient method
      can be employed.

(4)   Fields that are truncated in "MOVE" statements - analyze
      the data elements involved and determine the impact of
      the truncation. Modify the data element lengths where
      applicable.

(5)   Unused data elements - analyze the data elements involved
      to determine whether they can be deleted. Remove unused
      data elements where applicable.

(6)   Data element length mismatches - analyze the data
      elements involved to determine the impact of the length
      mismatch. Modify the data element lengths where
      applicable.

(7)   Unused copybooks - analyze the copybook usage and delete
      where applicable.

(8)   Standardize paragraph naming conventions utilizing an
      ascending numerical sequence. Move paragraphs performed
      once to in line.

(9)   Identify and remove unused variables that clutter
      Working Storage area.

(10) Remove commented and unexecuted logic.

(11) Consolidate duplicate CALLs and I/O functions.
     Remove redundant Claims history reads.

(12) Streamline the Inpatient Communication area.

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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 74
______________________________________________________________________________

Requirement 25
Ensure consistency edit '0020' applies the same logic
to Inpatient VA to require a Cancel-Only Adjustment
Code on an Action Code '4' Cancel.

ER '0020' - This Cancel Only Adjustment bill does not
            contain the Reason Code or contains a
            code other than 'C', 'D', 'H', 'P' or 'S'.

Requirement 26
Ensure consistency edit '5800' applies the same logic
to Inpatient VA with Action Code '3' (Debit Adjust)
to require Original ICN to be present.

ER '5800' - Part A claim with Action Code '3', the
            original ICN cannot be blank or null.

Requirement 27
When a VA Inpatient Adjustment (Action Code 3) is
accepted (UR AAAA) in CWF, and the original ICN is
posted on the VADE file, cancel the original claim
by posting 'Y' in the CANC-IND on the VADE file,
and post the adjustment to the VADE file.

Requirement 28
When a VA Inpatient Cancel (Action Code 4) is
accepted (UR AAAA) in CWF, and the matching ICN
is posted on the VADE file, Cancel the original
claim by posting 'Y' in the CANC-IND on the
VADE file.

Requirement 29
In a situation where the original VA Inpatient claim
is posted on the VADE file, and an adjustment is
received, CWF must back out any utilization that was
applied on the original and reapply utilization on
the adjustment.

 Requirement 30
 Since CWF has not always posted VA Part A Inpatient claims,
 the following modification will be required.
 When a VA Inpatient Adjustment (A/C 3) is received,
 and no match is found for the original ICN on the
 VADE file, and the process date is prior to 10/05/2009,
 CWF should process the record as an Initial (A/C 1)
 and not return UR '6000' (No Match on ICN). For process
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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 75
______________________________________________________________________________

 dates on or after 10/05/2009, CWF will require a match
 on ICN and will return UR '6000' on adjustments.

 Requirement 31
 When a VA Inpatient Cancel (A/C 4) is received and no
 match is found for the ICN on the VADE file, CWF should
 return UR '6000' in the response.
 Since their is no record to cancel, CWF should not
 accept the cancel transaction.

 Requirement 32
 Due to CMS CR 5788, Contractor '00400' is being moved to
 the A/B MAC Contractor '04401' with an implementation date
 of 06/16/2008. CWF will be required to make additional
 changes to the new VA Inpatient IUR process to ensure that
 any posted VA Inpatient claims with Contractor '00400'
 will generate the IUR to the new A/B MAC '04401' once
 this CR is implemented on 07/07/2008.

 NOTE: The existing logic that generates an IUR for VA on HUOP
 or HUBC due to overapplied Part B cash deductible was done
 under CMS CR 5788 for the new A/B MAC contractors.

   EVENT-RESPONSE LIST:

 Event 1.1
 Submit a VA Inpatient Adjustment (A/C 3) and the
 Dates of Service or on or after 01/01/2004.
 The VA claim will process with Contractor '00400' (04401)
 and DEMO '31'.

 Response
 The record does not set ER '0018'.

 Event 1.2
 Submit a VA Inpatient Cancel (A/C 4) and the
 Dates of Service or on or after 01/01/2004.
 The VA claim will process with Contractor '00400' (04401)
 and DEMO '31'.

 Response
 The record does not set ER '0018'.

 Event 2.1
 Submit a VA Inpatient Adjustment (A/C 3) and the
 Dates of Service do not fall within a Spell of
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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 76
______________________________________________________________________________

 Illness on the Beneficiary Master Record.

 Response
 The record does not set UR '6001'.

 Event 2.2
 Submit a VA Inpatient Cancel (A/C 4) and the
 Dates of Service do not fall within a Spell of
 Illness on the Beneficiary Master Record.

 Response
 The record does not set UR '6001'.

 Event 3.1
 Submit a VA Inpatient Adjustment (A/C 3) and the
 Dates of Service do not partially overlap a Spell
 of Illness on the Beneficiary Master Record.

 Response
 The record does not set UR '6002'.

 Event 3.2
 Submit a VA Inpatient Cancel (A/C 4) and the
 Dates of Service do not partially overlap a Spell
 of Illness on the Beneficiary Master Record.

 Response
 The record does not set UR '6002'.

 Event 4.1
 Submit a VA Inpatient Adjustment (A/C 3) and the
 Date of Service has no history for one or both
 Spells of Illness on the Beneficiary Master Record.

 Response
 The record does not set UR '6004'.

 Event 5.1
 Submit a VA Inpatient Adjustment (A/C 3) that will
 apply to an ICN that had previously been adjusted.

 Response
 The record does set UR '6006'.



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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 77
______________________________________________________________________________

Event 5.2
Submit a VA Inpatient Cancel (A/C 4) that will apply
to an ICN that had previously been adjusted or
canceled.

Response
The record does set UR '6006'.

Event 6.1
Submit a VA Inpatient adjustment (A/C 3) when no spells
are posted on the Beneficiary Master Record.

Response
The record does not set UR '6040'.

Event 6.2
Submit a VA Inpatient Cancel (A/C 4) when no spells
are posted on the Beneficiary Master Record.

Response
The record does not set UR '6040'.

Event 7.1
Submit a VA Inpatient claim (DEMO 31) with Full Days
and the Beneficiary has already used the 60 Full Days
from the regular and/or VA claim that are within 60 days.

Response
The claim returns AA '8001' (Full Days over utilized)
with the appropriate Trailer '07', '09', and '16' from
the regular and/or VA claims within the Spell of Illness.

Event 7.2
Submit a VA Inpatient claim (DEMO 31) with Full and CO
Days and the Beneficiary has not used the 60 Full Days
from the regular and/or VA claim that are within 60 days.

Response
The claim returns AA '8002' (Full Days under utilized)
with the appropriate Trailer '07', '09', and '16' from
the regular and/or VA claims within the Spell of Illness.

 Event 7.3
 Submit a VA Inpatient claim (DEMO 31) with CO and LTR
 Days and the Beneficiary has CO Days remaining from the
 regular and/or VA claim that are within 60 days.
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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 78
______________________________________________________________________________


Response
The claim returns AA '8003' (CO Days under utilized)
with the appropriate Trailer '07', '09', and '16' from
the regular and/or VA claims within the Spell of Illness.

Event 7.4
Submit a VA Inpatient claim (DEMO 31) with CO Days
and the Beneficiary does not have enough CO Days remaining
from the regular and/or VA claim that are within 60 days.

Response
The claim returns AA '8004' (CO Days over utilized)
with the appropriate Trailer '07', '09', and '16' from
the regular and/or VA claims within the Spell of Illness.

Event 7.5
Submit a VA Inpatient claim (DEMO 31) with cash deductible
and the Beneficiary has already applied the cash deductible
from the regular and/or VA claim that is within 60 days.

Response
The claim returns AA '8006' (Cash Deductible over applied)
with the appropriate Trailer '07', '09', and '16' from
the regular and/or VA claims within the Spell of Illness.

Event 7.6
Submit a VA Inpatient claim (DEMO 31) without cash deductible
and the Beneficiary has not applied the cash deductible
for the regular and/or VA claim Spell of Illness.

Response
The claim returns AA '8007' (Cash Deductible under applied)
with the appropriate Trailer '07', '09', and '16' from
the regular and/or VA claims within the Spell of Illness.

Event 7.7
Submit a VA Inpatient claim (DEMO 31) with Blood deductible
and the Beneficiary has already applied the blood deductible
from a regular and/or VA claims that are in the same year.

Response
The claim returns AA '8008' (Blood Deductible over applied)
with the appropriate Trailer '07', '09', and '16' from
the regular and/or VA claims within the same year.

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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 79
______________________________________________________________________________

Event 7.8
Submit a VA Inpatient claim (DEMO 31) without Blood deductible
and the Beneficiary has not applied the blood deductible
from the regular and/or VA claims that are in the same year.

Response
The claim returns AA '8009' (Blood Deductible under applied)
with the appropriate Trailer '07', '09', and '16' from
the regular and/or VA claims within the same year.

Event 7.9
Submit a VA Inpatient claim (DEMO 31) with LTR Days and
the Beneficiary has already applied all 60 LTR Days from
the regular or VA claims in history.

Response
The claim returns AA '8005' (LTR Days over utilized)
with the appropriate Trailer '07', '09', and '16' from
the regular and/or VA Spell of Illness and the LTR Days
remaining.

Event 7.10
Submit an Inpatient VA claim (DEMO 31) and the dates
will link two existing VA spell from the VADE file.
The VA claim is accepted (UR AAAA) in CWF.

Response
The claim is posted to the VADE file and the response
for the Trailer '09' will combine the VA claims from
the VADE file in the Spell of Illness.
The Spell on the Beneficiary Master Record is not updated.
See Event 8.1 for results of the IUR process for the
already posted VA claim that has over applied Cash
Deductible.

Event 7.11
Submit an Inpatient VA claim (DEMO 31) and the dates
will link two existing regular spells. The VA
claim is accepted (UR AAAA) in CWF.

Response
The claim is posted to the VADE file and the response
for the Trailer '09' will only include data from the
First Spell and the incoming VA claim.
This process has not changed due to this CR.

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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 80
______________________________________________________________________________

 Event 7.12
 Submit an Inpatient VA claim (DEMO 31) and the dates
 are for the prior year but links to another VA claim
 for the following year that applied Cash Deductible.
 The VA claim is accepted (UR AAAA) in CWF.

 Response
 The claim is posted to the VADE file and the response
 for the Trailer '09' will combine the VA claims from
 the VADE file in the Spell of Illness.
 The Spell on the Beneficiary Master Record is not updated.
 See Event 9.1 for results of the IUR process for the
 already posted VA claim that has over applied Cash
 Deductible.

 Event 7.13
 Submit an Inpatient VA claim (DEMO 31) and the dates
 do not link to any regular or VA claims in history.
 The VA claim is accepted (UR AAAA) in CWF.

 Response
 The claim is posted to the VADE file and the response
 for the Trailer '09' will include the VA claim in the
 Spell of Illness.
 The Spell on the Beneficiary Master Record is not updated.

 Event 7.14
 Submit an Inpatient VA claim (DEMO 31) and the dates
 are within 60 days of a regular claim. The VA claim
 is accepted (UR AAAA) in CWF.

 Response
 The claim is posted to the VADE file and the response
 for the Trailer '09' will combine both the regular
 and VA claims in the Spell of Illness.
 The Spell on the Beneficiary Master Record is not updated.

 Event 7.15
 Submit an Inpatient VA claim (DEMO 31) and the dates
 are within 60 days of a VA claim. The VA claim is
 accepted (UR AAAA) in CWF.

 Response
 The claim is posted to the VADE file and the response
 for the Trailer '09' will include the VA claims in
 the Spell of Illness.
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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 81
______________________________________________________________________________

 The Spell on the Beneficiary Master Record is not updated.

 Event 7.16
 Submit an Inpatient VA claim (DEMO 31) and the dates
 are within 60 days of a regular spell and the VA
 spell. The VA claim is accepted (UR AAAA) in CWF.

 Response
 The claim is posted to the VADE file and the response
 for the Trailer '09' will include the regular and VA
 claims for the Spell of Illness.
 The Spell on the Beneficiary Master Record is not updated.

 Event 8.1
 Submit an Inpatient VA claim (DEMO   31) and   the dates
 will link two existing VA Spell of   Illness   that has
 applied Cash Deductible in both VA   spells.   The VA
 claim is accepted (UR AAAA) in CWF   with no   Cash
 Deductible.

 Response
 An Informational Unsolicited Response (IUR) is generated
 with '8006' due to a VA claim has over applied cash
 deductible in the second spell. The VA claim returning
 the IUR will post a 'V' in the UNSOL IND but will
 not remove the over applied cash deductible in the
 VADE file. The IUR will return Trailer '07'
 and '24' with the updated information.

 Event 8.2
 Submit an Inpatient VA claim (DEMO 31) and the dates
 will link a posted VA and a regular claim where Cash
 Deductible is posted on both.
 The VA claim is accepted (UR AAAA) in CWF with no
 Cash Deductible.

 Response
 An Informational Unsolicited Response (IUR) is generated
 with '8006' due to a posted VA claim has over applied
 cash deductible. The VA claim returning the IUR will
 post a 'V' in the UNSOL IND but will not remove
 the over applied cash deductible in the VADE file.
 The IUR will return Trailer '07' and '24'
 with the updated information.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 82
______________________________________________________________________________

 Event 9.1
 Submit an Inpatient VA claim (DEMO 31) and the dates
 are for the prior year and link to VA claim of the
 next year that has applied the cash deductible. The
 VA claim is accepted (UR AAAA) in CWF with no Cash
 Deductible.

 Response
 An Informational Unsolicited Response (IUR) is generated
 with '8006' due to the VA claim has over applied the cash
 deductible due to the incorrect rate. The VA claim returning
 the IUR will post a 'V' in the UNSOL IND but will not
 update the rate for the cash deductible in the VADE file
 The IUR will return Trailer '07' and '24'
 with the updated information.

 Event 10.1
 Submit a regular Inpatient claim that is accepted
 and the dates will link to a VA Inpatient claim that
 is posted to the VADE file with Cash Deductible.

 Response
 An Informational Unsolicited Response (IUR) is generated
 with '8006' due to the VA claim has over applied cash
 deductible. The VA claim returning the IUR will post a
 'V' in the UNSOL IND but will not remove the cash deductible
 in the VADE file. The IUR will return Trailer '07'
 and '24' with the updated information.

 Event 11.1
 Submit a regular Inpatient claim that is accepted
 and the dates will link to a VA Inpatient claim that
 is posted to the VADE file that will cause over utilized
 Full Days on the VA claim.

 Response
 An Informational Unsolicited Response (IUR) is generated
 with '8001' on the VA claim due to over utilized Full Days.
 The VA claim returning the IUR will post a 'V' in the
 UNSOL IND but will not update the VA claim on the VADE
 file.
 The IUR will return Trailer '07' and '24'
 with the updated information.



______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 83
______________________________________________________________________________

Event 12.1
Submit a regular Inpatient claim that is accepted
and the dates will link to a VA Inpatient claim that
is posted to the VADE file that will cause over utilized
CO Days on the VA claim.

Response
An Informational Unsolicited Response (IUR) is generated
with '8004' on the VA claim due to over utilized CO Days.
The VA claim returning the IUR will post a 'V' in the
UNSOL IND but will not update the VA claim on the
VADE file.
The IUR will return Trailer '07' and '24'
with the updated information.

Event 13.1
Submit a regular Inpatient claim that is accepted
and will impact a VA Inpatient claim that is posted
to the VADE file that will cause over utilized LTR
Days on the VA claim.

Response
An Informational Unsolicited Response (IUR) is generated
with '8005' on the VA claim due to over utilized LTR Days.
The VA claim returning the IUR will post a 'V' in the
UNSOL IND but will not update the VA claim on the
VADE file. The IUR will return Trailer '07'
and '24' with the updated information.

Event 14.1
Submit a regular Inpatient claim that is accepted
and the Year will link to a VA Inpatient claim that
is posted to the VADE file that will cause over applied
Blood Deductible on the VA claim.

Response
An Informational Unsolicited Response (IUR) is generated
with '8008' on the VA claim due to over applied Blood
Deductible. The VA claim returning the IUR will post
a 'V' in the UNSOL IND but will not update the VA claim
on the VADE file. The IUR will return Trailer '07',
'16', and '24' with the updated information.

 Event 15.1
 Submit a regular HUIP record (TOB 11x, or 41x) or
 SNF (TOB 21x or 18x) or Christian Science (TOB 51x)
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 84
______________________________________________________________________________

 with Dates of Service 1989 or prior.

 Response
 The record does set ER '2217'.

 Event 15.2
 Submit an Inpatient VA claim (DEMO 31) and the dates
 prior to 01/01/2004.

 Response
 The record does set ER '2217'.

 Event 16.1
 Submit a regular HUIP (TOB 11x or 41x) or SNF (TOB 21x
 or 18x) or Christian Science (TOB 51x) or VA Inpatient
 Inpatient Claim (DEMO 31) where the Dates of Service
 will link back to spell of illness prior to 1990.

 Response
 The record does set UR '5711'.

 Event 17.1
 Modify CIOCBENE and recompile programs.

 Response
 The programs must recompile successfully.

 Event 17.2
 Submit HIID transaction for a new Beneficiary
 accretion

 Response
 The Beneficiary master record PRE90-CUTOFF-DATE must
 be initialized to 1990001. The PRE90-LIFE-RSV-USED,
 PRE90-LIFE-PSY-USED and PRE90-PREENT-PSY-DAYS
 must be initialized to zeros.

 Event 17.3
 Submit HIID transaction for a Beneficiary overlay.

 Response
 The Beneficiary master record PRE90-CUTOFF-DATE,
 PRE90-LIFE-RSV-USED, PRE90-LIFE-PSY-USED and
 PRE90-PREENT-PSY-DAYS must not be overlaid.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 85
______________________________________________________________________________

 Event 17.4
 Submit HIAB transaction for a new Beneficiary
 accretion on ITF.

 Response
 The Beneficiary master record PRE90-CUTOFF-DATE must
 be initialized to 1990001. The PRE90-LIFE-RSV-USED,
 PRE90-LIFE-PSY-USED and PRE90-PREENT-PSY-DAYS
 must be initialized to zeros.

 Event 18.1
 Execute the one-timer UTLJCATX with parameter
 as 'PROD'.

 Response
 The one-timer should create the PRE90-CUTOFF-DATE,
 PRE90-LIFE-RSV-USED, PRE90-LIFE-PSY-USED,
 and PRE90-PREENT-PSY-DAYS data elements
 on the Beneficiary master record for all HICS.
 The one-timer should generate a report for Beneficiaries
    - with PRE90-CUTOFF-DATES that are after 1990
    - with negative values in the Pre90 data elements

 Event 18.2
 Execute the one-timer UTLJCATX with parameter
 as 'TEST'.

 Response
 The one-timer should create the PRE90-CUTOFF-DATE,
 PRE90-LIFE-RSV-USED, PRE90-LIFE-PSY-USED,
 and PRE90-PREENT-PSY-DAYS data elements
 on the Beneficiary master record for all HICS.
 The one-timer should generate a report for Beneficiaries
    - with all non-default Pre-1990 data values
      i.e. PRE90-CUTOFF-DATE that are not 01/01/1990
      or Pre90 days used fields that are not zeros

 Event 18.3
 Execute the one-timer UTLJCATX with parameter as 'AUDIT'.

 Response
 The one-timer should not update the Beneficiary
 master record.
 The one-timer should generate a report for Beneficiaries
    - with PRE90-CUTOFF-DATES that are after 1990
    - with negative values in the Pre90 data elements
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 86
______________________________________________________________________________


 Event 19.1
 Execute the daily claims HISC process with Inpatient
 VA claims.

 Response
 Program HUIPVSPL must execute successfully
 and generate VA Spells for the Beneficiary.
 Comparison of baseline and new testing must not
 show any difference

 Note: Refer to Events/Responses and Test plan for
 Requirement (01 - 16 VA requirements) to completely
 test the HUIPVSPL program.

 Event 20.1
 Execute the daily claims HISC process with Inpatient
 regular claims.

 Response
 The regular inpatient spell and posting modules
 must generate regular spells for the Beneficiary.
 Comparison of baseline and new testing must not
 show any difference

 Event 21.1
 An HCPA HICR transaction (Spell Data Update) is submitted to
 change or remove information on the Beneficiary spell.

 Response
 The HCPA screen must display the PRE90-CUTOFF-DATE,
 PRE90-LIFETIME-DAYS-USED, PRE90-PSYC-USED and
 PRE90-PRE-ENTITL-DAYS fields.

 Event 21.2
 An HCPA HICR transaction (Spell Data Update) is submitted to
 change the Beneficiary Lifetime Reserve days. Additional
 updates are required to the PRE90-LIFETIME-DAYS-USED field due
 to the claim with Dates of Service prior to 1990.

 Response
 The HCPA screen must update the Lifetime reserve days
 remaining and also update the PRE90-LIFETIME-DAYS-USED field.



______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 87
______________________________________________________________________________

 Event 21.3
 An HCPA HICR transaction (Spell Data Update) is submitted to
 change the Beneficiary Psychiatric days remaining. Additional
 updates are required to the PRE PSYC Days Used field due
 to the claim with Dates of Service prior to 1990.

 Response
 The HCPA screen must update the psychiatric days remaining
 and also update to the PRE90-PSYC-DAYS-USED field.

 Event 21.4
 An HCPA HICR transaction (Spell Data Update) is submitted to
 change the Beneficiary PRE90-CUTOFF-DATE. The Beneficiary
 is entitled prior to 01/01/1990.

 Response
 The HCPA screen must update the PRE90-CUTOFF-DATE.
 The PRE90-CUTOFF-DATE must not be updated with dates
 prior to 1990.

 Event 21.5
 An HCPA HICR transaction (Spell Data Update) is submitted to
 change the Beneficiary PRE90-CUTOFF-DATE. The Beneficiary
 is entitled on or after 01/01/1990.

 Response
 The HCPA screen will highlight the PRE90-CUTOFF-DATE field.
 The PRE90-CUTOFF-DATE must be set to 01/01/1990.

 Event 21.6
 An HCPA HICR transaction (Spell Data Update) is submitted to
 change the Beneficiary PRE90-PRE-ENTITL-DAYS-USED field.

 Response
 The HCPA screen must update the PRE90-PRE-ENTITL-DAYS-USED.

 Event 21.7
 An HCPA HICR transaction (Spell Data Update) is accepted.

 Response
 The HICR Audit Report displays the following new fields:
 PRE90 LIFETIME DAYS USED: 00 PRE90 PSYC DAYS USED: 000
 PRE90 PRE-ENTITL DAYS:    000 PRE90 CLAIM CUTOFF DATE: MM/DD/CCYY



______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 88
______________________________________________________________________________

 Event 22.1
 Execute HICC HDRV transaction with daily XREF HBBM records.
 Inactive Beneficiary must contain claims prior to 1990 along
 with updated PRE90 data elements.
 Active Beneficiary must not contain any claims prior to 1990.

 Response
 HDRV transaction must successfully merge the Beneficiary
 active and inactive records. The PRE90-CUTOFF-DATE,
 PRE90-LIFE-RSV-USED, PRE90-LIFE-PSY-USED
 And PRE90-PREENT-PSY-DAYS must overlay the
 the active Beneficiary Master record fields.

 Event 22.2
 Execute HICC HDRV transaction with daily XREF HBBM records.
 Active Beneficiary must contain claims prior to 1990 along
 with updated PRE90 data elements. Inactive Beneficiary
 must not contain any claims prior to 1990.

 Response
 HDRV transaction must successfully merge the Beneficiary
 active and inactive records. The PRE90-CUTOFF-DATE,
 PRE90-LIFE-RSV-USED, PRE90-LIFE-PSY-USED
 And PRE90-PREENT-PSY-DAYS must not overlay the
 the active Beneficiary master record fields.

 Event 22.3
 Execute HICC HDRV transaction with daily XREF HBBM records.
 Both Active and Inactive Beneficiary transactions must contain
 claims prior to 1990 along with updated PRE90 data elements.

 Response
 HDRV transaction must successfully merge the Beneficiary
 active and inactive records. The PRE90-CUTOFF-DATE,
 PRE90-LIFE-RSV-USED, PRE90-LIFE-PSY-USED
 And PRE90-PREENT-PSY-DAYS fields must be recomputed
 on the active Beneficiary master record.

 Event 23.1
 Execute the daily claims HISC process with Inpatient
 regular claims.

 Response
 The regular inpatient spell and posting modules
 must generate regular spells for the Beneficiary.
 Comparison of baseline and new testing must not
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 89
______________________________________________________________________________

show any difference for claims after 1989.

Event 23.2
Execute the daily claims HISC process with Inpatient
VA claims.

Response
The VA inpatient spell and posting modules
must generate combined spells for the Beneficiary.
Comparison of baseline and new testing must not
show any difference for claims after 1989.

Event 24.1
Execute the daily claims HISC process with all Inpatient
claims.

Response
The Inpatient system must execute all the claims and
Generate spells, responses and extracts successfully.

Event 24.2
Execute the post claims batch process for generating
Eligibility extracts to MBD, NGD, NCH.

Response
The extracts must be generated successfully with no
changes in record or data formats.

Event 24.3
Execute the post claims batch process for generating
CMS extracts for TNIF, DOD, and Hospice.

Response
The extracts must be generated successfully with no
changes in record or data formats.

Event 25.1
Submit a VA Inpatient Cancel (Action Code 4) and the
Cancel-Only Adjustment Code is not present.
The Date of Service is on or after 01/01/2004.

Response
The record does set consistency edit '0020'.



______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 90
______________________________________________________________________________

 Event 25.2
 Submit a VA Inpatient Cancel (Action Code 4) and the
 Cancel-Only Adjustment Code is present.
 The Date of Service is on or after 01/01/2004.

 Response
 The record does not set consistency edit '0020'.

 Event 26.1
 Submit a VA Inpatient Adjustment (Action Code 3) and
 the original ICN is not present.

 Response
 The record does set consistency edit '5800'.

 Event 26.2
 Submit a VA Inpatient Adjustment (Action Code 3) and
 the original ICN is present.

 Response
 The record does not set consistency edit '5800'.

 Event 27.1
 Submit a VA Inpatient Adjustment (Action Code 3) and
 the original VA claim being adjusted is present on
 the VADE File. The adjustment is accepted (UR AAAA)
 in CWF. The Dates of Service are on or after 01/01/2004.

 Response
 The original VA claim is canceled from the VADE file by
 posting 'Y' in the CANC-IND, and post the adjustment
 record.

 Event 27.2
 Submit a VA Inpatient Adjustment (Action Code 3) and
 the original VA claim being adjusted is present on
 the VADE File. The adjustment is not accepted in CWF.
 The Dates of Service are on or after 01/01/2004.

 Response
 The original VA claim is not canceled from the VADE file
 by posting 'Y' in CANC-IND.

 Event 28.1
 Submit a VA Inpatient Cancel (Action Code 4) and
 the original VA claim being canceled is present on
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 91
______________________________________________________________________________

the VADE File. The Cancel is accepted (UR AAAA) in
CWF. The Date of Service is on or after 01/01/2004.

Response
The original VA claim is canceled from the VADE file
by posting 'Y' in CANC-IND.

Event 28.2
Submit a VA Inpatient Cancel (Action Code 4) and
the original VA claim being canceled is not present on
the VADE File. The Cancel is not accepted in CWF.
The Date of Service is on or after 01/01/2004.

Response
The original VA claim is not canceled from the VADE file.

Event 29.1
Submit a VA Inpatient Adjustment (Action Code 3) with
Cash Deductible and the original VA claim being adjusted
is present on the VADE File with Cash Deductible.

Response
The record is accepted and the VADE File does apply
the information from the adjustment due to backing
out the original and reapplying utilization.

Event 29.2
Submit a VA Inpatient Adjustment (Action Code 3) with
Cash Deductible and the original VA claim being adjusted
is present on the VADE File with Cash Deductible. However,
the Beneficiary has applied the Cash Deductible on a
regular claim within the same spell.

Response
The record is not accepted due to over applied cash
deductible and the original VA claim being adjusted is
not updated on the VADE File.

Event 30.1
Submit a VA Inpatient Adjustment (Action Code 3) and the
original ICN is not found on the VADE File.

Response
The record processes in CWF as initial VA claim and does
not process as adjustment and does not set UR '6000'.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 92
______________________________________________________________________________

Event 31.1
Submit a VA Inpatient Cancel (Action Code 4) and the
original ICN is not found on the VADE File.

Response
The record does return UR '6000' due to no match is found.

Event 32.1
An Informational Unsolicited Response (IUR) is generated
on a VA HUIP record where the Contractor is '00400'.

Response
The IUR indicates Contractor '04401'.

The Entity List includes only NEW acronyms and terminology
that is currently not in use in CWF.

Entity List: N/A

Areas Affected by the Problem.
  1. VADE file
  2. Inpatient VA Adjustment/Cancel Processing
  3. Inpatient Consistency and Utilization Modules

Solution Criteria: N/A

     EDITS AFFECTED:

a. Error Code:         0018   ( )New (X)Modified ( )Deleted
Disposition: ER

Type of Record: Hospital, OUTP

Error Message:
Claim is submitted with Demonstration Number '31', and the
Action Code is not equal to '1'.

OR

Claim is submitted with Demonstration Number '31', and the
Action Code is equal to '3' or '4' when the dates are
prior to 01/01/2004.




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 93
______________________________________________________________________________

 Set Condition for edit '0018':

 Hospital
 When the Demonstration Number is equal to '31', and the
 Action Code is not equal to '1', set the '0018' error code.

 When the Demonstration Number is equal to '31', and the
 Action Code is equal to '3' or '4' and the Dates of Service
 are prior to 01/01/2004, set the '0018' error code.

 OUTP
 When the Demonstration Number is equal to '31', and the
 Action Code is not equal to '1' for an Outpatient claim,
 set the '0018' error code.

 When the Demonstration Number is equal to '31', and the
 Action Code is equal to '3' or '4' and the dates are
 prior to 01/01/2004, set the '0018' error code.

 Trailer Information: 08


 b. Error Code:    6001    ( )New (X)Modified ( )Deleted
 Disposition: UR

 Type of Record: Hospital, SNF

 Error Message:
 Adjustment Bill - The cancel/credit claim Service Dates do
 not fall within a Spell of Illness on the Beneficiary
 Master file.

 Set Condition for edit '6001':

 For VA Inpatient adjustments (Action Code 3) or Cancels
 (Action Code 4), bypass this edit.

 Trailer Information: 08




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 94
______________________________________________________________________________

c. Error Code:    6002    ( )New (X)Modified ( )Deleted
Disposition: UR

Type of Record: Hospital, SNF

Error Message:
Adjustment Bill - The cancel/credit claim Service Dates
partially overlap a Spell of Illness on the Beneficiary
Master file.

Set Condition for edit '6002':
When WS-SPELL-FOUND-SW is not equal to 'Y', and the From Date
is greater than, or equal to, '1998001', set the '6002' error
code.

When the incoming claim dates do not match an existing spell,
bypass this edit.

For VA Inpatient adjustments (Action Code 3) or Cancels
(Action Code 4), bypass this edit.

Trailer Information: 08


d. Error Code:    6004    ( )New (X)Modified ( )Deleted
Disposition: UR

Type of Record: Hospital, SNF

Error Message:
A debit claim is combining two Spells of Illness and there is
no history for one or both Spells of Illness.

Set Condition for edit '6004':

For VA Inpatient adjustments (Action Code 3), bypass
this edit.

Catastrophic-only edit.    No detail description is provided.

Trailer Information: 08




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 95
______________________________________________________________________________

e. Error Code:    6006    ( )New (X)Modified ( )Deleted
Disposition: UR

Type of Record: Hospital, SNF, HHA, Hospice, OUTP

Error Message:
Match found on ICN, but History bill contains a Cancel Date.

Set Condition for edit '6006':

Hospital, SNF
If an incoming claim with Action Code of '4' or '6' matches an
existing history claim, and the history claim contains a
Cancel Date, set the '6006' error code.

If an incoming VA Inpatient claim with Action Code of
'3' matches the original history VA claim, and the
history claim has been adjusted (original canceled, but
reprocessed), set the '6006' error code.

If an incoming VA Inpatient claim with Action Code of
'4' matches the original history VA claim, and the
history claim contains a Cancel Date, set the '6006' error
code.

HHA, Hospice, OUTP
If the incoming claim matches a claim on history, and the
history claim contains a Cancel Date, set the '6006' error
code.

If an incoming VA Outpatient claim with Action Code of
'3' or '4' matches an existing history claim, and the
history claim contains a Cancel Date, set the '6006' error
code.

When the Action Code is not equal to '4' or '5', bypass this
edit.

Trailer Information: 08




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 96
______________________________________________________________________________

f. Error Code:    6040    ( )New (X)Modified ( )Deleted
Disposition: UR

Type of Record: Hospital, SNF

Error Message:
Master Beneficiary Record contains incorrect spell and/or
catastrophic data - verify - contact HICR staff for
correction.

Set Condition for edit '6040':
When an adjustment is received on a Beneficiary Master record
that contains incorrect spell and/or catastrophic data, set
the '6040' error code.

When the history spell number work area is less than one, set
the '6040' error code.

For VA Inpatient adjustments (Action Code 3) or Cancels
(Action Code 4), bypass this edit.

Trailer Information: 08


g. Error Code:    8001    ( )New (X)Modified ( )Deleted
Disposition: AA

Type of Record: Hospital

Error Message:
Hospital full days are over utilized. Hospital full days
exceed those remaining in the spell benefit period.

Set Condition for edit '8001':
When the CA-SPL-FULL-Hospital is less than '0', set the
'8001' error code.

When both VA Inpatient (Demonstration number 31) and Regular
Inpatient claims are read to create a combined benefit period,
and the CA-SPL-FULL-Hospital computed is less than '0',
set the '8001' error code.

When COND-CDE-69-PRESENT for an IME/GME claim, bypass this
edit.

 Trailer Information: 08
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 97
______________________________________________________________________________



 h. Error Code:    8002    ( )New (X)Modified ( )Deleted
 Disposition: AA

 Type of Record: Hospital

 Error Message:
 Hospital full days under utilized. Full days submitted are
 less than those remaining in the spell benefit period, yet
 coinsurance days were submitted.

 Set Condition for edit '8002':
 When the CA-SPL-FULL-Hospital is greater than zero, or one,
 and CA-SPLIT-COIN-DAYS is greater than zero, or one, set the
 '8002' error code.

 When both VA Inpatient (Demonstration number 31) and Regular
 Inpatient claims are read to create a combined benefit period,
 and CA-SPL-FULL-Hospital is greater than zero, or one,
 and CA-SPLIT-COIN-DAYS is greater than zero, or one, set the
 '8002' error code.

 When COND-CDE-69-PRESENT for an IME/GME claim, bypass this
 edit.

 Trailer Information: 08


 i. Error Code:    8003    ( )New (X)Modified ( )Deleted
 Disposition: AA

 Type of Record: Hospital

 Error Message:
 Hospital Coinsurance days are under utilized. Hospital
 coinsurance days submitted is less than what are remaining in
 the spell benefit period, and lifetime reserve days were
 submitted.

 Set Condition for edit '8003':
 When CA-SPL-CO-Hospital is greater than zero, or one, and
 there are lifetime reserve days on the submitted bill, set
 the '8003' error code.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 98
______________________________________________________________________________

When both VA Inpatient (Demonstration number 31) and Regular
Inpatient claims are read to create a combined benefit period,
and CA-SPL-CO-Hospital is greater than zero, or one, and
there are lifetime reserve days on the submitted bill, set
the '8003' error code.

When COND-CDE-69-PRESENT for an IME/GME claim, bypass this
edit.

Trailer Information: 08


j. Error Code:    8004    ( )New (X)Modified ( )Deleted
Disposition: AA

Type of Record: Hospital

Error Message:
Hospital coinsurance days are over utilized. Hospital
coinsurance days exceed those remaining in the spell benefit
period.

Set Condition for edit '8004':
When CA-SPL-CO-Hospital is less than '0' and the Inlier days
are not exhausted, set the '8004' error code.

When both VA Inpatient (Demonstration number 31) and Regular
Inpatient claims are read to create a combined benefit period,
and CA-SPL-CO-Hospital is less than '0' and the Inlier days
are not exhausted, set the '8004' error code.

When COND-CDE-69-PRESENT for an IME/GME-claim, bypass this
edit.

Trailer Information: 08


k. Error Code:    8005    ( )New (X)Modified ( )Deleted
Disposition: AA

Type of Record: Hospital

 Error Message:
 Hospital lifetime reserve days are over utilized. Lifetime
 reserve days submitted exceed those remaining in the
 Beneficiary's entitlement benefits.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                           Page 99
______________________________________________________________________________


 Set Condition for edit '8005':
 When the Beneficiary data indicator number '32' is set to a
 one or three, the bill has a claim record type of one, two,
 or three, then;

    If the lifetime days submitted on the bill are greater
    than the lifetime days remaining to be utilized, set
    the '8005' error code.

    When VA Inpatient (Demonstration number 31) is submitted
    with lifetime reserve days and the days submitted are
    greater than the combined lifetime days remaining for
    VA Inpatient and Regular Lifetime reserves days,
    set the '8005' error code.

 When COND-CDE-69-PRESENT for an IME/GME claim, bypass this
 edit.

 Trailer Information: 08


 l. Error Code:    8006    ( )New (X)Modified ( )Deleted
 Disposition: AA

 Type of Record: Hospital

 Error Message:
 Cash deductible over applied. Cash deductible submitted is
 greater than the amount left to be met.

 Set Condition for edit '8006':
 When the number of utilized days submitted on the Inpatient
 bill is zero, the bill is not an MSP bill, the Inpatient
 deductible applied for this bill is greater than zero
 (amounts for value Codes 'A1', 'B1', or 'C1'), and the bill
 is not being reprocessed in the combine spell procedure, set
 the '8006' error code.

 When the number of utilized days submitted on the Inpatient
 bill is greater than zero, or the bill is not an MSP bill,
 and the Inpatient deductible submitted with this bill is
 greater than the Inpatient deductible remaining to be met
 within the spell of illness, set the '8006' error code.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 100
______________________________________________________________________________

 When both VA Inpatient (Demonstration number 31) and Regular
 Inpatient claims are read to create a combined benefit period,
 and the number of utilized days submitted on the Inpatient
 bill is zero, the bill is not an MSP bill, the Inpatient
 deductible applied for this bill is greater than zero
 (amounts for value Codes 'A1', 'B1', or 'C1'), and the bill
 is not being reprocessed in the combine spell procedure, set
 the '8006' error code.

 When both VA Inpatient (Demonstration number 31) and Regular
 Inpatient claims are read to create a combined benefit period,
 and the number of utilized days submitted on the Inpatient
 bill is greater than zero, or the bill is not an MSP bill,
 and the Inpatient deductible submitted with this bill is
 greater than the Inpatient deductible remaining to be met
 within the spell of illness, set the '8006' error code.

 When COND-CDE-69-PRESENT for an IME/GME claim, bypass this edit.

 Trailer Information: 08


 m. Error Code:    8007    ( )New (X)Modified ( )Deleted
 Disposition: AA

 Type of Record: Hospital

 Error Message:
 Cash deductible under applied. Cash deductible submitted is
 less than what is left to be met for the benefit period, and
 total charges are greater than the deductible to be met.

 Set Condition for edit '8007':
 When the Inpatient deductible submitted with this bill is
 less than the Inpatient deductible remaining to be met wit
 the spell of illness, and the covered charges for the bill
 are greater than the deductible submitted, set the '8007'
 error code.

 When both VA Inpatient (Demonstration number 31) and Regular
 Inpatient claims are read to create a combined benefit period,
 and the Inpatient deductible submitted with this bill is
 less than the Inpatient deductible remaining to be met wit
 the spell of illness, and the covered charges for the bill
 are greater than the deductible submitted, set the '8007'
 error code.
______________________________________________________________________________
2020 Company, LLC                                           Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 101
______________________________________________________________________________


 When an Inpatient Claim has a Condition Code '78' and the
 Discharge Date is on or after 01/01/2006 and the Cash
 Deductibles under applied and either of the ICD-9 Codes
 are '37.94', set the '8007' error code.

 When an Inpatient Claim has a Condition Code '78' and the
 Discharge Date is on or after 01/01/2005 and the Cash
 Deductibles under applied and either of the ICD-9 Codes
 are '37.66' or '32.22', set the '8007' error code.

 When the claim Data Indicator '17' is greater than '1',
 bypass this edit.

 When the deductible submitted on the bill is greater than, or
 equal to, the bill's covered charges, bypass this edit.

 When the bill From Date is less than Julian Date '89213', the
 MSP Type Code is not 'A', 'B', or 'G', the reimbursement
 amount is zero, and there is an amount greater than zero for
 Value Codes '14', '15', '16', '41', '42', or '47', bypass
 this edit.

 When the bill is being reprocessed for the combine spell
 process, bypass this edit.

 When the bill is Clinical Trial claim (identified by
 Condition Code '30') and the Dates of Discharge on or after
 09/19/2000, bypass this edit.

 Trailer Information: 08


 n. Error Code:    8008    ( )New (X)Modified ( )Deleted
 Disposition: AA

 Type of Record: Hospital

 Error Message:
 Blood deductible over applied. Blood deductible submitted is
 greater than what is left to be met in the benefit period.

 Set Condition for edit '8008':
 When the blood deductible minus the blood deductible
 submitted on the bill is less than '0', the blood deductible
 is over applied, set the '8008' error code.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 102
______________________________________________________________________________


 When both VA Inpatient (Demonstration number 31) and Regular
 Inpatient claims are read to create a combined benefit period,
 and the blood deductible minus the blood deductible
 submitted on the bill is less than '0', the blood deductible
 is over applied, set the '8008' error code.

 When Condition Code '69' is present for an IME/GME claim,
 bypass this edit.

 Trailer Information: 08


 o. Error Code:    8009    ( )New (X)Modified ( )Deleted
 Disposition: AA

 Type of Record: Hospital

 Error Message:
 Blood deductible under applied. Blood deductible submitted
 is less than what is left to be met, and blood furnished as
 equal to or exceeds what is to be met for the benefit period.

 Set Condition for edit '8009':
 When the blood deductible minus the blood deductible
 submitted on the bill is greater than zero, and the blood
 furnished is greater than the deductible applied by the bill,
 set the '8009' error code.

 When both VA Inpatient (Demonstration number 31) and Regular
 Inpatient claims are read to create a combined benefit period,
 and the blood deductible minus the blood deductible
 submitted on the bill is greater than zero, and the blood
 furnished is greater than the deductible applied by the bill,
 set the '8009' error code.

 When COND-CDE-69-PRESENT for an IME/GME claim, bypass this
 edit.

 Trailer Information: 08




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 103
______________________________________________________________________________

 p. Error Code:    2217    (X)New ( )Modified ( )Deleted
 Disposition: ER

 Type of Record: Hospital, SNF

 Error Message:
 From and Thru Date are prior to 1990.

 OR

 From and Thru Dates are prior to 01/01/2004 for VA
 Demo Claims.

 Set Condition for edit '2217':
 When the From and Thru Date are prior to 1990,
 set the '2217' error code.

 OR

 When the From and Thru Date are prior to 01/01/2004 on
 Inpatient VA claim (DEMO 31) set the '2217' error code.

 Trailer Information: 08


 q. Error Code:    5711    (X)New ( )Modified ( )Deleted
 Disposition: UR

 Type of Record: Hospital

 Error Message:
 Claim links back to a Spell of Illness prior to 1990.

 Set Condition for edit '5711':
 When the claim's Date of Service link to a Spell of
 Illness prior to 1990, set the '5711' error code.

 When Inpatient Type of bill is '11A', '11D', '41A', '41B',
 '41D', bypass this edit.

 Trailer Information: 08




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 104
______________________________________________________________________________

 r. Error Code:    0020    ( )New (X)Modified ( )Deleted
 Disposition: ER

 Type of Record: HHA, Hospice, Hospital, OUTP, SNF

 Error Message:
 The cancel-only adjustment bill does not contain the Reason
 Code, or contains a code other than 'A', 'B', 'C', 'D',
 'E', 'F', 'H', 'P', or 'S'.

 Set Condition for edit '0020':

 Hospice, Hospital, OUTP, SNF
 When the Action Code is equal to '4', and the cancel only
 Adjustment Code is not equal to 'C', 'D', 'H', 'P', or 'S',
 set the '0020' error code.

 When Inpatient (Demonstration number 31) and
 the Action Code is equal to '4', and the cancel only
 Adjustment Code is not equal to 'C', 'D', 'H', 'P', or 'S',
 set the '0020' error code.

 HHA
 When the Action Code is equal to '4' and the cancel-only
 Adjustment Code is not equal to 'C', 'D', 'H', 'P', or 'S',
 for TOB equal to '32x' or '33x' for DOS prior to
 10/01/2000, set the '0020' error code.

 When the Action Code is equal to '4' and the cancel-only
 Adjustment Code is not equal to 'A', 'B', 'E', or 'F' for
 TOB equal to '32x' or '33x' for DOS on, or after
 10/01/2000, set the '0020' error code.

 Trailer Information: 08


 s. Error Code:    5800    ( )New (X)Modified ( )Deleted
 Disposition: ER

 Type of Record: Hospital

 Error Message:
 When the Action Code indicates a '3' or '9', and the
 original Intermediary control number is used as a reference
 for debit adjustment claims, and if this number is spaces
 or low values, set the '5800' error code.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 105
______________________________________________________________________________


 Set Condition for edit '5800':
 When the Action Code indicates a '3' or '9', and the
 original Intermediary control number is used as a reference
 for debit adjustment claims, and if this number is spaces
 or low values, set the '5800' error code.

 When Inpatient (Demonstration number 31) and
 the Action Code indicates a '3' or '9', and the
 original Intermediary control number is used as a reference
 for debit adjustment claims, and if this number is spaces
 or low values, set the '5800' error code.

 Trailer Information: 08


 t. Error Code:    6000    ( )New (X)Modified ( )Deleted
 Disposition: UR

 Type of Record: Hospital

 Error Message:
 Adjustments, Cancels - No match on ICN.

 OR

 Claim within catastrophic coverage and no catastrophic
 information present on Beneficiary Master Record.

 Set Condition for edit '6000':

 Note: The detail narrative for the catastrophic logic will not
       be included in this documentation.

 When the Action Code is equal to '4' or '5', and there is no
 matching history claim found by linking the ICN of the
 incoming claim to existing ICNs in history, and the claim is
 not a Late Charge claim, and there is no matching SNF claim in
 history, set the '6000' error code.

 When Inpatient (Demonstration number 31) and action code
 is equal to '4' and there is no matching history claim
 found by linking the ICN of the incoming claim to existing
 ICNs in history, set the '6000' error code.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 106
______________________________________________________________________________

 When Inpatient (Demonstration number 31) and action code is
 equal to '3', and there is a matching history claim found
 by linking the ICN of the incoming claim to the existing ICNs
 in history and the process date is on or after 10/05/2009,
 set the '6000' error code.

 When Inpatient (Demonstration number 31) and action code is
 equal to '3', and there is no matching history claim found
 by linking the ICN of the incoming claim to the existing ICNs
 in history and the process date is prior to 10/05/2009,
 bypass this edit.

 HHA, Hospice, OUTP
 When the matching claim in history is not found, and the claim
 is not a cancel claim, set the '6000' error code.

 When VA Outpatient (Demonstration number 31) and action code is
 equal to '3', and there is a matching history claim found
 by linking the ICN of the incoming claim to the existing ICNs
 in history and the process date is on or after 10/05/2009,
 set the '6000' error code.

 When the Action Code is not equal to '4' or '5', bypass this
 edit.

 When VA Outpatient (Demonstration number 31) and action code is
 equal to '3', and there is not matching history claim found
 by linking the ICN of the incoming claim to the existing ICNs
 in history and the process date is prior to 10/05/2009,
 bypass this edit.

 Trailer Information: 08

   INSTALLATION INSTRUCTIONS:

 **Refer to CR 00025816 for the Installation Instructions for this CR.**

   SYSTEMS DOCUMENTATION AFFECTED:

     EDITCONS              MODIFY THE '0018' FOR INPATIENT VA TO ALLOW
                           ADJUSTMENTS/CANCELS.

     EDITCONS              MODIFY THE '0020' FOR INPATIENT VA TO
                           INCLUDE VA CANCELS.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 107
______________________________________________________________________________

    EDITCONS             MODIFY THE '5800' FOR INPATIENT VA TO
                         INCLUDE VA ADJUSTMENTS AND CANCELS.

    EDITCONS             ADD NEW EDIT '2217' TO NOT ALLOW DOS
                         PRIOR TO 1990 FOR REGULAR HOSPITAL OR SNF.

    EDITLIST             ADD NEW EDIT '2217' TO NOT ALLOW DOS
                         PRIOR TO 1990 FOR REGULAR HOSPITAL OR SNF.

    EDITUTIL             MODIFY UR '6001', '6002', '6004', '6006',
                         AND '6040' FOR VA ADJUSTMENTS/CANCEL.

    EDITUTIL             MODIFY UR '6000' FOR VA ADJUSTMENT AND
                         AND CANCEL ON INPATIENT VA

    EDITUTIL             MODIFY AA '8001', '8002', '8003',
                         '8004', '8005', '8006', '8007', '8008', AND
                         '8009' FOR INPATIENT VA CLAIM.

    EDITLIST             ADD NEW EDIT '5711'.

    EDITUTIL             ADD NEW EDIT '5711' TO NOT ALLOW HOSPITAL
                         OR SNF OR VA INPATIENT WHERE THE DOS
                         LINK TO SPELL PRIOR TO 1990.

    EDITALRT             ADD IUR CODES '8001', '8004, '8005',
                         '8006', AND '8008' FOR INPATIENT VA CLAIM.

    LAYBENE              UPDATE TO PHYSICAL BENE RECORD.

    SCRHOST              UPDATE TO HCPA IN HICR.

    OVERINPA             INPATIENT REGULAR AND VA PROCESSING.

    XREF                 ADD PRE90 FIELD MERGE SITUATIONS.

    DATA DICTIONARY       MODIFY CIOCBENE.

    DESCLVL2             ADD PRE90 FIELDS.

    TRANSMNT             ADD PRE90 FIELDS.

    COPYXNTL             ADD UNSOL INDICATOR OF 'V' FOR HUIP AND
                         REMOVE CIOCBENE FROM THIS SECTION.

     INSTALL              ADD DESCRIPTION OF NEW OVERINPA SECTION.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 108
______________________________________________________________________________


   SATELLITE SYSTEM MODIFICATIONS:

**Refer to CR 00025817 for the Satellite System Modifications for this CR.**




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 109
______________________________________________________________________________

   4.   00025713   5828-CREATE USER ACCOUNT FOR NEXT GENERATION DESKTOP ON CWF

   REQUESTOR ID: CWFM2000

   IMPACT:
 (X) Host
 (X) Satellite Part A Inpatient
 (X) Satellite Part A Outpatient
 (X) Satellite Part B
 (X) Hospice
 (X) Home Health
 (X) DMERC

   REASON FOR CHANGE:
 Presently, the Next Generation Desktop (NGD) does not have
 access to submit files to the Host that would allow them
 to make changes to the MSP Auxiliary file. The changes being
 implemented in this CR will give NGD the capability to submit
 files.

 Note:
 Cost avoids are currently used in CWF to deny/non-covered
 claims when the MSP information for a Beneficiary is not
 available. The instruction in 5828 does not reference
 claims processing for NGD. Therefore, based on 5828 CWF
 is only providing NGD the capability to make Termination
 Date updates. CWF will not be creating a new cost avoid
 for Contractor Number '11140'.

   NEW BUSINESS REQUIREMENTS:

 Requirement 1
 CWF must add Contractor Number '11140' as a valid number for
 Next Generation Desktop (NGD) to make Termination Date updates
 to occurrences on the MSP Auxiliary file for 'Working Aged'
 Beneficiaries.

 Requirement 2
 CWF must update the Carrier Table (CONT) in CWF with the following
 name and address for Contractor Number '11140'.

   Next Generation Desktop
   8085 Knue Rd
   Indianapolis, IN 46250-1921


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 110
______________________________________________________________________________

       Note:
       The Termination Date HUSP update transactions for Contractor
       '11140' will be generated through the Mid-Atlantic (MA) Host
       site.

       The MA Host site will need to update their CABHOSC file.

 Requirement 3
 CWF retains a delete table to identify which Contractor
 has the authority to delete other Contractors.

 CWF must modify the 'COBC Contractor Delete Table' to include
 Contractor '11140' as a valid Contractor for the other COBC
 Contractors (11100-11126, 33333-99999) to delete.

                   CONTRACTOR DELETE TABLE

 Originating/Updating                  Contractor Who Can Delete
     Contractor
 --------------------                  -------------------------
       '11140'                          '11100-11118', '11125-11126',
                                        '33333', '55555', '77777',
                                        '88888', '99999'

 NOTE:
 Contractor Number '11140' may not delete any other contractor
 number.

 Requirement 4
 CWF must modify error code 'SP37' to include Source
 Code '40' as a valid value for Contractor Number '11140'.

 Requirement 5
 CWF must modify error code 'SP50' to set when Contractor
 Number '11140' attempts to add a Termination Date to an
 MSP occurrence and the MSP Type is not equal to 'A'
 'Working Aged'.

 CWF must modify error code 'SP50' to set when Contractor
 Number '11140' attempts to add a Termination Date to an
 MSP occurrence originated by COBC Contractor '11100'.

 CWF must add Contractor Number '11140' to the logic to
 set 'SP50' when Contractor Number '11140' attempts to
 update (add or change) any field other than the Termination
 Date for a 'Working Aged' Beneficiary.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 111
______________________________________________________________________________


 Note: If a Termination Date is submitted along with
       other changes, only the Termination Date will
       be updated.

      If other changes only are submitted, those changes
      will be ignored.

 Requirement 6
 COBC Contractor Numbers '11100-11118', '11125-11126',
 '33333', '55555', '77777', '88888', and '99999', can
 delete or change an occurrence terminated by Contractor
 Number '11140' for a 'Working Aged' Beneficiary.

 Requirement 7
 CWF must modify error code 'SP50' to set when an FI or
 Carrier attempts to delete an MSP occurrence updated by
 Contractor Number '11140' for a 'Working Aged' Beneficiary.

 CWF must modify error code 'SP73' to set when an FI or
 Carrier attempts to change a Termination Date on an MSP
 occurrence terminated by Contractor Number '11140'
 for a 'Working Aged' Beneficiary.

 Requirement 8
 CWF must modify error code 'SP57' to include Contractor
 Number '11140' in the bypass logic when an MSP update
 for a Termination Date is received and the Termination
 Date is greater than six months prior to when the record
 was added to CWF (DOA) for a 'Working Aged' Beneficiary.

 EX: Record was added to CWF 09/14/2008 (DOA)

   Effective Date 05/01/2007 Term Date added 12/31/2007

 Requirement 9
 CWF must modify error code 'SP59' to set when the
 Validity Indicator is equal to 'N', and the Insurer
 Type is not equal to spaces and the updating Contractor
 is equal to '11140' for a 'Working Aged' Beneficiary.

 Requirement 10
 CWF must modify error code 'SP20' to set when the Contractor
 Number '11140' submits an update (Termination Date) and the
 'Working Aged' record does not contain a 'Y' Validity Indicator.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 112
______________________________________________________________________________

 Requirement 11
 CWF must generate an unsolicited HUST (UR) to the MSP
 Contractor when an update transaction to add a Termination
 Date is originated by Contractor Number '11140' for a
 'Working Aged' Beneficiary.

 Requirement 12
 CWF must generate an unsolicited HUSC (HUSC) to the FI
 and Carriers when an update transaction to add a Termination
 Date is originated by Contractor Number '11140' for a
 'Working Aged' Beneficiary.

   EVENT-RESPONSE LIST:

 Event 1.1
 Submit a termination update to an HUSP occurrence for a
 Beneficiary who has a Working Aged record. The Contractor
 Number on the incoming update is from '11140'. The Validity
 Indicator on the record is equal to 'Y'.

 Response
 The transaction is accepted. The occurrence displays
 the added Termination Date.

 Event 2.1
 Access the CONT screen in HIMR for Contractor Number
 '11140'.

 Response
 The name and address for '11140' has been updated with
 the information for Next Generation Desktop.

 Event 3.1
 Review the 'Contractor Delete Table'.

 Response
 Contractor Number '11140' has been added as an Originating
 and Updating Contractor that COBC Contractor Numbers,
 '11100', '11110', '11112-11118', '11125-11126', '33333',
 '55555', '88888' and '99999' may delete.

 Event 4.1
 Submit an update transaction (termination date) on an HUSP
 occurrence from Contractor Number '11140' that contains
 Source Code '40'.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 113
______________________________________________________________________________

 Response
 The update transaction is accepted. Error code 'SP37' is
 not set.

 Event 5.1
 Submit a termination update to an HUSP occurrence for a
 Beneficiary who does not have a Working Aged record. The
 Contractor Number on the incoming update is from '11140'.
 The Validity Indicator on the record is equal to 'Y'.

 Response
 The update transaction is rejected. Error code 'SP50' is set.

 Event 5.2
 Submit a termination update to an HUSP occurrence for a
 Beneficiary who has a Working Aged record. The Contractor
 Number on the incoming update is from '11140'. The Validity
 Indicator on the record is equal to 'Y'. The occurrence was
 originated or last updated by Contractor Number '11100'.

 Response
 The update transaction is rejected. Error code 'SP50' is set.

 Event 5.3
 Submit an update transaction to add a new occurrence for a
 Beneficiary who has a Working Aged record. The Contractor
 Number on the incoming update is from '11140'. The Validity
 Indicator on the record is equal to 'Y'.

 Response
 The update transaction is rejected. Error code 'SP50' is set.

 Event 5.4
 Submit an update transaction to delete an occurrence for a
 Beneficiary who has a Working Aged record. The Contractor
 Number on the incoming update is from '11140'.
 The Validity Indicator on the record is equal to 'Y'.

 Response
 The update transaction is rejected. Error code 'SP50' is set.

 Event 5.5
 Submit an update transaction to change a field on an HUSP
 occurrence for a Beneficiary who has a Working Aged record.
 The Contractor Number on the incoming update is from '11140'
 The Validity Indicator on the record is equal to 'Y'.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 114
______________________________________________________________________________


 Response
 The update transaction is rejected. Error code 'SP50' is set.

 Event 6.1
 Submit an update transaction (delete) on an HUSP occurrence
 from one of the COBC Contractor Numbers, '11100', '11110',
 '11112-11118', '11125-11126', '33333', '55555', '88888', and
 '99999'. The Beneficiary is Working Aged and has a Termination
 Date updated by Contractor Number '11140'.

 Response
 The update transaction is accepted. Error code 'SP50' is
 not set.

 Event 6.2
 Submit an update transaction (change) on an HUSP occurrence
 from one of the COBC Contractor Numbers, '11100', '11110',
 '11112-11118', '11125-11126', '33333', '55555', '88888', and
 '99999'. The Beneficiary is Working Aged and has a Termination
 Date updated by Contractor Number '11140'.

 Response
 The update transaction is accepted. Error code 'SP50' is
 not set.

 Event 7.1
 Submit an update (delete) transaction from an FI or
 Carrier for a Beneficiary who has a Working Aged
 record. The last Termination Date on the occurrence was
 originated by Contractor Number '11140'. The Validity
 Indicator on the record is equal to 'Y'.

 Response
 The update is rejected. Error code 'SP50' is set.

 Event 7.2
 Submit an update (change) transaction from an FI or
 Carrier for a Beneficiary who has a Working Aged
 record. The last Termination Date on the occurrence was
 originated by Contractor Number '11140'. The Validity
 Indicator on the record is equal to 'Y'.

 Response
 The update is rejected. Error code 'SP73' is set.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 115
______________________________________________________________________________

 Event 8.1
 Submit a termination update to an HUSP occurrence for a
 Beneficiary who has a Working Aged record. The Contractor
 Number on the incoming update is from '11140'. The Validity
 Indicator on the record is equal to 'Y'. The Termination
 Date is greater than six months prior to when the record
 was added.

 Response
 The update is accepted. Error code 'SP57' is not set.

 Event 9.1
 Submit a termination update to an HUSP occurrence for a
 Beneficiary who has a Working Aged record. The Contractor
 Number on the incoming update is from '11140'. The Validity
 Indicator on the record is equal to 'N'. The Insurer Type
 is not equal to spaces.

 Response
 The transaction is rejected. Error code 'SP59' is set.

 Event 10.1
 Submit a termination update to an HUSP occurrence for a
 Beneficiary who has a Working Aged record. The Contractor
 Number on the incoming update is from '11140'. The Validity
 Indicator on the posted occurrence is not equal 'Y'.

 Response
 The transaction is rejected. Error code 'SP20' is set.

 Event 11.1
 Submit a termination update to an HUSP occurrence for a
 Beneficiary who has a Working Age record. The Contractor
 Number on the incoming update is from '11140'. The
 Validity Indicator on the record is equal to 'Y'. The
 update transaction is to add a Termination Date to the
 occurrence.

 Response
 The CWF Response File creates an HUST (UR) to the MSP
 Contractor with the updated Termination Date.

 Event 12.1
 Submit an HUIP, HUOP, HUHH, or HUHC record from an FI.
 The Contractor Number posts to the COBC Aux File. Submit
 a termination update to a HUSP occurrence for a Beneficiary
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 116
______________________________________________________________________________

 who has a Working Aged record. The Contractor Number on
 the incoming update is from '11140'. The Validity Indicator
 on the record is equal to 'Y'.

 Response
 An HUSC is generated to the contractor number on the
 CABCCOB file who processed the HUIP, HUOP, HUHH or HUHC
 record.

 Event 12.2
 Submit an HUBC or HUDC record from a Carrier. The Contractor
 Number posts to the COBC Aux File. Submit a termination
 update to a HUSP occurrence for a Beneficiary who has a
 Working Aged record. The Contractor Number on the incoming
 update is from '11140'. The Validity Indicator on the
 record is equal to 'Y'.

 Response
 An HUSC is generated to the contractor number on the
 CABCCOB file who processed the HUBC or HUDC record.

 The Entity List includes only NEW acronyms and terminology
 that is currently not in use in CWF.

 Entity List:

 Areas Affected by the Problem.
   1. MSP, Part B, DMERC, Part A, HUSC and HUST
   2. Modules : HIMCMSP, CABEDMSP and HIMCHUSC

 Solution Criteria: N/A

   EDITS AFFECTED:

 a. Error Code:      SP20   ( )New (X)Modified ( )Deleted
 Disposition:        SP

 Type of Record:     MSP

 Error Message:
 Invalid Validity Indicator/Occ W/in 100

 Set Condition for edit 'SP20':

 When the Validity Indicator is not equal to 'I', 'N' or
 'Y, set the 'SP20' error code.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 117
______________________________________________________________________________


 When the incoming Validity Indicator is equal to 'I',
 and there is another MSP occurrence posted with the
 Validity Indicator of 'I' or 'Y' that is Open, Closed,
 or Deleted, with the same MSP Type, the same Patient
 Relationship and the Effective Date of the incoming 'I'
 record is within 100 days of the Effective Date on
 the posted occurrence, set the 'SP20' error code.

 When the Validity Indicator on a 'Working Aged'
 Beneficiary is not equal to 'Y' and Contractor
 Number '11140' is submitting a Termination Date
 update, set the 'SP20' error code.

 When submitted by a COB contractor, bypass this edit.

 Trailer: '03', '08'


 b. Error Code:    SP37   ( )New (X)Modified ( )Deleted
 Disposition:      SP

 Type of Record:   MSP

 Error Message:
 Invalid Source Code.

 Set Condition for edit 'SP37':

 When the payer Source Code is not equal to spaces,
 'A-W', '0', '1-18', '25', '26' or '40', set the 'SP37'
 error code.

 When the MSP Maintenance Transaction Type is equal to
 '1', bypass this edit.

 Trailer: '03', '08'




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 118
______________________________________________________________________________

 c. Error Code:    SP50   ( )New (X)Modified ( )Deleted
 Disposition:      SP

 Type of Record:   MSP

 Error Message:
 Invalid function for update or delete. Contractor
 Number unauthorized.

 Set Condition for edit 'SP50':

 Note: There are two aspects to the 'SP50' error code, one
       for the Add/Update transactions, and one for Delete
       transactions.

 Effective 01/01/2001, FIs and Carriers may only add transactions
 with a Validity Indicator of 'I' (under investigation). FIs and
 Carriers may still add Termination Dates to 'I' records at the
 time it is being created. Changes for FIs and Carriers now
 include adding a Termination date to 'Y' records if one is not
 already present. All other changes, including deletes, are
 restricted to the COB Contractors only, set the 'SP50' error code.

 The COB Contractor Numbers include '11100-11118', '11125',
 '11126', '11140', '33333', '55555', '77777', '88888',
 and '99999'.

 When the logic has processed all of the matching MSP
 Auxiliary record iterations in the table, and has not set the
 trailer matched is true, set the 'SP50' error code.

 When the originating Contractor Number on the MSP Auxiliary
 record iteration is equal to '66666', and the Insurer's name
 on the incoming HUSP transaction is not equal to the
 Insurer's name on the MSP Auxiliary record iteration, or is
 not equal to spaces, set the 'SP50' error code.

 When the originating Contractor Number on the MSP Auxiliary
 record iteration is equal '11100' or the updating Contractor
 Number on the MSP Auxiliary record iteration is equal to
 '11100', then if the Contractor Number on the incoming HUSP
 transaction is not equal to '11100', set the 'SP50' error
 code.

 When the originating Contractor Number on the MSP Auxiliary
 record iteration is in the below table, then if the
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 119
______________________________________________________________________________

Contractor Number on the incoming HUSP Delete transaction is
not valid Deleting Contractor Number from the table, set the
'SP50' error code.

                      COBC CONTRACTOR DELETE TABLE

                  ORIGINATING/UPDATING
  CONTRACTOR      CONTRACTOR WHO CAN DELETE
  ----------      -------------------------
  11100           11100
  11101, 99999    11100, 11101, 11102, 11109,   11110,
  11111, 11102    77777, 11100, 11102, 11109,   11110, 11111
  11103, 55555    11100, 11103, 11109, 11110,   11111
  11104, 33333    11100, 11104, 11109, 11110,   11111, 11112
  11105, 88888    11100, 11105, 11109, 11110,   11111
  11106, 88888    11100, 11106, 11109, 11110,   11111
  11107           11100, 11107, 11109, 11110,   11111
  11108           11100, 11108, 11109, 11110,   11111
  11109           11100, 11109, 11110, 11111
  11110           11100, 11109, 11110, 11111
  11111           11100, 11109, 11110, 11111
  11112           11100, 11109, 11110, 11111,   11112
  11113           11100, 11109, 11110, 11111,   11113
  11114           11100, 11109, 11110, 11111,   11114
  11115           11100, 11109, 11110, 11111,   11115
  11116           11100, 11109, 11110, 11111,   11116
  11117           11100, 11109, 11110, 11111,   11117
  11118           11100, 11109, 11110, 11111,   11118
  11125           11100, 11125
  11126           11100, 11126
  11140           11100-11118, 11125, 11126,    33333
                  55555, 88888, 99999

When the contractor '11140' attempts to add a new record
or delete auxiliary record, set the 'SP50' error code.

When the contractor '11140' attempts to add a termination
date to an MSP occurrence and MSP type is not equal to
'A', set the 'SP50' error code.

When the contractor '11140' attempts to add a termination
date to an MSP occurrence originated by COBC contractor
'11100', set the 'SP50' error code.

 When the FI or Carrier attempts to delete an MSP occurrence
 updated by the contractor '11140', set the 'SP50' error code.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 120
______________________________________________________________________________


Trailer Information:     '03', '08'


d. Error Code:    SP57    ( )New (X)Modified ( )Deleted
Disposition:      SP

Type of Record:   MSP

Error Message:
Termination Date greater than six months prior to date
added for Contractor Numbers other than '11100-11118',
'11125-11126', '11140', '33333', '55555', '77777', '88888',
or '99999'.

Set Condition for edit 'SP57':

When the identification number of the Satellite who
established the Auxiliary information is equal to '77777',
and the Medicare as secondary payer Termination Date is not
six months greater than the date that the Beneficiary
Auxiliary, or claim information, was added to the Host
database, set the 'SP57' error code.

When the MSP Maintenance Transaction Type is not equal to
'0', bypass this edit.

When the Maintenance Record Type is not equal to equal to
HBSP or HUSP, bypass this edit.

When the identification number of the Satellite who last
updated the Auxiliary information is equal to '11102',
'11104', '33333', or '77777', bypass this edit.

Trailer Information:     '03', '08'


e. Error Code:    SP59    ( )New (X)Modified ( )Deleted
Disposition:      SP

Type of Record:   MSP

Error Message:
Invalid Insurer Type, and Validity Indicator combination.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 121
______________________________________________________________________________

 Set Condition for edit 'SP59':

 When the MSP Validity Indicator is equal to 'N', and the MSP
 Insurer type is not equal to spaces, and Contractor Numbers
 equal '11100-11118', '11125', '11126', '11140', '33333',
 '55555', '77777', '88888', or '99999', set the 'SP59' error
 code.

 When the MSP Maintenance Transaction Action Type is equal to
 '1', bypass this edit.

 Trailer Information:     '03', '08'


 f. Error Code:    SP73    ( )New (X)Modified ( )Deleted
 Disposition:      SP

 Type of Record:   MSP

 Error Message:
 Invalid Term Date/Delete Transaction attempted.

 Set condition for edit 'SP73':

 When a FI or Carrier attempts to change a Term Date on a MSP
 Auxiliary record with a 'I' or 'Y' Validity Indicator that is
 already terminated, or trying to add Term Date to 'N' record,
 set the 'SP73' error code.

 When a FI or Carrier attempts to change a Term Date on a MSP
 occurrence terminated by contractor number '11140', set the
 'SP73' error code.

 When a FI or Carrier attempts to delete a MSP Auxiliary
 record with a 'I' Validity Indicator, set the 'SP73' error
 code.

 Trailer Information: '03', '08'

   INSTALLATION INSTRUCTIONS:

 **Refer to CR 00025816 for the Installation Instructions for this CR.**




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 122
______________________________________________________________________________

   SYSTEMS DOCUMENTATION AFFECTED:

    EDITMNTS              MODIFY ERROR CODE 'SP20' TO ADD CONTRACTOR
                          NUMBER '11140'.

    EDITMNTS              MODIFY ERROR CODE 'SP37' TO ADD CONTRACTOR
                          NUMBER '11140'.

    EDITMNTS              MODIFY ERROR CODE 'SP50' TO ADD CONTRACTOR
                          NUMBER '11140'.

    EDITMNTS              MODIFY ERROR CODE 'SP57' TO ADD CONTRACTOR
                          NUMBER '11140'.

    EDITMNTS              MODIFY ERROR CODE 'SP59' TO ADD CONTRACTOR
                          NUMBER '11140'.

    EDITMNTS              MODIFY ERROR CODE 'SP73' TO ADD CONTRACTOR
                          NUMBER '11140'.

   SATELLITE SYSTEM MODIFICATIONS:   None




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 123
______________________________________________________________________________

   5.   00025723   UTILITY TO CORRECT DATA ON SMOKING CESSATION AUX FILE

   REQUESTOR ID: CWFM1000

   IMPACT:
 (X) Host
 ( ) Satellite Part A Inpatient
 (X) Satellite Part A Outpatient
 (X) Satellite Part B
 ( ) Hospice
 ( ) Home Health
 ( ) DMERC

   REASON FOR CHANGE:
 CWF CR 25100 corrected a posting issue caused when both the
 smoking cessation HCPCS codes 'G0375' and 'G0376' are billed
 in the same Period. CWF CR 25723 is to correct the Sessions
 that are already posted incorrectly in history on the SMOK
 Aux file with a utility. CWF will also recalculate the Periods
 to ensure they are within '11' full months. This issue is
 being addresses in CWF CR 25739 for claims processing.

   NEW BUSINESS REQUIREMENTS:

 Requirement 1
 CWF will create a utility to do the following:
 CWF must read the Beneficiary Master Record to identify
 HICs that contain a SMOK auxiliary file. Ensure that Periods
 with both smoking HCPCS codes 'G0375' and 'G0376' are
 applied to the correct Period. CWF must also update the
 Periods to apply only '11' full months. If CWF identifies
 a Session that was applied in the incorrect Period, the
 Session will be reapplied to the next Period.

 Example of correctly calculated periods:

 Counseling Period '1'
  05/01/2006 thru 04/31/2007

 The next counseling period will begin based on the earliest
 From Date of Service.

 DOS 05/01/2007 would post in Counseling Period '2'.
 DOS 05/01/2008 would post in Counseling Period '3'.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 124
______________________________________________________________________________

 Example of incorrect data displayed:

 COUNSELING PERIOD: 1 2 3 4 5
  TOTAL SESSIONS:   8 0 0 0 0
                                         CLM
  HCPCS     FROM - THRU      PERIOD QTY TYPE   ICN/DCN
  G0376 04/26/2006 04/26/2006 1      1    O     SMOK-1
        04/28/2006 04/28/2006 1      1    O     SMOK-2
        05/01/2006 05/01/2006 1      1    O     SMOK-3
        05/02/2006 05/02/2006 1      1    O     SMOK-4
        05/05/2006 05/05/2006 1      1    O     SMOK-5
        05/08/2006 05/08/2006 1      1    O     SMOK-6
        05/09/2006 05/09/2006 1      1    O     SMOK-7
  G0375 06/26/2007 06/28/2007 1      1    O     SMOK-8

 Because the DOS 06/26/2007 is past the '11' full month
 period for the earliest DOS (04/26/2006), the claim data
 for HCPCS code 'G0375' should be displayed with a Period
 '2'. Counseling Period 1 should display '7' Total Sessions
 and Counseling Period 2 should display '1' Total Sessions.

 Example of correct data displayed:

 COUNSELING PERIOD: 1 2 3 4 5
  TOTAL SESSIONS:   7 1 0 0 0
                                         CLM
  HCPCS     FROM - THRU      PERIOD QTY TYPE   ICN/DCN
  G0376 04/26/2006 04/26/2006 1      1    O     SMOK-1
        04/28/2006 04/28/2006 1      1    O     SMOK-2
        05/01/2006 05/01/2006 1      1    O     SMOK-3
        05/02/2006 05/02/2006 1      1    O     SMOK-4
        05/05/2006 05/05/2006 1      1    O     SMOK-5
        05/08/2006 05/08/2006 1      1    O     SMOK-6
        05/09/2006 05/09/2006 1      1    O     SMOK-7
  G0375 04/26/2007 04/26/2007 2      1    O     SMOK-8

 Requirement 2
 Generate a report by Host to identify the HIC that requires
 an update to the SMOK Aux file. This report will be generated
 only for testing purposes.




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 125
______________________________________________________________________________

  EVENT-RESPONSE LIST:

Event 1.1
Run the utility against the Beneficiary Master Records
to identify HICs with a SMOK Aux file. Verify the data
contained in the Counseling Period is valid for the HICs
identified in the CWF SMOK AUX file that contain both
smoking HCPCS codes 'G0375' and 'G0376'. Also verify
each Session is within '12' months.

Response
CWF will correct the Sessions to apply to the correct
Period with a maximum of '8'. Once a session has been
satisfied, the next session begins after '11' full months.

Event 2.1
Generate a report by Host identifying HICs requiring an
update to the SMOK Aux file.

Response
The report will be generated displaying HICs requiring
an update to the SMOK Aux file.

The Entity List includes only NEW acronyms and terminology
that is currently not in use in CWF.

Entity List: N/A

Areas Affected by the Problem.
  1. SMOK Aux File

Solution Criteria: N/A

  EDITS AFFECTED:   None

  INSTALLATION INSTRUCTIONS:

**Refer to CR 00025816 for the Installation Instructions for this CR.**

  SYSTEMS DOCUMENTATION AFFECTED:   None

  SATELLITE SYSTEM MODIFICATIONS:   None




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 126
______________________________________________________________________________

   6.   00025739   MODIFICATIONS NEEDED FOR DATA POSTED TO SMOK AUXILIARY FILE

   REQUESTOR ID: CWFM1000

   IMPACT:
 (X) Host
 ( ) Satellite Part A Inpatient
 (X) Satellite Part A Outpatient
 (X) Satellite Part B
 ( ) Hospice
 ( ) Home Health
 ( ) DMERC

   REASON FOR CHANGE:
 With the implementation of CR 24270, in Release 2005.2 five
 Counseling Periods were created to store the data for HCPCS
 codes 'G0375' and 'G0376'. When a claim came in that would
 create a sixth period, CR 24270 designated the oldest data
 would be removed. This change is no longer working to apply
 the incoming record to the SMOK Aux file and remove the oldest
 Counseling Period. This CR will be used to fix that code. The
 Counseling Periods were also being incorrectly calculated for
 '12' month periods. The Counseling Periods should be calculated
 as '11' full month periods for future processing.

 NOTE:
 CWF CR 25723 will address correcting existing Periods in the
 utility.

 Modifications to the following edits will be made to reflect
 '11' full months also.

 Consistency Edit '5A#2' - The units billed exceed '8'. (OUTP)

 Consistency Edit '66x8' - The units billed exceed '8'. (Pt B)

 Utilization Edit '539E' - Medicare does not pay for more
 than '8' sessions of Smoking Cessation Counseling.

 Modification for the next eligible date to be '11' full
 months for the NGD and MBD are also needed.




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 127
______________________________________________________________________________

   NEW BUSINESS REQUIREMENTS:

 Requirement 1
 Modify the SMOK Aux file to ensure the oldest Counseling
 Period is removed when a claim is received that would
 create a sixth Period and apply the incoming record to
 the appropriate Counseling Period since only 5 counseling
 Periods are displayed on the SMOK Aux file.

 EXAMPLE SMOK AUX FILE:
 (Before incoming claim that would create another period)

 COUNSELING PERIOD:   1    2     3   4   5
    TOTAL SESSIONS:   8    0     0   0   0
                                                         CLM
   HCPCS       FROM    -        THRU      PERIOD   QTY   TYPE   ICN/DCN
   G0376      10/01/2005       10/01/2005    1      1     O      TEST-1
              11/01/2005       11/01/2005    1      1     O      TEST-2
              12/01/2005       12/01/2005    1      1     O      TEST-3
              01/01/2006       01/01/2006    1      1     O      TEST-4
              02/01/2006       02/01/2006    1      1     O      TEST-5
              03/01/2006       03/01/2006    1      1     O      TEST-6
              04/01/2006       04/01/2006    1      1     O      TEST-7
              05/01/2006       05/01/2006    1      1     O      TEST-8

 INCOMING CLAIM                                          CLM
    HCPCS       FROM   -        THRU      PERIOD   QTY   TYPE   ICN/DCN
    G0375     10/01/2010       10/01/2010    1      1     O      TEST-10

 EXAMPLE SMOK AUX FILE:
 (After incoming claim that would create another period)

 COUNSELING PERIOD:   1    2     3   4   5
    TOTAL SESSIONS:   0    0     0   0   1
                                                         CLM
   HCPCS       FROM    -        THRU      PERIOD   QTY   TYPE   ICN/DCN
   G0375      10/01/2010       10/01/2010    1      1     O      TEST-10

 Requirement 2
 Modify the SMOK Aux file Counseling Period calculation to be
 '11' full months for each Period.

 EXAMPLE SMOK AUX FILE: (BEFORE)
 COUNSELING PERIOD:   1   2   3      4   5
    TOTAL SESSIONS:   1   1   1      1   1
                                                   CLM
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 128
______________________________________________________________________________

   HCPCS       FROM    -    THRU      PERIOD      QTY   TYPE     ICN/DCN
   G0375      10/01/2005   10/01/2005    1         1     B        TEST-1
              10/01/2006   10/01/2006    1         1     B        TEST-2
              10/01/2007   10/01/2007    1         1     B        TEST-3
              10/01/2008   10/01/2008    1         1     B        TEST-4
              10/01/2009   10/01/2009    1         1     B        TEST-5

Requirement 3
Modify consistency edit '5A#2' (The units billed exceed '8'
(OUTP)) to be calculated with '11' full months.

Requirement 4
Modify consistency edit '66x8' (The units billed exceed '8'
(PT B)) to be calculated with '11' full months.

Requirement 5
Modify utilization edit '539E' (Medicare does not pay for
more than '8' sessions of Smoking Cessation Counseling)
to be calculated with '11' full months for each Period.

Requirement 6
Modify the NGD/MBD to reflect the next eligible date for
Smoking Cessation as '11' full months instead of '12' months
when all 8 Sessions have been applied.

Requirement 7
Modify the HIMR SMOK screen to display the SMOK Initial Date.
This is the date of the first Smoking Cessation Training
claim and is used to derive the 5 training periods.

Note:   Updated 06/18/08 per C. Pflaum

        Only 10 years of Smoking Cessation data will be
        allowed after the Initial Date. Subsequent claims
        will post to the SMOK Auxiliary File and increment into
        the 10th year until 8 units have been accumulated.

EXAMPLE SMOK AUX FILE:

INITIAL DATE: 10/01/2010       <<<<<   New Field added in HIMR
                                       for Benes with claims after
                                       7/1/2008

COUNSELING PERIOD:    1    2     3     4   5
   TOTAL SESSIONS:    1    0     0     0   0
                                                   CLM
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 129
______________________________________________________________________________

   HCPCS      FROM    -        THRU      PERIOD   QTY   TYPE   ICN/DCN
   G0375     10/01/2010       10/01/2010    1      1     O      TEST-10

  EVENT-RESPONSE LIST:

Event 1.1
An HUBC/HUOP record for Smoking Cessation is received
for a Beneficiary that already has a SMOK Aux file with
data in Period 1 only. The incoming record will create
a new Period greater than Period 5.

Response
The oldest Period will drop off the SMOK Aux file and
the incoming record will now become Period 5.

EXAMPLE SMOK AUX FILE:
(Before incoming claim that would create another Period)

COUNSELING PERIOD:   1    2     3   4   5
   TOTAL SESSIONS:   8    0     0   0   0
                                                        CLM
   HCPCS      FROM    -        THRU      PERIOD   QTY   TYPE   ICN/DCN
   G0376     10/01/2005       10/08/2005    1      8     O      TEST-1

EXAMPLE SMOK AUX FILE:
(After incoming claim that would create a Period greater than Period 5)

COUNSELING PERIOD:   1    2     3   4   5
   TOTAL SESSIONS:   0    0     0   0   1
                                                        CLM
   HCPCS      FROM    -        THRU      PERIOD   QTY   TYPE   ICN/DCN
   G0375     10/01/2010       10/01/2010    1      1     O      TEST-2

Event 1.2
An HUBC/HUOP record for Smoking Cessation is received
for a Beneficiary that already has a SMOK Aux file
with data in Period 1, Period 2, and Period 5. No data
is reflected in Period 3 or Period 4. The incoming
record will create a new Period greater than Period 5.

Response
The oldest Period will drop off the SMOK Aux file and
the remaining data will be shifted up to accommodate
the new Period 5 data the incoming records created.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 130
______________________________________________________________________________

 EXAMPLE SMOK AUX FILE:
 (Before incoming claim that would create another period)

 COUNSELING PERIOD:   1    2     3   4   5
    TOTAL SESSIONS:   8    5     0   0   2
                                                         CLM
    HCPCS      FROM    -        THRU      PERIOD   QTY   TYPE   ICN/DCN
    G0376     10/01/2005       10/08/2005    1      8     O      TEST-1
    G0376     10/01/2006       10/05/2006    1      5     O      TEST-2
    G0376     10/01/2009       10/02/2009    1      2     O      TEST-3

 EXAMPLE SMOK AUX FILE:
 (After incoming claim that would create another period)

 COUNSELING PERIOD:   1    2     3   4   5
    TOTAL SESSIONS:   5    0     0   2   1
                                                         CLM
    HCPCS      FROM    -        THRU      PERIOD   QTY   TYPE   ICN/DCN
    G0376     10/01/2006       10/05/2006    1      5     O      TEST-2
    G0376     10/01/2009       10/02/2009    1      2     O      TEST-3
    G0375     10/01/2010       10/01/2010    1      1     O      TEST-4

 Event 1.3
 An HUBC/HUOP record for Smoking Cessation is received
 for a Beneficiary that already has a SMOK Aux file
 with data in Period 1 only. The incoming records Date
 of Service falls within Period 3.

 Response
 Period 1 remains the same and the incoming record is
 applied to Period 3.

 EXAMPLE SMOK AUX FILE:
 (Before incoming claim that would create another period)

 COUNSELING PERIOD:   1    2     3   4   5
    TOTAL SESSIONS:   8    0     0   0   0
                                                         CLM
    HCPCS      FROM    -        THRU      PERIOD   QTY   TYPE   ICN/DCN
    G0376     10/01/2005       10/08/2005    1      8     O      TEST-1

 INCOMING CLAIM                                          CLM
    HCPCS       FROM   -        THRU      PERIOD   QTY   TYPE   ICN/DCN
    G0375     10/01/2007       10/01/2007    1      1     O      TEST-2


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 131
______________________________________________________________________________

EXAMPLE SMOK AUX FILE:
(After incoming claim that would fall within Period 3)

COUNSELING PERIOD:   1    2     3   4   5
   TOTAL SESSIONS:   8    0     1   0   0
                                                        CLM
   HCPCS      FROM    -        THRU      PERIOD   QTY   TYPE   ICN/DCN
   G0376     10/01/2005       10/08/2005    1      8     O      TEST-1
   G0375     10/01/2007       10/01/2007    1      1     O      TEST-2

Event 2.1
An HUBC/HUOP Smoking Cessation record is received and
creates the first SMOK Aux file for the Beneficiary.
The next Smoking Cessation record that is received is
not within '11' full months of the existing Counseling
period already posted to the SMOK Aux file.

Response
The incoming record is posted to the appropriate Counseling
Period.

Event 2.2
An HUBC/HUOP Smoking Cessation record is received and
creates the first SMOK Aux file for the Beneficiary. The
next Smoking Cessation record that is received is within
'11' full months of the existing Counseling Period already
posted to the SMOK Aux file and the 8 sessions

Response
The incoming record is posted to the appropriate Counseling
Period.

Event 3.1
An HUOP record is received with HCPCS code 'G0375' or
'G0376' and Dates of Service prior to 01/01/2008 and
units exceeding '8'.

Response
The record is rejected, error code '5A#2' is set.

Event 3.2
An HUOP record is received with HCPCS code '99406' or
'99407' and Dates of Service on, or after 07/01/2008
and units exceeding '8'.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 132
______________________________________________________________________________

 Response
 The record is rejected, error code '5A#2' is set.

 Event 3.3
 An HUOP record is received with HCPCS code 'G0375' or
 'G0376' and Dates of Service prior to 01/01/2008 and
 units not exceeding '8'.

 Response
 The record is accepted, error code '5A#2' is not set

 Event 3.4
 An HUOP record is received with HCPCS code '99406' or
 '99407' and Dates of Service on, or after 07/01/2008
 and units not exceeding '8'.

 Response
 The record is accepted, error code '5A#2' is not set.

 Event 4.1
 An HUBC record is received with HCPCS code 'G0375' or
 'G0376' and Dates of Service prior to 01/01/2008 and
 units exceeding '8'.

 Response
 The record is rejected, error code '66x8' is set.

 Event 4.2
 An HUBC record is received with HCPCS code '99406' or
 '99407' and Dates of Service on, or after 07/01/2008
 and units exceeding '8'.

 Response
 The record is rejected, error code '66x8' is set.

 Event 4.3
 An HUBC record is received with HCPCS code 'G0375' or
 'G0376' and Dates of Service prior to 01/01/2008 and
 units not exceeding '8'.

 Response
 The record is accepted, error code '66x8' is not set.

 Event 4.4
 An HUBC record is received with HCPCS code '99406' or
 '99407' and Dates of Service on, or after 07/01/2008
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 133
______________________________________________________________________________

 and units not exceeding '8'.

 Response
 The record is accepted, error code '66x8' is not set.

 Event 5.1
 An HUBC/HUOP record is received with HCPCS code '99406'
 or '99407' and Dates of Service on, or after 07/01/2008
 The Beneficiary has '8' sessions posted in one Period
 of the 'SMOK' Auxiliary file. The incoming date is within
 '11' full months of the '8' posted sessions.

 Response
 The record is rejected, error code '539E' is set.

 Event 5.2
 An HUBC/HUOP record is received with HCPCS code 'G0375'
 or 'G0376' and Dates of Service prior to 01/01/2008.
 The Beneficiary has '8' sessions posted in one Period
 of the 'SMOK' Auxiliary file. The incoming date is within
 '11' full months of the '8' posted sessions.

 Response
 The record is rejected, error code '539E' is set.

 Event 5.3
 An HUBC/HUOP record is received with HCPCS code '99406'
 or '99407' and Dates of Service on, or after 07/01/2008
 The Beneficiary has '8' sessions posted in one Period
 of the 'SMOK' Auxiliary file. The incoming date is not
 within '11' full months of the '8' posted sessions.

 Response
 The record is accepted, error code '539E' is not set.

 Event 5.4
 An HUBC/HUOP record is received with HCPCS code 'G0375'
 or 'G0376' and Dates of Service prior to 01/01/2008.
 The Beneficiary has '8' sessions posted in one Period
 of the 'SMOK' Auxiliary file. The incoming date is not
 within '11' full months of the '8' posted sessions.

 Response
 The record is accepted, error code '539E' is not set.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 134
______________________________________________________________________________

Event 6.1
Review the NGD/MBD extract file for the next eligible date.

Response
The date reflected for the smoking HCPCS is within
'12' months.

Event 7.1
Review HIMR SMOK screen.

Response
The Initial Date field is populated with the Service date
of the first Smoking Cessation Training Claim.

The Entity List includes only NEW acronyms and terminology
that is currently not in use in CWF.

Entity List: N/A

Areas Affected by the Problem.
  1. EDITCONS HUOPCED / HUBCCED
  2. EDITUTIL HUOPCUT / HUBCCUT
  3. MBD/NGD extract file
  4. OVERHIMR

Solution Criteria: N/A

  EDITS AFFECTED:

a. Error Code:      5A#2   ( )New (X)Modified ( )Deleted
Disposition: ER

Type of Record: OUTP

Error Message:
The units billed exceed '8'. Medicare does not pay for more
than '8' sessions of Smoking Cessation Counseling in '11'
full months.

Set Condition for edit '5A#2':

When an Outpatient (HUOP) record with a Service Date
on or after 10/03/2005 has total units that exceed 8 for
HCPCS codes 'G0375' and/or 'G0376', set the '5A#2' error
code.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 135
______________________________________________________________________________

 When an Outpatient (HUOP) record with a Service Date
 on or after 07/01/2008 has total units that exceed 8 for
 HCPCS codes '99406' and/or '99407', set the '5A#2' error
 code.

 When the No-Pay Code is 'N', bypass this edit.

 When the Total Charges equal the Non-covered Charges,
 bypass this edit.

 Trailer Information:     08


 b. Error Code:    66x8    ( )New (X)Modified ( )Deleted
 Disposition: ER

 Type of Record: Pt. B Carrier

 Error Message:
 The units billed exceed '8'. Medicare does not pay for more
 than '8' sessions of Smoking Cessation Counseling in '11'
 full months.

 Set Condition for edit '66x8':

 When a Part B (HUBC) record with a Service Date
 on or after 10/03/2005 has total units that exceed 8 for
 HCPCS codes 'G0375' and/or 'G0376', set the '66x8' error
 code.

 When a Part B (HUBC) record with a Service Date
 on or after 07/01/2008 has total units that exceed 8 for
 HCPCS codes '99406' and/or '99407', set the '66x8' error
 code.

 When the Entry Code is '3', bypass this edit.

 If the claim or line item is denied, bypass this edit.

 Trailer Information: '08'




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 136
______________________________________________________________________________

 c. Error Code:    539E   ( )New (X)Modified ( )Deleted
 Disposition: UR

 Type of Record: OUTP

 Error Message:
 Medicare does not pay for more than '8' sessions of Smoking
 Cessation Counseling in '11' full months.

 Set Condition for edit '539E':

 If an incoming Outpatient record has HCPCS code 'G0375'
 or 'G0376' with a Service Date on or after 10/03/2005
 and the number of units will cause the number of units on
 an existing Smoking Cessation Training period on the TRNGAUX
 file to exceed a total of '8', set the '539E' error code.

 If an incoming Outpatient record has HCPCS code '99406'
 or '99407' with a Service Date on or after 07/01/2008
 and the number of units will cause the number of units on
 an existing Smoking Cessation Training period on the TRNGAUX
 file to exceed a total of '8', set the '539E' error code.

 When the No-Payment Code is 'B' or 'N', bypass the edit.

 When the No-Payment Code is not present, but the Non-Covered
 Charge for the detail line item is equal to the Total Charge,
 bypass the edit.

 When the Action Code is '4' (Cancel Only), bypass the edit.

 When the Action Code is '7' (History Bill), bypass the edit.

 Trailer Information: '08'

   INSTALLATION INSTRUCTIONS:     None

   SYSTEMS DOCUMENTATION AFFECTED:

     EDITCONS                MODIFY '66X8' WITH '11' FULL MONTH LOGIC.

     EDITCONS                MODIFY '5A#2' WITH '11' FULL MONTH LOGIC.

     EDITUTIL                MODIFY '539E' WITH '11' FULL MONTH LOGIC.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 137
______________________________________________________________________________

    COPYXTNL              POST THE UPDATES FOR NEXT ELIGIBLE DATES
                          TO THE CABEMBD/CABENGD COPYBOOK.

   SATELLITE SYSTEM MODIFICATIONS:

**Refer to CR 00025817 for the Satellite System Modifications for this CR.**




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 138
______________________________________________________________________________

   7.   00025740   5855-SYSTEMS CHANGES FOR PRESCRIPTION ORDER NUMBERS FOR CAPS

   REQUESTOR ID: CWFM2000

   IMPACT:
 (X) Host
 ( ) Satellite Part A Inpatient
 ( ) Satellite Part A Outpatient
 (X) Satellite Part B
 ( ) Hospice
 ( ) Home Health
 ( ) DMERC

   REASON FOR CHANGE:
 Providers are submitting CAP claims with inappropriate
 prescription order numbers. The inappropriate prescription
 order numbers are disrupting the matching process with
 the vendor claims. Contractors shall be directed to treat
 these claims as unprocessable. Contractors shall also be
 directed to treat as unprocessable CAP claims received
 with prescription order numbers less than ten characters.

 CAP Providers and CAP vendors will not be allowed to submit
 new claims (processed as an Entry Code '1') with prescription
 order numbers that they have already submitted on previously
 adjudicated claims, even if the prior claims have been denied.
 The CAP Providers and CAP vendors must request an adjustment
 which will be processed as an Entry Code '5' to the original
 claim. CWF will continue to overlay these adjustments (entry
 code 5) on the CAP Auxiliary (AUX) file. CWF shall also continue
 to return an Informational Unsolicited Response when the
 adjustment overlays the current record and the pay/process
 indicator has changed. Claims that have been returned as
 unprocessable may be accepted with the original prescription
 order number when resubmitted after being corrected.

 CWF will create a new utilization error code that will be
 returned when it receives a claim (entry code '1') that has
 a prescription order number on it that matches a prescription
 order number already on the CAP AUX file from a different claim.
 CWF coding will differentiate between claims from the Providers
 and claims from the CAP vendor. It will be acceptable to allow
 a claim with a duplicate prescription order number as long as
 one claim is from a Provider and the other claim is from the
 vendor. This will allow the prescription order number matching
 process to continue.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 139
______________________________________________________________________________


  NEW BUSINESS REQUIREMENTS:

Requirement 1
CWF will create new utilization edit '5711' for an
HUBC Vendor (Specialty Type '95' from designated
Carrier '66001') claim with Entry Code '1' (initial
claim) that has a duplicate Vendor prescription
number that is already present on the CAPS AUX file.

The new utilization edit '5711' will also edit for
an HUBC Physician (WITHOUT Specialty Type '95' from
a Carrier other than '66001') claim with Entry Code
'1' (initial claim) that has a duplicate Physician
prescription number that is already present on the
CAPS AUX file.

CWF coding will differentiate between claims from the
physicians and claims from the CAP vendor. It will be
acceptable to allow a claim with a duplicate prescription
order number as long as one claim is from a physician
and the other claim is from the vendor. This will allow
the prescription order number matching process to
continue.

The new edit will NOT apply to Entry Code '5' (adjustments)
or Entry Code '3' (Cancels) but continue to overlay the
existing record with the same prescription number.

  EVENT-RESPONSE LIST:

Event 1.1
An HUBC physician (WITHOUT Specialty Type '95' from a Carrier
other than '66001') Entry Code '1' (initial claim) claim is
received with a duplicate physician prescription number that
is already present on the CAPS AUX file.

Response
The record is rejected, utilization edit '5711' is set.

Event 1.2
An HUBC vendor (Specialty Type '95' from designated Carrier
'66001') Entry Code '1' (initial claim) claim is received
with a duplicate vendor prescription number that is already
present on the CAPS AUX file.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 140
______________________________________________________________________________

Response
The record is rejected, utilization edit '5711' is set.

Event 1.3
An HUBC physician (WITHOUT Specialty Type '95' from a Carrier
other than '66001') Entry Code '1' (initial claim) claim is
received with a physician prescription number that is not
already present on the CAPS AUX file.

Response
The record is accepted, utilization edit '5711' is not set.

Event 1.4
An HUBC vendor (Specialty Type '95' from designated Carrier
'66001') Entry Code '1' (initial claim) claim is received
with a vendor prescription number that is not already
present on the CAPS AUX file.

Response
The record is accepted, utilization edit '5711' is not set.

Event 1.5
An HUBC physician (WITHOUT Specialty Type '95' from a Carrier
other than '66001') Entry Code '5' (adjustment) claim is
received with a duplicate physician prescription number that
is already present on the CAPS AUX file.

Response
The record is accepted, utilization edit '5711' is not set.

Event 1.6
An HUBC vendor (Specialty Type '95' from designated Carrier
'66001') Entry Code '5' (adjustment) claim is received
with a duplicate vendor prescription number that is already
present on the CAPS AUX file.

Response
The record is accepted, utilization edit '5711' is not set.

Event 1.7
An HUBC physician (WITHOUT Specialty Type '95' from a Carrier
other than '66001') Entry Code '3' (Cancel) claim is received
with a duplicate physician prescription number that is already
present on the CAPS AUX file.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 141
______________________________________________________________________________

Response
The record is accepted, utilization edit '5711' is not set.

Event 1.8
An HUBC vendor (Specialty Type '95' from designated Carrier
'66001') Entry Code '3' (cancel) claim is received with a
duplicate vendor prescription number that is already present
on the CAPS AUX file.

Response
The record is accepted, utilization edit '5711' is not set.

The Entity List includes only NEW acronyms and terminology
that is currently not in use in CWF.

Entity List: N/A

Areas Affected by the Problem.
  1. Utilization

Solution Criteria: N/A

  EDITS AFFECTED:

a. Error Code:      5711   (X)New ( )Modified ( )Deleted
Disposition: UR

Type of Record: PT. B Carrier

Error Message:
Duplicate prescription number on the CAPS Auxiliary File.

Set Condition for edit '5711':

When an HUBC physician (WITHOUT Specialty Type '95' from a
Carrier other than '66001') Entry Code '1' (initial claim)
claim is received with a duplicate physician prescription
number that is already present on the CAPS AUX file, set the
'5711' error code.

When an HUBC vendor (Specialty Type '95' from designated Carrier
'66001') Entry Code '1' (initial claim) claim is received
with a duplicate vendor prescription number that is already
present on the CAPS AUX file, set the '5711' error code.

 When the edit for entry code equals '3' and '5', bypass this edit.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 142
______________________________________________________________________________


Trailer Information: 08

  INSTALLATION INSTRUCTIONS:   None

  SYSTEMS DOCUMENTATION AFFECTED:

    EDITUTIL              ADD NEW UR EDIT '5711'.

    EDITLIST              ADD NEW UR EDIT '5711'.

  SATELLITE SYSTEM MODIFICATIONS:     None




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 143
______________________________________________________________________________

   8.   00025747   5210 REC'D IN ERROR

   REQUESTOR ID: EMBCBS1000

   IMPACT:
 (X) Host
 (X) Satellite Part A Inpatient
 ( ) Satellite Part A Outpatient
 ( ) Satellite Part B
 ( ) Hospice
 ( ) Home Health
 ( ) DMERC

   REASON FOR CHANGE:
 CWF is incorrectly setting utilization edit '5210' on Inpatient
 claims submitted by PPS Providers when the Thru Date is after
 the Part A Termination Date.

 5210 - Services After Benefits Terminated.

   NEW BUSINESS REQUIREMENTS:

 Requirement 1
 CWF will modify utilization edit '5210' to bypass when an
 Inpatient claim is submitted by a PPS Provider and the
 Thru Date is greater than the Part A Termination Date.
 The Admit Date on the PPS claim will be used to determine
 if the '5210' edit should set.
 The logic will not be changed for PPS psychiatric claims.

   EVENT-RESPONSE LIST:

 Event 1.1
 Submit an Inpatient claim from a PPS Provider. The Thru Date
 is after the Part A Termination Date. The Admit Date of the PPS claim
 is within the Part A Entitlement and Termination Dates.

 Response
 Edit '5210' is not set.

 Event 1.2
 Submit an Inpatient claim from a PPS Provider. The From
 Date is after the Part A Termination Date. The Admit Date of
 the PPS claim is within the Part A Entitlement and Termination Dates.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 144
______________________________________________________________________________

Response
Edit '5210' is not set.

Event 1.3
Submit an Inpatient claim from a PPS Provider. The Admit Date of
the PPS claim is after the Part A Termination Date.

Response
Edit '5210' is set.

The Entity List includes only NEW acronyms and terminology
that is currently not in use in CWF.

Entity List: N/A

Areas Affected by the Problem.
  1.   Utilization - HUOPCUT

Solution Criteria: N/A

  EDITS AFFECTED:

a. Error Code: 5210       ( )New (X)Modified ( )Deleted
Disposition: UR

Type of Record:     Hospital, SNF, HHA, Hospice, OUTP

Error Message:
Services After Benefits Terminated.

Set Condition for edit '5210':

Hospital, SNF
When the claim service From Date is greater than, or equal to,
the Beneficiary Part A entitlement Start Date, and the
Beneficiary Part A entitlement Start Date is not equal to
zero, and the claim service From Date is greater than the
Beneficiary Part A entitlement Termination Date, set the
'5210' error code.

 When the claim service From Date is greater than, or equal to,
 the Beneficiary Part A entitlement Start Date, and the
 Beneficiary Part A entitlement Start Date is not equal to
 zero, and the claim service From Date is less than the
 Beneficiary Part A entitlement Termination Date, and the claim
 service Thru Date is greater than the Beneficiary Part A
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 145
______________________________________________________________________________

 Termination Date, set the '5210' error code.

 When the claim service From Date is less than the Beneficiary
 Part A entitlement Start Date, and is greater than the
 Beneficiary prior Part A Termination Date, set the '5210'
 error code.

 When the claim service From Date is greater than the claim GHO
 Termination1 Date, set the '5210' error code.

 When the claim service From Date is less than the Beneficiary
 Part A entitlement Start Date, and is greater than the
 Beneficiary prior Part A Termination Date, set the '5210'
 error code.

 When the claim service From Date is greater than the claim GHO
 Termination1 Date, set the '5210' error code.

 When Condition Code '65' is present CWF will read the From and
 Thru Date of the claim.

 When Condition Code '65' is NOT present CWF will read the
 Admit Date of the claim.

 If the Type of Bill is '11Z' and the Demo Number is '38' and
 the Admit Date is during the Part A entitlement period or the
 Admit Date is during the Part B entitlement period, bypass
 this edit.

 If the Type of Bill is not '11Z' and the Beneficiary does not
 have Part A entitlement, bypass this edit.

 When the claim Action Code is equal to '2', '4', or '6',
 bypass this edit.

 When an Inpatient claim is submitted by a PPS Provider and
 the Admit Date is greater than, or equal to the Part A Termination
 Date, bypass this edit.

 HHA, Hospice
 When the service From Date is greater than the Beneficiary
 current Part A entitlement Termination Date, set the '5210'
 error code.

 When the service From Date is greater than the Beneficiary
 current Part A entitlement Start Date, and the service Thru
______________________________________________________________________________
2020 Company, LLC                                           Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 146
______________________________________________________________________________

 Date is greater than the Beneficiary current Part A
 entitlement Termination Date, set the '5210' error code.

 When the service From Date is greater than the Beneficiary
 prior Part A entitlement Start Date, and the service From Date
 is greater than the Beneficiary prior Part A entitlement
 Termination Date, set the '5210' error code.

 When the service From Date is greater than the Beneficiary
 prior Part A entitlement Start Date, and the service From Date
 is greater than the Beneficiary prior Part A entitlement
 Termination Date, set the '5210' error code.

 When the service From Date is greater than the Part A Prior
 Entitlement Term Date, set the '5210' error code.

 Hospice, OUTP
 When the service From Date is greater than the Beneficiary
 current Part B entitlement Termination Date, set the '5210'
 error code.

 When the service From Date is greater than the Beneficiary
 current Part B entitlement Start Date, and the service Thru
 Date is greater than the Beneficiary current Part B
 entitlement Termination Date, set the '5210' error code.

 When the service From Date is greater than the Beneficiary
 prior Part B entitlement Start Date, and the service From Date
 is greater than the Beneficiary prior Part B entitlement
 Termination Date, set the '5210' error code.

 When the service From Date is greater than Part A Prior
 Entitlement Termination Date, set the '5210' error code.

 When the Outpatient data indicator (Occurrence Span Code '26')
 is greater than one, bypass this edit.
 Inpatient/SNF/Hospice/Home Health for Part A services.

 When a 'Y' is present in the field 'ESRD' on the Beneficiary
 Master Record, if the Dates of Service are after the Part A
 Termination Date, but prior to 12/01/2003, bypass this edit.

 Trailer Information:   04, 08



______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 147
______________________________________________________________________________

  INSTALLATION INSTRUCTIONS:   None

  SYSTEMS DOCUMENTATION AFFECTED:

    EDITUTIL             ADD BYPASS FOR PPS PROVIDERS FOR EDIT
                         '5210'.

  SATELLITE SYSTEM MODIFICATIONS:     None




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 148
______________________________________________________________________________

  9.   00025753   UR5703/UR5704 ISSUES

  REQUESTOR ID: CWFM1000

  IMPACT:
(X) Host
( ) Satellite Part A Inpatient
( ) Satellite Part A Outpatient
(X) Satellite Part B
( ) Hospice
( ) Home Health
( ) DMERC

  REASON FOR CHANGE:
Part B claims submitted with Dates of Service that are
within 90 days of the history claim with the same UPIN
and the same Category '13' HCPCS code should set
utilization error code '5703'.

When the Date of Service on the incoming claim is within
90 days prior to the history claim, utilization error
'5704' is setting in error.

Note: Utilization '5703' sets correctly when the incoming
      Date of Service is within 90 days after the Date of
      Service of the history claim.

  NEW BUSINESS REQUIREMENTS:

Requirement 1
CWF must set error code '5703' when an incoming HUBC record
contains a Date of Service that is within 90 days prior to
the Date of Service posted to a history claim. The incoming
and history claim contains the same UPIN and the same HCPCS
code that is in Category '13'.

  EVENT-RESPONSE LIST:

Event 1.1
Submit an HUBC record that contains a Category '13' HCPCS
code and the same UPIN of an HUBC record posted to history.
The Date of Service on the incoming claim is within 90 days
prior to the Date of Service on the posted claim.

 Response
 The record is rejected, error code '5703' is set.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 149
______________________________________________________________________________


  EDITS AFFECTED:

a. Error Code:      5703   ( )New (X)Modified ( )Deleted
Disposition:        UR

Type of Record:     Pt. B Carrier

Error Message:
Possible Duplicate Billing - by same physician
for the same surgery within 90 days.

Set Condition for edit '5703':

Effective Date: 01/01/1992
When an incoming Part B claim contains an HCPCS code in
Category '13', and there is a Part B claim on history with the
same HCPCS code and servicing Provider UPIN that has Dates of
Service that overlapping, between, equal to, or within 90 days
prior to the incoming claim, the Type of Service on both
claims is '2', and the history claim Dates of Service also
fall on, or after, the error code Effective Date, set the '5703'
error code.

When the Part B incoming claim has a Modifier equal to '51',
'55', '58', '59', '62', '66', '76', '77', '78', '79', 'E1',
'E2', 'E3', 'E4', 'F1', 'F2', 'F3', 'F4', 'F5', 'F6', 'F7',
'F8', 'F9', 'FA', 'GB', 'SG', 'T1', 'T2', 'T3', 'T4', 'T5',
'T6', 'T7', 'T8', 'T9', or 'TA', and the Effective Date is
equal to 01/01/1992, bypass this edit.

When the Part B history claim has a Modifier equal to '51',
'55', '58', '76', '77', '78', '79', or 'SG', bypass this edit.

When the Part B incoming claim has a Modifier equal to 'LT'
and the history claim has 'RT' Modifier, bypass this edit.

When the Part B incoming claim has Modifier equal to 'RT' and
the history claim has 'LT' Modifier, bypass this edit.

When the Part B claim is incoming or on history and has
Payment/Process Indicator other than 'A', 'R', or 'S', bypass
this edit.

 When the Ordering Physician UPIN is not present but the detail
 NPI Rendering Physician is present, bypass this edit.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 150
______________________________________________________________________________


 Trailer Information:     06, 08


 b. Error Code:    5704    ( )New (X)Modified ( )Deleted
 Disposition:      UR

 Type of Record:   Pt. B Carrier

 Error Message:
 Possible Duplicate Billing - by same physician
 for any procedure within 90 days.

 Set Condition for edit '5704':

 Effective Date: 01/01/1992
 When an incoming Part B claim contains an HCPCS codes in
 Category '13', and there is a Part B claim on history with the
 same servicing Provider UPIN that has Dates of Service that
 are equal to, overlapping, or within 90 days before or after
 the incoming claim, and the Type of Service on both claims is
 '2', the history claim Dates of Service also fall on, or
 after, the error code Effective Date, and the history claim
 contains one of the HCPCS codes in Category '13', set the
 '5704' error code.

 When the Part B incoming claim has a Modifier equal to '51'
 '55', '58', '59', '62', '66', '76', '77', '78', '79', 'E1
 'E2', 'E3', 'E4', 'F1', 'F2', 'F3', 'F4', 'F5', 'F6', 'F7
 'F8', 'F9', 'FA', 'GB', 'SG', 'T1', 'T2', 'T3', 'T4', 'T5
 'T6', 'T7', 'T8', 'T9', or 'TA', bypass this edit.

 When the Part B history claim has a Modifier equal to '51'
 '55', '58', '76', '77', '78', '79', or 'SG', bypass this edit.

 When the Part B incoming claim has a Modifier equal to 'LT'
 and the history claim has 'RT' Modifier, bypass this edit.

 When the Part B incoming claim has a Modifier equal to 'RT'
 and the history claim has 'LT' Modifier, bypass this edit.

 When the Part B claim is incoming or on history and has
 Payment/Process Indicator other than 'A', 'R', or 'S', bypass
 this edit.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 151
______________________________________________________________________________

 When the Ordering Physician UPIN is not present but the detail
 NPI Rendering Physician is present, bypass this edit.

 Trailer Information: 06, 08

   INSTALLATION INSTRUCTIONS:   None

   SYSTEMS DOCUMENTATION AFFECTED:

    EDITUTIL              MODIFY ERROR CODE '5703' TO REMOVE
                          REFERENCES TO MULTIPLE HCPCS ON
                          SAME CLAIM SETTING THE '5703' EDIT.

    EDITUTIL              MODIFY ERROR CODE '5704' TO REMOVE
                          REFERENCES TO MULTIPLE HCPCS ON
                          SAME CLAIM SETTING THE '5704' EDIT.

   SATELLITE SYSTEM MODIFICATIONS:     None




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 152
______________________________________________________________________________

   10. 00025755   A/B EDIT 7251 SETTING INCORRECTLY

   REQUESTOR ID: CWFM1000

   IMPACT:
 (X) Host
 (X) Satellite Part A Inpatient
 (X) Satellite Part A Outpatient
 ( ) Satellite Part B
 ( ) Hospice
 ( ) Home Health
 ( ) DMERC

   REASON FOR CHANGE:
 When an SNF Inpatient Part A claim is posted to history
 with an Occurrence Code '22' and a subsequent SNF claim
 with a Discharge Date is posted to history CWF is incorrectly
 setting A/B Crossover edit '7251' when an incoming Outpatient
 claim has a detail line item Date of Service that equals the
 SNF Discharge Date.

   NEW BUSINESS REQUIREMENTS:

 Requirement 1
 When an SNF Inpatient Part A claim (21x) has processed with
 an Occurrence Code '22' and Patient Status '30' and there is
 a subsequent SNF discharge claim that has processed for that
 SNF stay with the same Admission and an incoming Outpatient
 claim detail line item Date of Service equals the SNF
 Discharge Date CWF should not set A/B Crossover edit '7251'.

   EVENT-RESPONSE LIST:

 Event 1.1
 Posted to history are multiple SNF Inpatient Part A claims
 (21x). One claim has Occurrence Code '22' with Patient
 Status '30'. The second SNF claim is the discharge claim
 with patient status other than '30' that posted to history.

 An incoming Outpatient claim is received with a therapy
 HCPCS code(s)/Revenue Code(s). The detail line item Date
 of Service equals the SNF Discharge Date.

 Response
 A/B Crossover edit '7251' is not set.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 153
______________________________________________________________________________

Event 1.2
Posted to history are multiple SNF Inpatient Part A claims
(21x). One claim has Occurrence code Date '22' with Patient
Status '30'. The SNF Discharge claim is not yet posted in
history.

An incoming Outpatient claim is received with a therapy
HCPCS code(s)/Revenue Code(s). The detail line item Date
of Service is after the Occurrence code date '22'.

Response
A/B Crossover edit '7251' is set.

The Entity List includes only NEW acronyms and terminology
that is currently not in use in CWF.

Entity List: N/A

Areas Affected by the Problem.
  1. A/B Crossover module

Solution Criteria: N/A

  EDITS AFFECTED:   None

  INSTALLATION INSTRUCTIONS:     None

  SYSTEMS DOCUMENTATION AFFECTED:       None

  SATELLITE SYSTEM MODIFICATIONS:       None




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 154
______________________________________________________________________________

   11. 00025764   5880-MODIFICATION OF PAYMENT WINDOW EDITS IN CWF

   REQUESTOR ID: CWFM2000

   IMPACT:
 (X) Host
 (X) Satellite Part A Inpatient
 (X) Satellite Part A Outpatient
 ( ) Satellite Part B
 ( ) Hospice
 ( ) Home Health
 ( ) DMERC

   REASON FOR CHANGE:
 Currently, the CWF edits look at the statement covers Thru Date
 of the Outpatient claim to determine what services fall within the
 payment window. CWF has been instructed to modify the payment
 window edits to use the line item Dates of Service rather
 than the statement covers Thru Date.

 CWF will modify A/B crossover edits to read line item Date
 of Service on the HUOP incoming record or the HUOP history
 record for the following edits:

 '7109':
 An Outpatient claim with the Thru Date, or if present, the
 Occurrence Span Code '72' Thru Date, greater than the
 Inpatient Admission Date minus four days, or is equal to the
 Inpatient Date and one or more diagnostic Revenue Codes are
 present.

 '7112':
 Inpatient claim overlaps an Outpatient Bill with a CWF
 Source Code '2' or '3' from the same Provider.

 '7113':
 An Inpatient claim with the Admission Date less than four
 days from the Outpatient history Thru Date, or if present,
 the Occurrence Span Code '72' Date, and the Outpatient claim
 is for the diagnostic services only.

 '7114':
 An Outpatient claim that contains therapeutic services
 against a posted Inpatient history claim with the Thru Date
 greater than the Inpatient Admission Date, minus four days,
 or is equal to the Admission Date.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 155
______________________________________________________________________________


'7115':
An Inpatient claim against a posted Outpatient history claim
that contains therapeutic services and the Outpatient Thru
Date, or if present, the Occurrence Span Code '72' Thru
Date, is greater than the Inpatient Admission Date minus
four days or equal to the Admission Date.

'7119':
An Outpatient claim with the Thru Date, or if present, the
Occurrence Span Code '72' Thru Date is equal to the Inpatient
Admission Date or the Inpatient Admission Date minus one day,
and one or more diagnostic Revenue Codes are on the
Outpatient claim. The Inpatient history claim has a Condition
Code of '65', or Providers, LTCH or IRF.

'7121':
An Outpatient claim with the Thru Date (or if present,
Occurrence Span Code '72' Date) equal to the Inpatient
Admission Date or the Inpatient Admission Date minus one day,
and one or more therapeutic Revenue Codes are on the
Outpatient claim, and the Inpatient history claim has a
Condition Code of '65' or Providers, LTCH or IRF.

'7122':
An Inpatient claim with Condition Code '65' present, or
Providers LTCH or IRF, with the Admission Date, or the
Admission Date minus one day, equal to the Outpatient history
Thru Date (or if present, Occurrence Span Code '72' Thru
Date), and the Outpatient history claim has one or more
therapeutic Revenue Codes present.

CWF has also been instructed to add missing Revenue Codes and modify
some Revenue Codes in the diagnostic payment window edits.

Edits '7109', '7112', '7113', '7119' and '7120' will be modified
to remove Revenue Code '048X' and replace it with Revenue
Code '0482' and '0483'.

The above edits will also be modified to include Revenue
Codes '481' and '489'; HCPCS '93501', '93503', '93505', '93508',
'93510', '93526', '93541', '93542', '93543', '93544', '93556',
'93561' and '93562'.



______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 156
______________________________________________________________________________

   NEW BUSINESS REQUIREMENTS:

 Requirement 1
 CWF will modify A/B crossover edit '7109' (Outpatient claim with
 Thru Date greater than the Inpatient Admission minus four days
 or is equal to the Inpatient Date and one or more diagnostic
 Revenue Codes are present) to no longer read the incoming
 Outpatient Thru Date but read the line item date of the
 diagnostic Revenue Codes to compare to the Inpatient
 claim in history to set the edit.

 Requirement 2
 CWF will modify A/B Crossover edit '7112' (Inpatient claim overlaps
 an Outpatient bill with diagnostic Revenue Code for same Provider)
 to no longer read the Outpatient Thru Date in history but read
 the line item date of the diagnostic Revenue Codes to set the edit.

 Requirement 3
 CWF will modify A/B Crossover edit '7113' (Inpatient claim is within
 four days of Outpatient claim in history with diagnostic Revenue
 Codes and can have different diagnosis codes) to no longer read
 the Outpatient Thru Date in history but read the line item date
 of the diagnostic Revenue Codes to set the edit.

 Requirement 4
 CWF will modify A/B Crossover edit '7119' (Outpatient claim with
 diagnostic Revenue Codes within one day of Inpatient claim in
 history with different diagnosis codes) to no longer read
 the Outpatient Thru Date in history but read the line item date
 of the diagnostic Revenue Codes to set the edit.

 Requirement 5
 CWF will modify A/B Crossover edit '7120' (Inpatient claim is within
 one day of an Outpatient in history with diagnostic Revenue Codes
 and can have different diagnosis codes) to no longer read the
 Outpatient Thru Date in history but read the line item date of
 the diagnostic Revenue Codes to set the edit.

 Requirement 6
 CWF will modify A/B Crossover edit '7114' (Outpatient claim with
 therapeutic Revenue Codes within four days of Inpatient in
 history and must have the same diagnosis codes) to no longer
 read the Outpatient Thru Date but read the line item date of
 the therapeutic Revenue Codes to set the edit.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 157
______________________________________________________________________________

 Requirement 7
 CWF will modify A/B Crossover edit '7115' (Inpatient claim within
 four days of Outpatient claim in history with therapeutic Revenue
 Codes and must have the same diagnosis codes) to no longer read
 the Outpatient Thru Date but read the line item date of the
0 therapeutic Revenue Codes to set the edit.

 Requirement 8
 CWF will modify A/B Crossover edit '7121' (Outpatient claim with
 therapeutic Revenue Codes within one day of Inpatient claim in
 history and must have the same diagnosis codes) to no longer read
 the Outpatient Thru Date but read the line item date of the
 therapeutic Revenue Codes to set the edit.

 Requirement 9
 CWF will modify A/B Crossover edit '7122' (Inpatient claim within
 one day of Outpatient claim in history with Therapeutic Revenue
 Codes and must have same diagnosis codes) to no longer read
 the Outpatient Thru Date but read the line item date of the
 therapeutic Revenue Codes to set the edit.

 Requirement 10
 CWF will modify A/B Crossover edit '7109' to remove Revenue Code
 '048x' and be replaced with Revenue Code '0482' and '0483'.
 This edit will set for any HCPCS present with these two Revenue Codes.

 Requirement 11
 CWF will modify A/B Crossover edit '7112' to remove Revenue Code
 '048x' and be replaced with Revenue Codes '0482' and '0483'.
 The edit will set for any HCPCS present with these two Revenue Codes.

 Requirement 12
 CWF will modify A/B Crossover edit '7113' to remove Revenue Code
 '048x' and be replaced with Revenue Codes '0482' and '0483'.
 The edit will set for any HCPCS present with these two Revenue Codes.

 Requirement 13
 CWF will modify A/B Crossover edit '7119' to remove Revenue Code
 '048x' and be replaced with Revenue Codes '0482' and '0483'.
 The edit will set for any HCPCS present with these two Revenue Codes.

 Requirement 14
 CWF will modify A/B Crossover edit '7120' to remove Revenue Code
 '048x' and be replaced with Revenue Codes '0482' and '0483'.
 The edit will set for any HCPCS present with these two Revenue Codes.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 158
______________________________________________________________________________

Requirement 15
CWF will modify A/B Crossover edit '7109' to add Revenue Code '0481'
and '0489' to set if one of the following HCPCS is present:
'93501', '93503', '93505', '93508', '93510', '93526', '93541',
'93542', '93543', '93544', '93556', '93561', or '93562'.

Note: If another HCPCS is present with Revenue Code '0481' or '0489'
do not apply the edit.

Requirement 16
CWF will modify A/B Crossover edit '7112' to add Revenue Code '0481'
and '0489' to set if one of the following HCPCS is present:
'93501', '93503', '93505', '93508', '93510', '93526', '93541',
'93542', '93543', '93544', '93556', '93561', or '93562'.

Note: If another HCPCS is present with Revenue Code '0481' or '0489'
do not apply the edit.

Requirement 17
CWF will modify A/B Crossover edit '7113' to add Revenue Code '0481'
and '0489' to set if one of the following HCPCS is present:
'93501', '93503', '93505', '93508', '93510', '93526', '93541',
'93542', '93543', '93544', '93556', '93561', or '93562'.

Note: If another HCPCS is present with Revenue Code '0481' or '0489'
do not apply the edit.

Requirement 18
CWF will modify A/B Crossover edit '7119' to add Revenue Code '0481'
and '0489' to set if one of the following HCPCS is present:
'93501', '93503', '93505', '93508', '93510', '93526', '93541',
'93542', '93543', '93544', '93556', '93561', or '93562'.

Note: If another HCPCS is present with Revenue Code '0481' or '0489'
do not apply the edit.

Requirement 19
CWF will modify A/B Crossover edit '7120' to add Revenue Code '0481'
and '0489' to set if one of the following HCPCS is present:
'93501', '93503', '93505', '93508', '93510', '93526', '93541',
'93542', '93543', '93544', '93556', '93561', or '93562'.

Note: If another HCPCS is present with Revenue Code '0481' or '0489'
do not apply the edit.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 159
______________________________________________________________________________

  EVENT-RESPONSE LIST:

Event 1.1
Enter an HUOP claim with a diagnostic Revenue Code and the line
item Date of Service is within three days prior to the Inpatient
Admission Date. The Provider Numbers are the same.

Response
Edit '7109' is set.

Event 1.2
Enter an HUOP claim with a diagnostic Revenue Code and the line
item Date of Service is not within three days prior to the Inpatient
Admission Date. The Provider Numbers are the same.

Response
Edit '7109' is not set.

Event 2.1
Enter an HUIP claim where the Admit Date is equal to or one day
after the line item Date of Service of an HUOP claim in history
with a diagnostic Revenue Code.

Response
Edit '7112' is set.

Event 2.2
Enter an HUIP claim where the Admit Date is not equal to or one
day after the line item Date of Service of an HUOP claim in
history with a diagnostic Revenue Code.

Response
Edit '7112' is not set.

Event 3.1
Enter an HUIP claim where the Admission Date is within three
days of an Outpatient claim in history with diagnostic
Revenue Codes.

Response
Edit '7113' is set.

 Event 3.2
 Enter an HUIP claim where the Admission Date is not within three
 days of an Outpatient claim in history with diagnostic
 Revenue Codes.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 160
______________________________________________________________________________


Response
Edit '7113' is not set.

Event 4.1
Enter an HUOP claim with diagnostic Revenue Codes, line item
Date of Service is equal to an Inpatient history claim
Admission Date minus one day. The Inpatient history claim
has a Condition Code of '65', LTCH, or IRF Providers.

Response
Edit '7119' is set.

Event 4.2
Enter an HUOP claim with diagnostic Revenue Codes, line item
Date of Service not equal to an Inpatient history claim
Admission Date minus one day. The Inpatient history claim
has a Condition Code of '65', LTCH, or IRF Providers.

Response
Edit '7119' is not set.

Event 5.1
Enter an HUIP claim where the Admission Date is equal to
or one day prior to the line item Date of Service of a posted
HUOP claim with diagnostic Revenue Codes. The HUIP claim
contains Condition Code '65', LTCH, or IRF Providers.

Response
The record is rejected and edit '7120' is set.

Event 5.2
Enter an HUIP claim where the Admission Date is not equal to
or one day prior to the line item Date of Service of a posted
HUOP claim with diagnostic Revenue Codes. The HUIP claim
contains Condition Code '65', LTCH, or IRF Providers.

Response
Edit '7120' is not set.

Event 6.1
Enter an HUOP claim that contains therapeutic services. The
line item Date of Service is within three days prior or equal to
a posted Inpatient claim Admission Date.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 161
______________________________________________________________________________

 Response
 The record is rejected and edit '7114' is set.

 Event 6.2
 Enter an HUOP claim that contains therapeutic services. The
 line item Date of Service is not within three days prior to
 or equal to a posted Inpatient claim Admission Date.

 Response
 Edit '7114' is not set.

 Event 7.1
 Enter an HUIP claim where the Admission Date equals or is
 one day after the line item Date of Service of a posted
 HUOP claim with therapeutic services.

 Response
 The record is rejected and edit '7115' is set.

 Event 7.2
 Enter an HUIP claim where the Admission Date does not equal or
 is not one day after the line item Date of Service of a posted
 HUOP claim with therapeutic services.

 Response
 Edit '7115' is not set.

 Event 8.1
 Enter an HUIP claim where the Admission Date is equal to
 or one day prior to the line item Date of Service of a posted
 HUOP claim with therapeutic Revenue Codes. The HUIP claim
 contains Condition Code '65', LTCH, or IRF Providers.
 Enter an HUOP claim

 Response
 The record is rejected and edit '7121' is set.

 Event 8.2
 Enter an HUIP claim where the Admission Date is not equal to
 or one day prior to the line item Date of Service of a posted
 HUOP claim with therapeutic Revenue Codes. The HUIP claim
 contains Condition Code '65', LTCH, or IRF Providers.

 Response
 Edit '7121' is not set.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 162
______________________________________________________________________________

 Event 9.1
 Enter an HUIP claim where the Admit Date is equal to or one day
 after the line item Date of Service of an HUOP claim in history
 with therapeutic Revenue Codes. The HUIP claim has Condition
 Code '65', LTCH, or IRF Providers.

 Response
 The record is rejected and edit '7122' is set.

 Event 9.2
 Enter an HUIP claim where the Admit Date is not equal to or one day
 after the line item Date of Service of an HUOP claim in history
 with therapeutic Revenue Codes. The HUIP claim has Condition
 Code '65', LTCH, or IRF Providers.

 Response
 Edit '7122' is not set.

 Event 10.1
 Enter an HUOP claim with Revenue Code '048x'. The line item
 Date of Service is equal to or within three days prior to a
 posted HUIP claim Admission Date.

 Response
 Edit '7109' is not set.

 Event 10.2
 Enter an HUOP claim with Revenue Code '0482'. The line item
 Date of Service is equal to or within three days prior to a
 posted HUIP claim Admission Date.

 Response
 The record is rejected and edit '7109' is set.

 Event 10.3
 Enter an HUOP claim with Revenue Code '0483'. The line item
 Date of Service is equal to or within three days prior to a
 posted HUIP claim Admission Date.

 Response
 The record is rejected and edit '7109' is set.

 Event 11.1
 Enter an HUIP claim and the Admission Date is equal to or
 one day after the line item Date of Service of a posted HUOP
 claim with diagnostic Revenue Code '048x'.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 163
______________________________________________________________________________


 Response
 Edit '7112' is not set.

 Event 11.2
 Enter an HUIP claim and the Admission Date is equal to or one day
 after the line item Date of Service of a posted HUOP claim with
 diagnostic Revenue Code '048x'.

 Response
 The record is rejected and edit '7112' is set.

 Event 11.3
 Enter an HUIP claim and the Admission Date is equal to or one day
 after the line item Date of Service of a posted HUOP claim with
 diagnostic Revenue Code '048x'.

 Response
 The record is rejected and edit '7112' is set.

 Event 12.1
 Enter an HUIP record with Type of Bill '11x' or '41x'. The
 HUIP Admission Date is equal to or one day after the line
 item Date of Service of an HUOP claim in history with
 Revenue Code '048x'. The Providers are the same.

 Response
 Edit '7113' is not set.

 Event 12.2
 Enter an HUIP record with Type of Bill '11x' or '41x'. The
 HUIP Admission Date is equal to or one day after the line
 item Date of Service of an HUOP claim in history with
 Revenue Code '0482'. The Providers are the same.

 Response
 The record is rejected and edit '7113' is set.

 Event 12.3
 Enter an HUIP record with Type of Bill '11x' or '41x'. The
 HUIP Admission Date is equal to or one day after the line
 item Date of Service of an HUOP claim in history with
 Revenue Code '0483'. The Providers are the same.

 Response
 The record is rejected and edit '7113' is set.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 164
______________________________________________________________________________


Event 13.1
Enter an HUOP claim and the From Date is greater than 10/31/1994
and the line item Date of Service is equal to, or the day prior to
the Admission Date of a posted HUIP record. The Providers
are the same. The HUOP record contains Revenue Code '048x'.

Response
Edit '7119' is not set.

Event 13.2
Enter an HUOP record and the From Date is greater than 10/31/1994
and the line item Date of Service is equal to, or the day prior to
the Admission Date of a posted HUIP record. The Providers
are the same. The HUOP record contains Revenue Code '0482'.

Response
The record is rejected and edit '7119' is set.

Event 13.3
Enter an HUOP claim and the From Date is greater than 10/31/1994
and the line item Date of Service is equal to, or the day prior to
the Admission Date of a posted HUIP record. The Providers
are the same. The HUOP record contains Revenue Code '0483'.

Response
The record is rejected and edit '7119' is set.

Event 14.1
Enter an HUIP record. An HUOP record is posted to history with
a line item Date of Service equal to the HUIP Admission Date or
one day prior to the Admission Date. The Providers are the same
and the HUOP Revenue Code is '048X'.

Response
Edit '7120' is not set.

Event 14.2
Enter an HUIP record. An HUOP record is posted to history with
a line item Date of Service equal to the HUIP Admission Date or
one day prior to the Admission Date. The Providers are the same
and the HUOP Revenue Code is '0482'.

Response
The record is rejected and edit '7120' is set.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 165
______________________________________________________________________________

Event 14.3
Enter an HUIP record. An HUOP record is posted to history with
a line item Date of Service equal to the HUIP Admission Date or
one day prior to the Admission Date. The Providers are the same
and the HUOP Revenue Code is '0483'.

Response
The record is rejected and edit '7120' is set.

Event 15.1
Enter an HUOP record with a line item Date of Service equal to
or 3 days prior to a posted HUIP claim Admission Date.
The HUOP record contains Revenue Code '0481' and one of the
following HCPCS:
'93501', '93503', '93505', '93508', '93510', '93526', '93541',
'93542', '93543', '93544', '93556', '93561', or '93562'.

Response
The record is rejected and edit '7109' is set.

Event 15.2
Enter an HUOP record with a line item Date of Service
equal to, or 3 days prior to a posted HUIP claim Admission Date.
The HUOP record contains Revenue Code '0489' and one of the
following HCPCS:
'93501', '93503', '93505', '93508', '93510', '93526', '93541',
'93542', '93543', '93544', '93556', '93561', or '93562'.

Response
The record is rejected and edit '7109' is set.

Event 15.3
Enter an HUOP record with a line item Date of Service
equal to, or 3 days prior to a posted HUIP Admission Date.
The HUOP record contains Revenue Code '0489' and one of the
following HCPCS is not present:
'93501', '93503', '93505', '93508', '93510', '93526', '93541',
'93542', '93543', '93544', '93556', '93561', or '93562'.

Response
Edit '7109' is not set.

 Event 16.1
 Enter an HUIP claim. An Outpatient claim is posted to history
 line item Date of Service equal to the Inpatient Admission Date
 or one day prior to the Admission Date. The Outpatient history
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 166
______________________________________________________________________________

 record From Date is less than 10/01/1991, the Providers are the same,
 Revenue Code '0481' and one of the following HCPCS is present:
 '93501', '93503', '93505', '93508', '93510', '93526', '93541',
 '93542', '93543', '93544', '93556', '93561', or '93562'.

 Response
 The record is rejected, edit '7112' is set.

 Event 16.2
 Enter an HUIP claim. An Outpatient claim is posted to history with a
 line item Date of Service equal to the Inpatient Admission Date
 or one day prior to the Admission Date. The Outpatient history
 record From Date is less than 10/01/1991, the Providers are the same,
 Revenue Code '0489' and one of the following HCPCS is present:
 '93501', '93503', '93505', '93508', '93510', '93526', '93541',
 '93542', '93543', '93544', '93556', '93561', or '93562'.

 Response
 The record is rejected, edit '7112' is set.

 Event 16.3
 Enter an HUIP claim where the Admission Date is equal to or one
 day after the line item Date of Service of a posted HUOP claim.
 The HUOP claim has a From Date less than 10/01/1991, the Providers are
 the same, Revenue Code '0489' and one of the following HCPCS is not
 present:
 '93501', '93503', '93505', '93508', '93510', '93526', '93541',
 '93542', '93543', '93544', '93556', '93561', or '93562'.

 Response
 Edit '7112' is not set.

 Event 17.1
 Submit an HUIP claim where the Admission Date is equal to or one
 day after the line item Date of Service of a posted HUOP claim.
 The Providers are the same, HUOP Revenue Code is '0481' and one of
 the following HCPCS is present:
 '93501', '93503', '93505', '93508', '93510', '93526', '93541',
 '93542', '93543', '93544', '93556', '93561', or '93562'.

 Response
 The record is rejected, edit '7113' is set.

 Event 17.2
 Submit an HUIP claim where the Admission Date is equal to or one
 day after the line item Date of Service of a posted HUOP claim.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 167
______________________________________________________________________________

The Providers are   the same and the Outpatient Revenue Code is
'0489' and one of   the following HCPCS is present:
'93501', '93503',   '93505', '93508', '93510', '93526', '93541',
'93542', '93543',   '93544', '93556', '93561', or '93562'.

Response
The record is rejected, edit '7113' is set.

Event 17.3
Submit an HUIP claim where the Admission Date is equal to or one
day after the line item Date of Service of a posted HUOP claim.
The Providers are the same and the Outpatient Revenue Code is
'0489' and one of the following HCPCS is not present:
'93501', '93503', '93505', '93508', '93510', '93526', '93541',
'93542', '93543', '93544', '93556', '93561', or '93562'.

Response
Edit '7113' is not set.

Event 18.1
Enter an HUOP claim with a line item Date of Service is equal to,
or the day prior to the Admission Date of a posted HUIP claim.
The Providers are the same and the Outpatient Revenue Code is
'0481' and one of the following HCPCS is present:
'93501', '93503', '93505', '93508', '93510', '93526', '93541',
'93542', '93543', '93544', '93556', '93561', or '93562'.

Response
Edit '7119' is set.

Event 18.2
Enter an HUOP claim with a line item Date of Service equal to, or
the day prior to the Admission Date of a posted HUIP record.
The Providers are the same and the Outpatient Revenue Code is
'0489' and one of the following HCPCS is present:
'93501', '93503', '93505', '93508', '93510', '93526', '93541',
'93542', '93543', '93544', '93556', '93561', or '93562'.

Response
The record is rejected, edit '7119' is set.

 Event 18.3
 Enter an HUOP claim and with a line item Date of Service equal to, or
 the day prior to the Admission Date of a posted HUIP record. The
 Providers are the same and the Outpatient Revenue Code is '0489'
 and one of the following HCPCS is not present:
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 168
______________________________________________________________________________

 '93501', '93503', '93505', '93508', '93510', '93526', '93541',
 '93542', '93543', '93544', '93556', '93561', or '93562'.

 Response
 Edit '7119' is not set.

 Event 19.1
 Enter an HUIP claim where the Admission Date equals or is one day
 after the line item Date of Service of a posted HUOP claim. The
 Providers are the same and the Outpatient Revenue Code is '0481'
 and one of the following HCPCS is present:
 '93501', '93503', '93505', '93508', '93510', '93526', '93541',
 '93542', '93543', '93544', '93556', '93561', or '93562'.

 Response
 The record is rejected, edit '7120' is set.

 Event 19.2
 Enter an HUIP claim where the Admission Date equals or is one day
 after the line item Date of Service of a posted HUOP claim. The
 Providers are the same and the Outpatient Revenue Code is '0489' and
 one of the following HCPCS is present:
 '93501', '93503', '93505', '93508', '93510', '93526', '93541',
 '93542', '93543', '93544', '93556', '93561', or '93562'.

 Response
 The record is rejected, edit '7120' is set.

 Event 19.3
 Enter an HUIP claim where the Admission Date equals or is one day
 after the line item Date of Service of a posted HUOP claim. The
 Providers are the same and the Outpatient Revenue Code is '0489'
 and one of the following HCPCS is not present:
 '93501', '93503', '93505', '93508', '93510', '93526', '93541',
 '93542', '93543', '93544', '93556', '93561', or '93562'.

 Response
 Edit '7120' is not set.

 The Entity List includes only NEW acronyms and terminology
 that is currently not in use in CWF.

 Entity List: N/A

 Areas Affected by the Problem.
   1. A/B Crossover
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 169
______________________________________________________________________________


 Solution Criteria: N/A

   EDITS AFFECTED:

 a. Error Code: 7109        ( )New (X)Modified ( )Deleted
 Disposition: CR

 Type of Record:     OUTP

 Error Message:
 An Outpatient claim with the Thru Date, or if present, the
 Occurrence Span Code '72' Thru Date, greater than the
 Inpatient Admission Date minus four days, or is equal to the
 Inpatient Date and one or more diagnostic Revenue Codes are
 present.

 Set Condition for edit '7109':

 Note: The date criteria for this edit is:
       If Condition Code '65' is present on the Inpatient
       history claim and the Outpatient From Date is greater
       than 12/31/1990 and less than 10/31/1994.

 When the incoming claim From Date is greater than 12/31/1990
 and the Line Item Date is equal to, or within three days prior
 to the history Inpatient Admission Date, and there is an
 inpatient claim with a bill type of '11x' or '41x', the
 Providers are the same, and the Outpatient Revenue Code is
 '030x', '031x', '032x', '035x', '040x', '046x', '061x',
 '073x', '074x', '092x', '0254', '0255', '0341', '0343',
 '0371', '0372', '0471', '0621', '0622', '0918' or
 '0482', '0483' or
 '0481', '0489' (Cardiology) when present with the following
 HCPCS codes:
 '93015', '93307', '93308', '93320', '93501', '93503',
 '93505', '93508', '93510', '93526', '93541 - 93552',
 '93556', '93561', or '93562', set the '7109' error code.

 When the Inpatient record is cancelled, bypass this edit.

 The Inpatient Bill Source is other than a '2' or '3', bypass
 this edit.

 The Inpatient Action Code is a '2', '4', or '6', bypass this
 edit.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 170
______________________________________________________________________________


The Inpatient No-Payment Code is a 'B', 'C', 'N', or 'R',
bypass this edit.

When the Providers are LTCH (xx2000-xx2299) or IRF (xx3025-
xx3099) or third digit equals 'R' or 'T', bypass this edit.

The Outpatient claim is for Revenue Code of '0403' and a
HCPCS codes of '76092', '77052', '77057', 'G0202', or 'G0203',
and is the only Revenue Code on the claim, bypass this edit.

The Outpatient claim is for Revenue Code of '0403' and a
HCPCS code of '76085' and '76092' combination present and is
the only Revenue Code on the history claim, bypass this
edit.

The Outpatient claim is for Revenue Code of '0403' and a
HCPCS code of '76083' and '76092' combination present and is
the only Revenue Code on the history claim, bypass this
edit.

The Outpatient claim is for Revenue Code of '0403' and a
HCPCS code of '77052' and '77057' combination present and is
the only Revenue Code on the history claim, bypass this
edit.

When the Outpatient bill type is '72x' and the principal
diagnosis is not equal to the Inpatient principal diagnosis,
bypass this edit.

When the Outpatient bill type is '85x', bypass this edit.

When the Outpatient bill type is '12x', bypass this edit.

When the incoming Outpatient bill type is '14x' and Provider
range from 'XX1300-XX1399', bypass this edit.

When the incoming Outpatient Action Code is a '7', bypass
this edit.

When the Inpatient Type of Bill is other than '11x' or
'41x', bypass this edit.

When the incoming Outpatient claim Demonstration Number is
equal to '31', bypass this edit.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 171
______________________________________________________________________________

When the incoming Outpatient claim is an Encounter and the
Inpatient History claim is an IME/GME with Condition Codes
'04' and '69', bypass this edit.

When the No-Pay code is 'N', bypass this edit.

When the incoming Outpatient claim Total Charge equals the
Non-covered Charge, bypass this edit.

When the history Inpatient Cancer Provider is equal to
'050146', '050660', '100079', '100271', '220162',
'330154', '330354', '360242', '390196', '450076',
'500138', bypass this edit.

When the Inpatient record in history is Provider Number
'xx4000-xx4499', or 'xxSxxx' and Condition Code '65' is not
present, bypass this edit.

Trailer Information:   08, 13


b. Error Code: 7112     ( )New (X)Modified ( )Deleted
Disposition: CR

Type of Record:   Hospital

Error Message:
Inpatient claim overlaps an Outpatient Bill with a CWF
Source Code '2' or '3' from the same Provider.

Set Condition for edit '7112':

Note:   The date criteria for this edit is:
        If the Outpatient history From Date or the Occurrence
        Span Code '72' From Date is less than 10/01/1991.

 When the incoming Inpatient claim is a bill type '11x' or
 '41x', and the Outpatient history claim Line Item Date is
 equal to the Inpatient Admission Date or one day prior to
 the Admission Date, and the From Date is less than 10/01/1991,
 and the Outpatient Revenue Code is equal to '030x', '031x',
 '032x', '035x', '040x', '046x', '053x', '061x', '062x', '073x',
 '074x', '075x', '092x', '0254', '0255', '0341', '0343', '0371',
 '0372', '0471', '0918' or Revenue Code '0482', '0483' or
 Revenue Code '0481', '0489' when present with the following
 HCPCS codes:
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 172
______________________________________________________________________________

 '93015', '93307',    '93308', '93320', '93501', '93503',
 '93505', '93508',    '93510', '93526', '93541 - 93552',
 '93556', '93561',    or '93562'
 and the Providers    are the same or not match on the
 third position of    the Inpatient Provider Number that has
 'M', 'R', 'S', or    'T' in this position, set the '7112'
 error code.

 The Inpatient bill contains a No-Payment Code of 'B', 'C',
 'N', or 'R', bypass this edit.

 The Provider is Maryland ('21' in positions '1' and '2' of
 the Provider Number), bypass this edit.

 The Outpatient claim type cancelled, bypass this edit.

 The Outpatient History bill type is '12x' or '85x', bypass
 this edit.

 When the Outpatient history bill type is '14x' and Provider
 ranges from 'XX1300-XX1399', bypass this edit.

 The Outpatient claim bill source is other than '2' or '3',
 bypass this edit.

 The Outpatient claim Action Code is a '2', '4', or '6' and
 the Transaction Code is a '6', bypass this edit.

 The Outpatient Revenue Code is '054x', bypass this edit.
 The Demonstration Project Number is equal to '31'. The
 history Outpatient claim has a diagnostic Revenue Code of
 '0403', and the HCPCS is '76092', 'G0202', or 'G0203',
 bypass this edit.

 Trailer Information: 08, 13


 c. Error Code: 7113       ( )New (X)Modified ( )Deleted
 Disposition: CR

 Type of Record:     Hospital

 Error Message:
 An Inpatient claim with the Admission Date less than four
 days from the Outpatient history Thru Date, or if present,
 the Occurrence Span Code '72' Date, and the Outpatient claim
______________________________________________________________________________
2020 Company, LLC                                           Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 173
______________________________________________________________________________

is for the diagnostic services only.

Set Condition for edit '7113':

Note: The date criteria for this edit is:
      If Condition Code '65' is present on the Inpatient
      Claim and the Outpatient history From Date or the
      Occurrence Span Code '72' From Date is greater than
      12/31/1990 and less than 10/31/1994.

If Condition Code '65' is not present on the Inpatient claim
and the Outpatient history From Date or if present, the
Occurrence Span Code '72' From Date is greater than
12/31/1990, set the '7113' error code.

When the incoming Inpatient claim is a bill type '11x' or
'41x', and the Outpatient history claim Line Item Date is equal
to the Inpatient Admission Date or within three days prior
to the Admission Date, and the Provider Numbers are equal,
and the Outpatient Revenue Code is equal to '030x',
'031x', '032x', '035x', '040x', '046x', '061x', '073x',
'074x', '092x', '0254', '0255', '0341', '0343', '0371',
'0372', '0471', '0621', '0622', '0918' or Revenue Code
'0482', '0483' or Revenue Code '0481', '0489' (Cardiology)
when present with the following HCPCS codes:
'93015', '93307', '93308', '93320', '93501', '93503',
'93505', '93508', '93510', '93526', '93541 - 93552',
'93556', '93561', or '93562', set the '7113' error code.

When the Providers are LTCH (xx2000-xx2299) or IRF (xx3025-
xx3099) or third digit equals 'R' or 'T' bypass this edit.

The Outpatient Action Code is a '2', '4', or '6' and
Transaction Code is a '6', bypass this edit.

The Inpatient No-Payment Code is a 'B', 'C', 'N', or 'R',
bypass this edit.

The Outpatient history is for a Revenue Code of '0403' and a
HCPCS code of '76083' and '76092' combination present and is
the only Revenue Code on the claim, bypass this edit.

The Outpatient history is for a Revenue Code of '0403' and a
HCPCS code of '77052' and '77057' combination present and is
the only Revenue Code on the claim, bypass this edit.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 174
______________________________________________________________________________

 The Outpatient history bill type is '12x' or '85x', bypass
 this edit.

 When the Outpatient history bill type is '14x' and Provider
 ranges from 'XX1300-XX1399', bypass this edit.

 The Outpatient bill type is '72x' and the principal
 diagnosis is not equal to the Inpatient principal diagnosis,
 bypass this edit.

 The Demonstration Project Number is equal to '31', bypass
 this edit.

 When the incoming Inpatient claim is an IME/GME with
 Condition Codes '04' and '69' and the History Outpatient
 claim is an Encounter, bypass this edit.

 When the incoming Inpatient Cancer Provider is equal to
 '050146', '050660', '100079', '100271', '220162'
 '330154', '330354', '360242', '390196', '450076'
 '500138', bypass this edit.
 OUTP
 When the No-Pay code is 'N', bypass this edit.

 When the incoming Outpatient claim Total Charge equals the
 Non-covered Charge, bypass this edit.

 Trailer Information:   08, 13


 d. Error Code: 7114     ( )New (X)Modified ( )Deleted
 Disposition: CR

 Type of Record:   HHA, OUTP

 Error Message:
 An Outpatient claim that contains therapeutic services
 against a posted Inpatient history claim with the Thru Date
 greater than the Inpatient Admission Date, minus four days,
 or is equal to the Admission Date.

 Set Condition for edit '7114':

 Note: The date criteria for this edit is:
    - If Condition Code '65' is present on the
       Inpatient history claim and the Outpatient From
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 175
______________________________________________________________________________

       Date is greater than 09/30/1991 and less
       than 10/31/1994.

   -   If Condition Code '65' is not present on the
       Inpatient history claim and the Outpatient From
       Date is greater than 09/30/1991.

 When the Outpatient From Date (or if present, Occurrence
 Span Code '72' From Date) is greater than '90365', and the
 Outpatient Line Item Date (or if present, Occurrence Span Code
 '72' Thru Date) is equal to or within three days prior to a
 history Inpatient Admission Date that has a bill type '11x'
 or '41x', and the Providers are the same, and an Outpatient
 Revenue Code is equal to '0250', '0251', '0252', '0256',
 '0257', '0258', '0259', '026x', '027x', '028x', '033x',
 '0340', '0342', '0349', '036x', '0370', '0374', '0379',
 '041x', '042x', '043x', '044x', '045x', '0472', '049x',
 '051x', '052x', '053x', '055x', '056x', '0623', '063x',
 '070x', '071x', '072x', '075x', '076x', '079x', '090x',
 '091x', or '094x', and if the diagnosis on the incoming
 claim and the history are equal, set the '7114' error code.

 When the history Inpatient bill source is not a '2' or '3',
 bypass this edit.

 When the Cancel Date is greater than zero, bypass this edit.

 When the Outpatient From Date (or if present, the Occurrence
 Span Code '72' From Date) is equal to or greater than the
 history Inpatient Discharge Date, bypass this edit.

 When the Outpatient Action Code is a '7', bypass this
 edit.

 When the incoming Outpatient bill type is a '12x' or '85x',
 bypass this edit.

 When the Outpatient bill type is '14x' and Provider ranges
 from 'XX1300-XX1399', bypass this edit.

 When the history Inpatient claim has a No-Pay code of 'B',
 bypass this edit.

 When the history Inpatient Action Code is a '2', '4', or
 '6', bypass this edit.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 176
______________________________________________________________________________

 When the Inpatient claim has bill type '11x' or '41x', and
 the Outpatient From Date (or if present, Occurrence Span
 Code '72' From Date) is prior to '+91274', bypass this edit.

 When the Inpatient claim has bill type '11x' or '41x', and
 the Outpatient claim has bill type '72x', and the principal
 diagnosis codes are not equal, bypass this edit.

 When the Inpatient claim contains a Condition Code '65' and
 the Outpatient From Date (or if present, Occurrence Span
 Code '72' From Date) is greater than '+94303', bypass this
 edit.

 When the Inpatient claim does not contain a Condition Code
 '65', and the Outpatient From Date (or if present,
 Occurrence Span Code '72' From Date) is less than or equal
 to '+91273', bypass this edit.

 When the Type of Bill on the incoming Outpatient claim is
 '85x', and the only Therapeutic Revenue Code on the
 Outpatient claim is '0510', and there are not charges
 associated with this Revenue Code, bypass this edit.

 When the incoming Outpatient claim is an Encounter and the
 Inpatient History claim is an IME/GME with Condition Codes
 '04' and '69', bypass this edit.

 When the No-Pay code is 'N', bypass this edit.

 When the incoming Outpatient claim Total Charge equals the
 Non-covered Charge, bypass this edit.

 When the Providers are LTCH (xx2000-xx2299) or IRF (xx3025-
 xx3099) or third digit equals 'R' or 'T', bypass this edit.

 Trailer:   08, 13


 e. Error Code: 7115       ( )New (X)Modified ( )Deleted
 Disposition: CR

 Type of Record:     Hospital

 Error Message:
 An Inpatient claim against a posted Outpatient history claim
 that contains therapeutic services and the Outpatient Thru
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 177
______________________________________________________________________________

 Date, or if present, the Occurrence Span Code '72' Thru
 Date, is greater than the Inpatient Admission Date minus
 four days or equal to the Admission Date.

 Set condition for edit '7115':

 When incoming bill type is '11x' or '41x', and the
 Outpatient Line Item Date (or if present, Occurrence Span Code
 '72' Thru Date) is equal to the Inpatient Admission Date or
 one of the three days prior to the Admission Date, and if
 the Provider Numbers are equal, and if a Revenue Code is
 equal to '0250', '0251', '0252', '0256', '0257',
 '0258', '0259', '026x', '027x', '028x', '033x', '0340',
 '0342', '0349', '036x', '0370', '0374', '0379', '041x',
 '042x', '043x', '044x', '045x', '0472', '049x', '051x',
 '052x', '053x', '055x', '056x', '0623', '063x', '070x',
 '071x', '072x', '075x', '076x', '079x', '090x', '091x',
 or '094x', and if the diagnosis on the incoming claim
 and the history are equal, set the '7115' error code.

 When the history Outpatient claim has a Cancel Date,
 bypass this edit.

 When the bill source is not equal to a '2' or '3', and the
 Action Code is equal to '2', '4', or '6', and the
 Transaction Code is a '6', bypass this edit.

 When the Action Code is a '7', bypass this edit.

 When the Inpatient claim has a No-Pay Code of 'B', 'C', 'N',
 or 'R', bypass this edit.

 When the incoming Inpatient Provider Number begins with
 '21', bypass this edit.

 When the history Outpatient bill type is '14x' and
 Provider ranges from 'XX1300-XX1399', bypass this edit.

 When the Outpatient Thru Date (or if present, Occurrence
 Span Code '72' Thru Date) is greater than the Inpatient
 Admission Date, or is more than three days prior to the
 Admission Date, bypass this edit.

 When the Provider Numbers are equal, and the Outpatient From
 Date (or if present, Occurrence Span Code '72' From Date) is
 prior to '+91274', bypass this edit.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 178
______________________________________________________________________________


When the Provider Numbers are equal, and the Outpatient bill
type is '72x', and the principal diagnosis codes are not
equal, bypass this edit.

When the Inpatient claim contains a Condition Code '65', and
the Outpatient From Date (or if present, Occurrence Span
Code '72' From Date) is less than, or equal to '+91273',
bypass this edit.

When the Inpatient claim does not contain a Condition Code
'65', and the Outpatient From Date (or if present,
Occurrence Span Code '72' From Date) is less than, or equal
to '+91273', bypass this edit.

When the Demonstration Project Number is equal to '31',
bypass this edit.

When the Type of Bill on the history Outpatient claim is
'85x', the only therapeutic Revenue Code on the Outpatient
claim is '0510', and there are no charges associated with
this Revenue Code, bypass this edit.

When the incoming Inpatient record has a Provider Number
'xx4000-xx4499', or not present, bypass this edit

Trailer Information:     08, 13


f. Error Code: 7119       ( )New (X)Modified ( )Deleted
Disposition: CR

Type of Record:   OUTP

Error Message:
An Outpatient claim with the Thru Date, or if present, the
Occurrence Span Code '72' Thru Date is equal to the Inpatient
Admission Date or the Inpatient Admission Date minus one day,
and one or more diagnostic Revenue Codes are on the
Outpatient claim. The Inpatient history claim has a Condition
Code of '65', or Providers, LTCH or IRF.




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 179
______________________________________________________________________________

 Set Condition for edit '7119':

 Note: The date criteria for this edit is:
       The Outpatient From Date or the Occurrence Span Code
       '72' From Date, is greater than 10/30/1994.

 When Providers are the same or the Providers not match
 only on third position and third digit of Inpatient History
 Provider is 'S', 'T', 'R' or 'M', continue this edit.

 When the incoming claim From Date is greater than
 10/30/1994 and the Line Item Date is equal to the Inpatient
 Admission Date or the day prior to the Admission Date on a
 History record, and the Outpatient Revenue
 Code is '030x', '031x', '032x', '035x', '040x', '046x', '053x',
 '061x', '062x', '073x', '074x', '092x', '0254', '0255',
 '0341', '0343', '0371', '0372', '0471', '0918', '0482', or
 '0483', set the '7119' error code.

 When '0481', '0489' (Cardiology) present with the following
 HCPCS codes:
 '93015', '93307', '93308', '93320', '93501', '93503',
 '93505', '93508', '93510', '93526', '93541 - 93552',
 '93556', '93561', or '93562', set the '7119' error code.

 When the above condition and the Providers are LTCH
 (xx2000-xx2299) or IRF (xx3025-xx3099) or third digit
 equals 'T', 'R' or 'M', set the '7119' error code.

 When the Inpatient record in history is Provider Number
 'xx4000-xx4499', or 'xxSxxx', set the '7119' error code.

 The Provider is Maryland ('21' in positions 1 and 2 of the
 Provider Number), bypass this edit.

 The claim is a bill type '12x', bypass this edit.

 The claim is for a Revenue Code of '0403' and a HCPCS code
 of '76092', '77057', 'G0202', or 'G0203', and is the only
 Revenue Code on the claim, bypass this edit.

 The Inpatient history bill Action Code is '2', '4', or '6',
 bypass this edit.

 The Outpatient bill type is '72x' and the principal
 diagnosis is not equal to the Inpatient principal
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 180
______________________________________________________________________________

 diagnosis, bypass this edit.

 The Inpatient history bill is cancelled, bypass this edit.

 The Inpatient history bill No-Payment Code is 'B', 'C',
 'N', or 'R', bypass this edit.

 The Inpatient history bill type is not '11x' or '41x',
 bypass this edit.

 The Outpatient bill type is '85x', bypass this edit.

 The incoming Outpatient Action Code is a '7', bypass this
 edit.

 When the incoming Outpatient claim is an Encounter and the
 Inpatient History claim is an IME/GME with Condition Codes
 '04' and '69', bypass this edit.

 When the No-Pay code is 'N', bypass this edit.

 When the incoming Outpatient claim Total Charge equals the
 Non-covered Charge, bypass this edit.

 Trailer Information:     08, 13


 g. Error Code: 7120       ( )New (X)Modified ( )Deleted
 Disposition: CR

 Type of Record:   OUTP

 Error Message:
 An Inpatient claim with Condition Code '65' present, or
 Providers, LTCH or IRF, with an Admission Date, or the
 Admission Date minus one day, equal to the Outpatient history
 Thru Date, or if present, the Occurrence Span Code '72' Thru
 Date, and the Outpatient history claim has one or more
 diagnostic Revenue Codes present.

 Set Condition for edit '7120':
 An Inpatient claim with Condition Code '65' present, or
 Providers, LTCH or IRF, with an Admission Date, or the
 Admission Date minus one day, equal to the Outpatient history
 Line Item Date, or if present, the Occurrence Span Code '72'
 Thru Date, and the Outpatient history claim has one or more
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 181
______________________________________________________________________________

 diagnostic Revenue Codes present.

 Note: The date criteria for this edit is:
       The Outpatient history From Date or, if present, the
       Occurrence Span Code '72' From Date, is greater than
       10/30/1994.

 When Providers are the same or the Providers do not match
 only on third position and third digit of Inpatient claim
 Provider is 'M', 'R', 'S', or 'T', continue this edit.
 When the incoming claim bill type is '11x' or '41x', and
 the Thru Date is equal to the Admission Date, or the day
 prior to the Admission Date, and the Outpatient History Revenue
 Code is equal to '030x', '031x', '032x', '035x', '040x',
 '046x', '053x', '061x', '062x', '073x', '074x',
 '092x', '0254', '0255', '0341', '0343', '0371',
 '0372', '0471', '0918', '0482, or '0483', set the '7120' error code.

 When '0481', '0489' (Cardiology) present with the following
 HCPCS codes:
 '93015', '93307', '93308', '93320', '93501', '93503',
 '93505', '93508', '93510', '93526', '93541 - 93552',
 '93556', '93561', or '93562', set the '7120' error code.

 When the above condition and the Providers are LTCH
 (xx2000-xx2299) or IRF (xx3025-xx3099) or third digit
 equals 'M', 'R' or 'T', set the '7120' error code.

 When the incoming Inpatient record has a Provider Number
 'xx4000-xx4499', or 'xxSxxx', set the '7120' error code.

 The Provider is Maryland ('21' in positions '1' and '2' of
 the Provider Number), bypass this edit.

 The Inpatient history bill No-Payment Code is 'B', 'C',
 'N', or 'R', bypass this edit.

 The Inpatient Claim is for a Revenue Code of '0403', and a
 HCPCS code of '76092', '77057', 'G0202', or 'G0203', and
 is the only Revenue Code on the claim, bypass this edit.

 The Outpatient history bill has a Cancel Date, bypass this
 edit.

 The Outpatient history bill type is '12x', bypass this edit.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 182
______________________________________________________________________________

 The Outpatient bill type is '72x' and the principal
 diagnosis is not equal to the Inpatient principal
 diagnosis, bypass this edit.

 The Outpatient history bill type is '85x', bypass this
 edit.

 When the Outpatient history bill type is '14x' and Provider
 ranges from 'XX1300-XX1399', bypass this edit.

 The Action Code is a '7', bypass this edit.

 The Demonstration Project Number is equal to '31', bypass
 this edit.

 When the incoming Inpatient claim is an IME/GME with
 Condition Codes '04' and '69' and the History Outpatient is
 an Encounter, bypass this edit.

 When the No-Pay code is 'N', bypass this edit.

 When the incoming Outpatient claim Total Charge equals the
 Non-covered Charge, bypass this edit.

 Trailer Information:     08, 13


 h. Error Code: 7121       ( )New (X)Modified ( )Deleted
 Disposition: CR

 Type of Record:   OUTP

 Error Message:
 An Outpatient claim with the Thru Date (or if present,
 Occurrence Span Code '72' Date) equal to the Inpatient
 Admission Date or the Inpatient Admission Date minus one day,
 and one or more therapeutic Revenue Codes are on the
 Outpatient claim, and the Inpatient history claim has a
 Condition Code of '65' or Providers, LTCH or IRF.

 Set Condition for edit '7121':

 Note:   This edit only applies when the Outpatient From
         Date (or if present, Occurrence Span Code '72' From
         Date) is greater than 10/30/1994.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 183
______________________________________________________________________________

 When Providers are the same or the Providers do not match
 only on third position and third digit of Inpatient claim
 Provider is 'M', 'R', 'S', or 'T', continue this edit.

 When the Outpatient From Date (or if present, Occurrence
 Span Code '72' From Date) is greater than '+94303', and the
 Outpatient Line Item Date (or if present, Occurrence Span Code
 '72' Thru Date) is equal to the Inpatient Admission Date or
 the day prior to the Admission Date, and the Inpatient bill
 type is '11x' or '41x', and a Condition Code '65' is present,
 and the Outpatient principal diagnosis code is equal to the
 Inpatient principal diagnosis code, and an Outpatient
 Revenue Code is equal to '0250', '0251', '0252', '0256',
 '0257', '0258', '0259', '026x', '027x', '028x', '033x',
 '0340', '0342', '0349', '036x', '0370', '0374', '0379',
 '041x', '042x', '043x', '044x', '045x', '0472', '049x',
 '051x', '052x', '055x', '056x', '063x', '070x', '071x',
 '072x', '075x', '076x', '079x', '090x', '091x', or
 '094x', set the '7121' error code.

 When the above condition and the Providers are LTCH
 (xx2000-xx2299) or IRF (xx3025-xx3099) or third digit
 equals 'M', 'R', or 'T', set the '7121' error code.

 When the Inpatient record in history is Provider Number
 'xx4000-xx4499', or 'xxSxxx', set the '7121' error code.

 When the incoming claim From Date (or if present,
 Occurrence Span Code '72' From Date) is greater than the
 history claim Thru Date, bypass this edit.

 When the history Inpatient bill source is not a '2' or '3',
 bypass this edit.

 When the Cancel Date is greater than zero, bypass this
 edit.

 When the Outpatient From Date (or if present, Occurrence
 Span Code '72' From Date) is equal to or greater than the
 history Inpatient Discharge Date, bypass this edit.

 When the Outpatient Action Code is a '7', bypass this edit.

 When the incoming Outpatient Provider Number begins with
 '21', bypass this edit.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 184
______________________________________________________________________________

 When the incoming Outpatient bill type is a '12x',
 bypass this edit.

 When the history Inpatient claim has a No-Pay Code of 'B',
 'C', 'N', or 'R', bypass this edit.

 When the history Inpatient Action Code is a '2', '4', or
 '6', bypass this edit.

 When the Outpatient Line Item Date (or if present, Occurrence
 Span Code '72' Thru Date) is greater than the Inpatient
 Admission Date, bypass this edit.

 When the Outpatient Line Item Date (or if present, Occurrence
 Span Code '72' Thru Date) is more than three days prior to
 the Inpatient Admission Date, bypass this edit.

 When the history Inpatient Action Code is a '2', '4', or
 '6', bypass this edit.

 When the Outpatient Line Item Date (or if present, Occurrence
 Span Code '72' Thru Date) is greater than the Inpatient
 Admission Date, bypass this edit.

 When the Outpatient Line Item Date (or if present, Occurrence
 Span Code '72' Thru Date) is more than three days prior to
 the Inpatient Admission Date, bypass this edit.

 When the Inpatient claim has a bill type '11x' or '41x',
 and the Outpatient From Date (or if present, Occurrence
 Span Code '72' From Date) is less than '+91274',
 bypass this edit.

 When the Inpatient claim has a bill type '11x' or '41x',
 and the Outpatient claim has a bill type '72x', and the
 principal diagnosis codes are not equal, bypass this edit.

 When the Type of Bill on the incoming Outpatient claim is
 '85x', the only therapeutic Revenue Code on the Outpatient
 claim is '0510', bypass this edit.

 When the Type of Bill on the incoming Outpatient claim is
 '85x', bypass this edit.

 When the incoming Outpatient bill type is '14x' and
 Provider ranges from 'XX1300-XX1399', bypass this edit.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 185
______________________________________________________________________________


 When the incoming Outpatient claim is an Encounter and the
 Inpatient History claim is an IME/GME with Condition Codes
 '04' and '69', bypass this edit.

 When the No-Pay code is 'N', bypass this edit.

 When the incoming Outpatient claim Total Charge equals the
 Non-covered Charge, bypass this edit.

 Trailer Information:   08, 13


 i. Error Code: 7122     ( )New (X)Modified ( )Deleted
 Disposition: CR

 Type of Record:   Hospital

 Error Message:
 An Inpatient claim with Condition Code '65' present, or
 Providers LTCH or IRF, with the Admission Date, or the
 Admission Date minus one day, equal to the Outpatient history
 Thru Date (or if present, Occurrence Span Code '72' Thru
 Date), and the Outpatient history claim has one or more
 therapeutic Revenue Codes present.

 Set Condition for edit '7122':

 Note:   This edit only applies when the Outpatient history
         From Date (or if present, Occurrence Span Code '72'
         From Date) is greater than 10/30/1994.

 When Providers are the same or the Providers do not match
 only on third position and third digit of Inpatient claim
 Provider is 'S', 'T', 'R' or 'M', continue this edit.

 When the Inpatient bill type is '11x' or '41x', and the
 Outpatient Line Item Date (or if present, Occurrence Span Code
 '72' Thru Date) is equal to the Admission Date, or the day
 prior to the Admission Date,
 and the principal diagnosis codes are equal, and the
 Inpatient claim contains a Condition Code '65', and Revenue
 Code is equal to '0250', '0251', '0252', '0256', '0257',
 '0258', '0259', '026x', '027x', '028x', '033x', '0340',
 '0342', '0349', '036x', '0370', '0374', '0379', '041x',
 '042x', '043x', '044x', '045x', '0472', '049x', '051x',
______________________________________________________________________________
2020 Company, LLC                                           Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 186
______________________________________________________________________________

'052x', '055x', '056x', '063x', '070x', '071x', '072x',
'075x', '076x', '079x', '090x', '091x', or '094x',
set the '7122' error code.

When the above condition and the Providers are LTCH
(xx2000-xx2299) or IRF (xx3025-xx3099) or third digit
equals 'M', 'R', or 'T', set the '7122' error code.

When the incoming Inpatient record has a Provider Number
'xx4000-xx4499', or 'xxSxxx', set the '7122' error code.

When the Type of Bill on the history Outpatient claim is
'85x', the only therapeutic Revenue Code on the Outpatient
claim is '0510', bypass this edit.

When the Type of Bill on the history Outpatient claim is
'85x' or '12x', bypass this edit.

When the history Outpatient bill type is '14x' and Provider
ranges from 'XX1300-XX1399', bypass this edit.

When the incoming Inpatient claim is an IME/GME with
Condition Codes '04' and '69' and the History Outpatient
claim is an Encounter, bypass this edit.

OUTP
When the No-Pay code is 'N', bypass this edit.

When the incoming Outpatient claim Total Charge equals the
Non-covered Charge, bypass this edit.

Trailer Information:   08, 13

  INSTALLATION INSTRUCTIONS:    None

  SYSTEMS DOCUMENTATION AFFECTED:

    EDITABX               ADD EDIT WILL SET BASED ON LINE ITEM DATE
                          OF SERVICE, NOT OUTPATIENT THRU DATE TO
                          THE FOLLOWING EDITS:
                          '7109', '7112', '7113', '7114', '7115',
                          '7119', '7121', '7122'.

    EDITABX               REMOVE REVENUE CODE '048X' AND REPLACE WITH
                          '0482' AND '0483' FOR THE FOLLOWING EDITS:
                          '7109', '7112', '7113', '7119', '7120'.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 187
______________________________________________________________________________


    EDITABX               INCLUDE REVENUE CODES '481' AND '489' WITH
                          HCPCS (93501, 93503, 93505, 93508, 93510,
                          93526, 93541, 93542, 93543, 93544, 93556,
                          93561, 93562) FOR EDITS
                          '7109', '7112', '7113', '7119' AND '7120'

   SATELLITE SYSTEM MODIFICATIONS:   None




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 188
______________________________________________________________________________

  12. 00025765   5878-SMOKING AND TOBACCO USE CESSATION COUNSELING UPDATE

  REQUESTOR ID: CWFM2000

  IMPACT:
(X) Host
( ) Satellite Part A Inpatient
(X) Satellite Part A Outpatient
(X) Satellite Part B
( ) Hospice
( ) Home Health
( ) DMERC

  REASON FOR CHANGE:
The 2008 Medicare Physician Fee Database (MPFSDB) includes
two new CPT codes for Smoking and Tobacco Use Cessation
Counseling services to replace the temporary HCPCS codes
currently in use for billing of these services. The new codes
are effective for services performed on or after 01/01/2008.

Medicare systems shall recognize new CPT codes '99406' and
'99407' for Smoking and Tobacco-Use Cessation Counseling
services on all provider inquiry screens (HIQA, HUQA, HIQH,
ELGA, ELGB, and ELGH).

NOTE:   HCPCS codes 'G0375' and 'G0376' are being discontinued
        effective 01/01/2008.

Beginning with Dates of Service on or after 07/01/2008,
the CWF shall edit for the frequency of service limitations
for Smoking and Tobacco-Use Cessation Counseling services
recognizing new CPT codes '99406' and '99407' in place of
deleted HCPCS codes 'G0375' and 'G0376'.

  NEW BUSINESS REQUIREMENTS:

Requirement 1
Modify SMOK Auxiliary File to include logic for Dates of
Service 07/01/2008 and after to display new HCPCS '99406'
and '99407'.

These new HCPCS replace HCPCS 'G0375' and 'G0376', which
are effective only through 12/31/2007.

 Continue to apply existing logic for HCPCS 'G0375' and
 'G0376' with Dates of Service prior to 01/01/2008.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 189
______________________________________________________________________________


 Requirement 2
 Modify consistency edit '5A#2' (units billed exceed '8')
 for Dates of Service on or after 07/01/2008 to edit for the
 frequency of service limitations recognizing new HCPCS
 codes '99406' and '99407'.

 These new HCPCS replace HCPCS 'G0375' and 'G0376', which
 are effective only through 12/31/2007.

 Continue to apply existing logic for HCPCS 'G0375' and
 'G0376' with Dates of Service prior to 01/01/2008.

 Requirement 3
 Modify consistency edit '66x8' (units billed exceed '8')
 for Dates of Service on or after 07/01/2008 to edit for the
 frequency of service limitations recognizing new HCPCS
 codes '99406' and '99407'.

 These new HCPCS replace HCPCS 'G0375' and 'G0376', which
 are effective only through 12/31/2007.

 Continue to apply existing logic for HCPCS 'G0375' and
 'G0376' with Dates of Service prior to 01/01/2008.

 Requirement 4
 Modify utilization edit '539E' (Medicare does not pay for
 more than '8' sessions of Smoking Cessation Counseling
 in '11' full months) for Dates of Service on or after
 07/01/2008 to edit for the frequency of service
 limitations recognizing new HCPCS codes '99406' and '99407'.

 These new HCPCS replace HCPCS 'G0375' and 'G0376', which
 are effective only through 12/31/2007.

 Ensure that all HCPCS 'G0375', 'G0376', '99406' and '99407'
 are included in the calculation for the same 11 full month
 period when applicable.

 Continue to apply existing logic for HCPCS 'G0375' and
 'G0376' with Dates of Service prior to 01/01/2008.

 Requirement 5
 Modify Provider Inquiry Screens HIQA, HUQA, HIQH, ELGA, ELGB,
 and ELGH to recognize new HCPCS codes '99406' and '99407'
 for Smoking and Tobacco Use Cessation.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 190
______________________________________________________________________________


 These new HCPCS replace HCPCS 'G0375' and 'G0376', which
 are effective only through 12/31/2007.

 Continue to apply existing logic for HCPCS 'G0375' and
 'G0376' with Dates of Service prior to 01/01/2008.

   EVENT-RESPONSE LIST:

 Event 1.1
 Access the 'SMOK' Auxiliary file in HIMR for a Beneficiary
 that has received services with HCPCS code '99406' or
 '99407' with a Date of Service on, or after 07/01/2008.

 Response
 The data displayed contains the new HCPCS codes.

 Event 1.2
 Access the 'SMOK' Auxiliary file in HIMR for a Beneficiary
 that has received services with HCPCS code 'G0375' or
 'G0376' with a Date of Service prior to 01/01/2008.

 Response
 The data displayed contains the old HCPCS codes.

 Event 2.1
 An HUOP record is received with HCPCS code '99406' or
 '99407' and Dates of Service on, or after 07/01/2008.
 The units on the record total more than '8'.

 Response
 The record is rejected, error code '5A#2' is set.

 Event 2.2
 An HUOP record is received with HCPCS code 'G0375' or
 'G0376' and Dates of Service prior to 01/01/2008.
 The units on the record total more than '8'.

 Response
 The record is rejected, error code '5A#2' is set.

 Event 2.3
 An HUOP record is received with HCPCS code '99406' or
 '99407' and Dates of Service on, or after 07/01/2008.
 The units on the record total less than '8'.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 191
______________________________________________________________________________

 Response
 The record is accepted, error code '5A#2' is not set.

 Event 2.4
 An HUOP record is received with HCPCS code 'G0375' or
 'G0376' and Dates of Service prior to 01/01/2008.
 The units on the record total less than '8'.

 Response
 The record is accepted, error code '5A#2' is not set.

 Event 3.1
 An HUBC record is received with HCPCS code '99406' or
 '99407' and Dates of Service on, or after 07/01/2008.
 The units on the record total more than '8'.

 Response
 The record is rejected, error code '66x8' is set.

 Event 3.2
 An HUBC record is received with HCPCS code 'G0375' or
 'G0376' and Dates of Service prior to 01/01/2008.
 The units on the record total more than '8'.

 Response
 The record is rejected, error code '66x8' is set.

 Event 3.3
 An HUBC record is received with HCPCS code '99406' or
 '99407' and Dates of Service on, or after 07/01/2008.
 The units on the record total less than '8'.

 Response
 The record is accepted, error code '66x8' is not set.

 Event 3.4
 An HUBC record is received with HCPCS code 'G0375' or
 'G0376' and Dates of Service prior to 01/01/2008.
 The units on the record total less than '8'.

 Response
 The record is accepted, error code '66x8' is not set.

 Event 4.1
 An HUBC/HUOP record is received with HCPCS code '99406'
 or '99407' and Dates of Service on, or after 07/01/2008.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 192
______________________________________________________________________________

 The Beneficiary has 8 sessions posted to the 'SMOK'
 Auxiliary file. The incoming date is within '11' full
 months of the posted session.

 Response
 The record is rejected, error code '539E' is set.

 Event 4.2
 An HUBC/HUOP record is received with HCPCS code 'G0375'
 or 'G0376' and Dates of Service prior to 01/01/2008.
 The Beneficiary has 8 sessions posted to the 'SMOK'
 Auxiliary file. The incoming date is within '11' full
 months of the posted session.

 Response
 The record is rejected, error code '539E' is set.

 Event 4.3
 An HUBC/HUOP record is received with HCPCS code '99406'
 or '99407' and Dates of Service on, or after 07/01/2008.
 The Beneficiary has 8 sessions posted with HCPCS code
 'G0375' or 'G0376' to the 'SMOK' Auxiliary file. The
 incoming date is within '11' full months of the posted
 session.

 Response
 The record is rejected, error code '539E' is set.

 Event 4.4
 An HUBC/HUOP record is received with HCPCS code '99406'
 or '99407' and Dates of Service on, or after 07/01/2008.
 The Beneficiary has 8 sessions posted to the 'SMOK'
 Auxiliary file. The incoming date is not within '11'
 full months of the posted session.

 Response
 The record is accepted, error code '539E' is not set.

 Event 4.5
 An HUBC/HUOP record is received with HCPCS code 'G0375'
 or 'G0376' and Dates of Service prior to 01/01/2008.
 The Beneficiary has 8 sessions posted to the 'SMOK'
 Auxiliary file. The incoming date is not within '11'
 full months of the posted session.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 193
______________________________________________________________________________

Response
The record is accepted, error code '539E' is not set.

Event 5.1
Initiate a HIQA inquiry on a Beneficiary record that
contains HCPCS '99406' or '99407' on the SMOK Auxiliary
file.

Response
The HIQA screen displays the new HCPCS code from the
SMOK Auxiliary file for smoking and tobacco use cessation
counseling services.

Event 5.2
Initiate a HIQA inquiry on a Beneficiary record that
contains HCPCS 'G0375' or 'G0376' on the SMOK Auxiliary
file.

Response
The HIQA screen displays the old HCPCS code from the
SMOK Auxiliary file for smoking and tobacco use cessation
counseling services.

Event 5.3
Initiate a HUQA inquiry on a Beneficiary record that
contains HCPCS '99406' or '99407' smoking session data
on the SMOK Auxiliary file.

Response
The HUQA displays the new HCPCS code from the SMOK
Auxiliary file for smoking and tobacco use cessation
counseling services.

Event 5.4
Initiate a HUQA inquiry on a Beneficiary record that
contains HCPCS 'G0375' or 'G0376' smoking session data
on the SMOK Auxiliary file.

Response
The HUQA displays the old HCPCS code from the SMOK
Auxiliary file for smoking and tobacco use cessation
counseling services.

 Event 5.5
 Initiate a HIQH inquiry on a Beneficiary record that
 contains HCPCS '99406' or '99407' smoking session data
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 194
______________________________________________________________________________

 SMOK Auxiliary file.

 Response
 The HIQH screen displays the new HCPCS code from the SMOK
 Auxiliary file for smoking and tobacco use cessation
 counseling services.

 Event 5.6
 Initiate a HIQH inquiry on a Beneficiary record that
 contains HCPCS 'G0375' or 'G0376' smoking session data
 SMOK Auxiliary file.

 Response
 The HIQH screen displays the old HCPCS code from the SMOK
 Auxiliary file for smoking and tobacco use cessation
 counseling services.

 Event 5.7
 Initiate a ELGA inquiry on a Beneficiary record that
 contains HCPCS '99406' or '99407' smoking session data
 on the SMOK Auxiliary file.

 Response
 The ELGA screen displays the new HCPCS code from the SMOK
 Auxiliary file for smoking and tobacco use cessation
 counseling services.

 Event 5.8
 Initiate a ELGA inquiry on a Beneficiary record that
 contains HCPCS 'G0375' or 'G0376' smoking session data
 on the SMOK Auxiliary file.

 Response
 The ELGA screen displays the old HCPCS code from the SMOK
 Auxiliary file for smoking and tobacco use cessation
 counseling services.

 Event 5.9
 Initiate a ELGB inquiry on a Beneficiary record that
 contains HCPCS '99406' or '99407' smoking session data
 on the SMOK Auxiliary file.

 Response
 The ELGB screen displays the new HCPCS code from the SMOK
 Auxiliary file for smoking and tobacco use cessation
 counseling services.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 195
______________________________________________________________________________


 Event 5.10
 Initiate a ELGB inquiry on a Beneficiary record that
 contains HCPCS 'G0375' or 'G0376' smoking session data
 on the SMOK Auxiliary file.

 Response
 The ELGB screen displays the old HCPCS code from the SMOK
 Auxiliary file for smoking and tobacco use cessation
 counseling services.

 Event 5.11
 Initiate a ELGH inquiry on a Beneficiary record that
 contains HCPCS '99406' or '99407' smoking session data
 on the SMOK Auxiliary file.

 Response
 The ELGH screen displays the new HCPCS code from the SMOK
 Auxiliary file for smoking and tobacco use cessation
 counseling services.

 Event 5.12
 Initiate a ELGH inquiry on a Beneficiary record that
 contains HCPCS 'G0375' or 'G0376' smoking session data
 on the SMOK Auxiliary file.

 Response
 The ELGH screen displays the old HCPCS code from the SMOK
 Auxiliary file for smoking and tobacco use cessation
 counseling services.

 The Entity List includes only NEW acronyms and terminology
 that is currently not in use in CWF.

 Entity List: N/A

 Areas Affected by the    Problem.
   1. EDITCONS HUOPCED    / HUBCCED
   2. Provider inquiry    screens HIQA, HUQA, HIQH, ELGA, ELGB, ELGH
   3. EDITUTIL HUOPCUT    / HUBCCUT

 Solution Criteria: N/A




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 196
______________________________________________________________________________

  EDITS AFFECTED:

a. Error Code:      5A#2    ( )New (X)Modified ( )Deleted
Disposition: ER

Type of Record: OUTP

Error Message:
The units billed exceed '8'. Medicare does not pay for more
than '8' sessions of Smoking Cessation Counseling in '11'
full months.

Set Condition for edit '5A#2':

When an Outpatient (HUOP) record with a Service Date on or
after 10/3/2005 has total units that exceed 8 for HCPCS
codes 'G0375' and/or 'G0376', set the '5A#2' error code.

When an Outpatient (HUOP) record with a Service Date
on or after 07/01/2008 has total units that exceed 8 for
HCPCS codes '99046' and/or '99407', set the '5A#2' error
code.

When the No-Pay Code is 'N', bypass this edit.

When the Total Charges equal the Non-covered Charges,
bypass this edit.

Trailer Information:       08


b. Error Code:      66x8    ( )New (X)Modified ( )Deleted
Disposition: ER

Type of Record: Pt. B Carrier

Error Message:
The units billed exceed '8'. Medicare does not pay for more
than '8' sessions of Smoking Cessation Counseling in '11'
full months.

Set Condition for edit '66x8':

 When a Part B (HUBC) record with a Service Date on or after
 10/3/2005 has total units that exceed 8 for HCPCS codes
 'G0375' and/or 'G0376', set the '66x8' error code.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 197
______________________________________________________________________________


 When a Part B (HUBC) record with a Service Date
 on or after 07/01/2008 has total units that exceed 8 for
 HCPCS codes '99406' and/or '99407', set the '66x8' error
 code.

 When the Entry Code is '3', bypass this edit.

 If the claim or line item is denied, bypass this edit.

 Trailer Information: '08'


 c. Error Code:    539E   ( )New (X)Modified ( )Deleted
 Disposition: UR

 Type of Record: OUTP

 Error Message:
 Medicare does not pay for more than '8' sessions of Smoking
 Cessation Counseling in '11' full months.

 Set Condition for edit '539E':

 If an incoming Outpatient record has HCPCS code 'G0375',
 or 'G0376' with a Service Date on or after 10/03/2005
 and the number of units will cause the number of units on
 an existing Smoking Cessation Training period on the TRNGAUX
 file to exceed a total of '8', set the '539E' error code.

 If an incoming Outpatient record has HCPCS code '99406',
 or '99407' with a Service Date on or after 07/01/2008
 and the number of units will cause the number of units on
 an existing Smoking Cessation Training period on the TRNGAUX
 file to exceed a total of '8', set the '539E' error code.

 When the No-Payment Code is 'B' or 'N', bypass the edit.

 When the No-Payment Code is not present, but the Non-Covered
 Charge for the detail line item is equal to the Total Charge
 bypass the edit.

 When the Action Code is '4' (Cancel Only), bypass the edit.

 When the Action Code is '7' (History Bill), bypass the edit.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 198
______________________________________________________________________________

 Trailer Information: '08'

   INSTALLATION INSTRUCTIONS:     None

   SYSTEMS DOCUMENTATION AFFECTED:

    EDITCONS                 ADD NEW HCPCS CODES TO EDIT '66X8'.

    EDITCONS                 ADD NEW HCPCS CODES TO EDIT '5A#2'.

    EDITUTIL                 ADD NEW HCPCS CODES TO EDIT '539E'.

   SATELLITE SYSTEM MODIFICATIONS:

**Refer to CR 00025817 for the Satellite System Modifications for this CR.**




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 199
______________________________________________________________________________

   13. 00025773   5877 CORRECTION TO LOW UTILIZATION PAYMENT ADJUSTMENT ADD-ON

   REQUESTOR ID: CWFM2000

   IMPACT:
 (X) Host
 ( ) Satellite Part A Inpatient
 ( ) Satellite Part A Outpatient
 ( ) Satellite Part B
 ( ) Hospice
 (X) Home Health
 ( ) DMERC

   REASON FOR CHANGE:
 System changes are necessary to prevent low utilization payment
 adjustment (LUPAs) add-on payments on HH PPS claims where the
 add-on does not apply.

 LUPA add-on payments should only be made for the first episode
 in a sequence of adjacent episodes or the only episode of care
 received by a Beneficiary.

 CWF will create a new utilization error code to ensure LUPA
 add-on payments are not made incorrectly.

   NEW BUSINESS REQUIREMENTS:

 Requirement 1
 CWF will create a new utilization error code '539H' to reject
 a LUPA add-on with Pricer return code '14' when the episode
 is not the first or the only episode in a sequence of adjacent
 episodes.

 The RHHI's will submit a LUPA add-on record with four or less
 visits, Type of Bill '32x' or '33x', HIPPS code '1' or '2',
 and Source of Admission Code 'B' or 'C' is not present.

 A sequence of adjacent episodes is defined as: If a patient
 is admitted to a first episode at one HHA then discharged
 and readmitted to the same or another HHA within the 60-day
 period between episodes.

 The edit will apply to Dates of Service on, or after, 01/01/2008.

 Note: CWF must read Home Health episodes prior to Dates of
       Service 01/01/2008 to determine if the incoming LUPA
______________________________________________________________________________
2020 Company, LLC                                           Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 200
______________________________________________________________________________

       add-ons with Dates of Service on, or after 01/01/2008
       is the first episode in a sequence of adjacent episodes.

 CWF will bypass the edit when:
   The No-Payment Code equals 'B' or 'N'
   The Action Code equals '4' (Cancel only).

 CWF will return Trailer '08' with the new error code '539H'.

 CWF will return Trailer '23' to identify the Home Health
 episode.

   EVENT-RESPONSE LIST:

 Event 1.1
 An incoming LUPA add-on record (32x or 33x) is received with
 Pricer Return Code '14'.

 A Home Health PPS episode is posted to the Beneficiary's
 record (DOEBA/DOLBA date present) that is not the first episode
 or the only episode in a sequence of adjacent episodes.

 Response
 Error code '539H' is set. Trailer '08' and '23' is returned.

 Event 1.2
 An incoming LUPA add-on record (32x or 33x) is received with
 Pricer Return Code '14'.

 A Home Health PPS episode is posted to the Beneficiary's
 record (DOEBA/DOLBA date present) that is the first episode
 or the only episode in a sequence of adjacent episodes.

 Response
 Error code '539H' is not set.

 Event 1.3
 An incoming LUPA add-on record (32x or 33x) is received with
 Pricer Return Code '14' and No-Pay Code of 'B' or 'N' is
 present.

 A Home Health PPS episode is posted to the Beneficiary's
 record (DOEBA/DOLBA date present) that is not the first episode
 or the only episode in a sequence of adjacent episodes.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 201
______________________________________________________________________________

 Response
 Error code '539H' is not set.

 Event 1.4
 An incoming LUPA add-on record (32x or 33x) is received with
 Pricer Return Code '14' and Action Code equals '4'.

 A Home Health PPS episode is posted to the Beneficiary's
 record (DOEBA/DOLBA date present) that is not the first episode
 or the only episode in a sequence of adjacent episodes.

 Response
 Error code '539H' is not set.

 Event 1.5
 An incoming LUPA add-on record (32x or 33x) is received with
 Pricer Return Code '14' with Dates of Service 01/01/2008.

 The Beneficiary's has a Home Health episode that is prior to
 01/01/2008 that is adjacent to the incoming LUPA add-on.

 Response
 Error code '539H' is set.

 The Entity List includes only NEW acronyms and terminology
 that is currently not in use in CWF.

 Entity List: N/A

 Areas Affected by the Problem.
   1. Part A Utilization module

 Solution Criteria: N/A

   EDITS AFFECTED:

 a. Error Code:      539H   (X)New ( )Modified ( )Deleted
 Disposition: UR

 Type of Record: HHA

 Error Message:
 The Home Health Episode is not the first or the only episode
 in a sequence of adjacent episodes.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 202
______________________________________________________________________________

Set Condition for edit '539H':

When an incoming LUPA add-on record (32x or 33x) is received
with Pricer Return Code '14' and the episode is not the
first or the only episode in a sequence of adjacent episodes,
set the '539H' error code.

The RHHI's will submit a LUPA add-on record with four or less
visits, Type of Bill '32x' or '33x', HIPPS code '1' or '2',
and Source of Admission Code 'B' or 'C' is not present.

When the Date of Service is on or after 01/01/2008, set the
'539H' error code.

Note:
CWF must read Home Health episodes prior to Dates of
Service 01/01/2008 to determine if the incoming LUPA
add-ons with Dates of Service on, or after 01/01/2008
is the first episode in a sequence of adjacent episodes.

Trailer Information: 08, 23

  INSTALLATION INSTRUCTIONS:     None

  SYSTEMS DOCUMENTATION AFFECTED:

    EDITUTIL             ADD NEW ERROR CODE '539H'.

    EDITLIST             ADD NEW ERROR CODE '539H'.

  SATELLITE SYSTEM MODIFICATIONS:       None




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 203
______________________________________________________________________________

   14. 00025774   77X1 SHOULD BYPASS WHEN THE CLAIM OR LINE ITEM IS DENIED

   REQUESTOR ID: EMBCBS1000

   IMPACT:
 (X) Host
 ( ) Satellite Part A Inpatient
 ( ) Satellite Part A Outpatient
 (X) Satellite Part B
 ( ) Hospice
 ( ) Home Health
 (X) DMERC

   REASON FOR CHANGE:
 CWF is not bypassing denied services when the Place of Service
 is invalid. Consistency error code '77x1' is being set in error
 on Part B and DMERC claims.

   NEW BUSINESS REQUIREMENTS:

 Requirement 1
 CWF must bypass consistency error code '77x1' (Invalid
 Place of Service) when the entire claim is denied or a
 detail line of the claim is denied that contains an
 invalid Place of Service.

 CWF will utilize the Payment Process Indicator to
 determine if the claim is denied or paid. CWF will
 bypass the '77x1' if the Payment Process Indicator
 is not equal to 'A', 'R' or 'S'.

   EVENT-RESPONSE LIST:

 Event 1.1
 Submit an HUBC record that contains an invalid Place of
 Service (POS). The Payment Process Indicator on the claim
 is not equal to 'A', 'R' or 'S'.

 Response
 The incoming record is processed, error code '77x1' is not set.

 Event 1.2
 Submit an HUDC record that contains an invalid Place of
 Service (POS). The Payment Process Indicator on the claim
 is not equal to 'A', 'R' or 'S'.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 204
______________________________________________________________________________

 Response
 The incoming record is processed, error code '77x1' is not set.

   EDITS AFFECTED:

 a. Error Code:      77x1   ( )New (X)Modified ( )Deleted
 Disposition:        ER

 Type of Record:     Pt. B Carrier

 Error Message:
 Invalid Type of Service.

 Set Condition for edit '77x1':

 When the Place of Service is not equal to:

 '01' Pharmacy
 '03' School
 '04' Homeless Shelter
 '05' Indian Health Service Free-standing Facility
 '06' Indian Health Service Provider-based Facility
 '07' Tribal 638 Free-standing Facility
 '08' Tribal 638 Provider-based Facility
 '09' Prison/Correctional Facility
 '11' Office
 '12' Home
 '13' Assisted Living Facility
 '14' Group Home
 '15' Mobile Unit
 '16' Temporary Lodging
 '20' Outpatient
 '21' Inpatient Hospital
 '22' Outpatient Hospital
 '23' Emergency Room Hospital
 '24' Ambulatory Surgical Center
 '25' Birthing Center
 '26' Military Treatment Center
 '31' Skilled Nursing Facility
 '32' Nursing Facility
 '33' Custodial Care Facility
 '34' Hospice
 '41' Ambulance - Land
 '42' Ambulance - Air or Water 1
 '49' Independent Clinic
 '50' Federally Qualified Health Center
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 205
______________________________________________________________________________

 '51'   Inpatient Psychiatric Facility
 '52'   Psychiatric Facility Partial Hospitalization
 '53'   Community Mental Health Center
 '54'   Intermediate Care Facility/Mentally Retarded
 '55'   Substance Abuse Treatment Facility
 '56'   Psychiatric Treatment Facility
 '57'   Non-residential Substance Abuse Treatment Facility
 '60'   Mass Immunization Center
 '61'   Comprehensive Inpatient Rehabilitation Facility
 '62'   Comprehensive Outpatient Rehabilitation Facility
 '65'   End Stage Renal Disease Treatment
 '71'   Public Health Clinic
 '72'   Rural Health Clinic
 '81'   Independent Laboratory
 '99'   Other Unlisted Facility, set the '77x1' error code.

 When the Pay Denial Indicator is equal to 'O', or
 Pay Denial Ind and Pay Process Ind equal '00', '12', '13',
 '14', '15', '16', '17', '18', '25', '26', 'E ', 'F ', 'G ',
 'H ', 'J ', 'K ', 'Q ', 'T ', 'U ', 'V ', 'X ', 'Y '
 bypass this edit.

 When the Payment Process Indicator is not equal to 'A', 'R'
 or 'S', bypass this edit.

 Trailer Information: '08'


 b. Error Code:    77x1     ( )New (X)Modified ( )Deleted
 Disposition:      ER

 Type of Record:   DMEPOS

 Error Message:
 Invalid Type of Service.

 Set Condition for edit '77x1':
 When the Place of Service is not equal to:
 '01' Pharmacy
 '03' School
 '04' Homeless Shelter
 '05' Indian Health Service Free-standing Facility
 '06' Indian Health Service Provider-based Facility
 '07' Tribal 638 Free-standing Facility
 '08' Tribal 638 Provider-based Facility
 '11' Office
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 206
______________________________________________________________________________

'12'   Home
'13'   Assisted Living Facility
'14'   Group Home
'15'   Mobile Unit
'20'   Outpatient Hospital
'21'   Inpatient Hospital
'22'   Outpatient Hospital
'23'   Emergency Room Hospital
'24'   Ambulatory Surgical Center
'25'   Birthing Center
'26'   Military Treatment Center
'31'   Skilled Nursing Facility
'32'   Nursing Facility
'33'   Custodial Care Facility
'34'   Hospice
'41'   Ambulance - Land
'42'   Ambulance - Air or Water
'49'   Independent Clinic
'50'   Federally Qualified Health Center
'51'   Inpatient Psychiatric Facility
'52'   Psychiatric Facility Partial Hospitalization
'53'   Community Mental Health Center
'54'   Intermediate Care Facility/Mentally Retarded
'55'   Substance Abuse Treatment Facility
'56'   Psychiatric Treatment Facility
'57'   Non-residential Substance Abuse Treatment Facility
'60'   Mass Immunization Center
'61'   Comprehensive Inpatient Rehabilitation Facility
'62'   Comprehensive Outpatient Rehabilitation Facility
'65'   End Stage Renal Disease Treatment
'71'   Public Health Clinic
'72'   Rural Health Clinic
'81'   Independent Laboratory or
'99'   Other Unlisted Facility, set the '77x1' error code.

When the Pay Denial Indicator is equal to 'O', or
Pay Denial Ind and Pay Process Ind equal '00', '12', '13',
'14', '15', '16', '17', '18', '25', '26', 'E ', 'F ', 'G ',
'H ', 'J ', 'K ', 'Q ', 'T ', 'U ', 'V ', 'X ', 'Y '
bypass this edit.

When the Payment Process Indicator is not equal to 'A', 'R'
or 'S', bypass this edit.

Trailer Information: 08

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 207
______________________________________________________________________________

   INSTALLATION INSTRUCTIONS:   None

   SYSTEMS DOCUMENTATION AFFECTED:

    EDITCONS              MODIFY ERROR CODE '77X1' TO BYPASS ALL
                          DENIED SERVICES (PAYMENT PROCESS INDICATOR
                          NOT EQUAL TO A, R OR S) FOR PT. B.

    EDITCONS              MODIFY ERROR CODE '77X1' TO BYPASS ALL
                          DENIED SERVICES (PAYMENT PROCESS INDICATOR
                          NOT EQUAL TO A, R OR S) FOR DMEPOS.

   SATELLITE SYSTEM MODIFICATIONS:     None




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 208
______________________________________________________________________________

   15. 00025789   COBC PROCESS MUST BE RE-WRITTEN TO PROCESS BASED ON LIDOS

   REQUESTOR ID: CWFM1000

   IMPACT:
 (X) Host
 (X) Satellite Part A Inpatient
 (X) Satellite Part A Outpatient
 (X) Satellite Part B
 (X) Hospice
 (X) Home Health
 (X) DMERC

   REASON FOR CHANGE:
 Currently the From and Thru Dates (Part A) and the First and
 Last Service Dates (Part B/DME) are used to determine up to 10
 BOI records which a might either include or exclude for crossover
 during Coordination of Benefits Agreement (COBA) processing.
 This has proved to be inadequate since the claim might possibly
 not have a line item service date which occurs during a
 particular BOI period.

 The purpose of this change is to eliminate any of the up to
 10 selected BOI records prior to inclusion/exclusion processing
 if there is no line item on the claim which falls within
 the BOI period. In a case where there is no Line Item Date
 of Service, the elimination process will be bypassed.

   NEW BUSINESS REQUIREMENTS:

 Requirement 1
 For incoming Part A claims (HUIP, HUOP, HUHH and HUHC)
 records, CWF must continue to use the From/Thru Dates
 to select and prioritize up to 10 BOI records which will
 be subjected to the COBA Inclusion/Exclusion process.

 CWF must modify the existing process to eliminate any of
 the up to 10 BOI records if the claim does not contain a
 line item Date of Service that falls within a/any specific
 BOI periods.

 A Trailer '29' will not be generated when the BOI is
 eliminated because the line item Dates of Service did
 not fall within a/any BOI period.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 209
______________________________________________________________________________

 Requirement 2
 For incoming Part B/DME claims (HUBC/HUDC) records, CWF must
 continue to use the First and Last Service Dates on the claim
 to select and prioritize up to 10 BOI records which will be
 subjected to the COBA Inclusion/Exclusion process.

 CWF must modify the existing process to eliminate any of the
 up to 10 BOI records if the claim does not contain a line
 item Date of Service that falls within a/any specific BOI
 periods.

 A Trailer '29' will not be generated when the BOI is
 eliminated because the line item Dates of Service did
 not fall within a/any BOI period.

   EVENT-RESPONSE LIST:

 Event 1.1
 Submit an HUIP/HUOP/HUHH/HUHC record for a Beneficiary
 that has more than ten COBA IDs on the COIF File. The line
 item dates on the claim fall within the some of the Effective
 and Termination Dates of the COBA IDs.

 Response
 The claim is processed. A Trailer '29' is generated with
 only the COBA IDs that fall within the line item Date of
 Service. The COBA IDs that were eliminated because the
 dates did not fall within the line item dates do not
 generate a '29' Trailer.

 Event 2.1
 Submit an HUBC/HUDC record for a Beneficiary that has more
 than ten COBA IDs on the COIF File. The detail line Dates
 of Service on the claim fall within the some of the Effective
 and Termination Dates of the COBA IDs.

 Response
 The claim is processed. A Trailer '29' is generated with
 only the COBA IDs that fall within the line item Date of
 Service. The COBA IDs that were eliminated because the
 dates did not fall within the line item dates do not
 generate a '29' Trailer.




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 210
______________________________________________________________________________

   EDITS AFFECTED:   None

   INSTALLATION INSTRUCTIONS:   None

   SYSTEMS DOCUMENTATION AFFECTED:     None

   SATELLITE SYSTEM MODIFICATIONS:     None




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 211
______________________________________________________________________________

   16. 00025800   5907-UPDATE TO CWF EDITS 7284 AND 7548

   REQUESTOR ID: CWFM2000

   IMPACT:
 (X) Host
 ( ) Satellite Part A Inpatient
 (X) Satellite Part A Outpatient
 ( ) Satellite Part B
 ( ) Hospice
 ( ) Home Health
 ( ) DMERC

   REASON FOR CHANGE:
 Currently, CWF does not verify a Beneficiary's Part A
 entitlement at the time services were rendered on Type
 of Bill (TOB) '12x'. CMS has requested that CWF bypass
 edit '7284' (IHS/Tribal facility including IHS/Tribal
 Critical Access Hospital presumed to represent a social
 admission) when the Beneficiary was not entitled to
 Medicare Part A at the time the service was rendered.
 Also do not generate Informational Unsolicited Response
 '7284' (IHS/Tribal facility including IHS/Tribal Critical
 Access Hospital presumed to represent a social admission)
 or '7548' (An IHS/Tribal Provider Type of Bill '12x' has
 a line item Date of Service that equals or is the day
 following the Discharge Date of the same Provider for an
 Inpatient stay) when the Beneficiary was not entitled to
 Medicare Part A at the time the service was rendered.

   NEW BUSINESS REQUIREMENTS:

 Requirement 1
 Modify A/B Crossover edit '7284' to bypass when the Beneficiary
 was not entitled to Medicare Part A at the time the service was
 rendered.

 Requirement 2
 Modify the '7284' Informational Unsolicited Response to not
 generate when the Beneficiary was not entitled to Medicare
 Part A at the time the service was rendered.

 Requirement 3
 Modify the '7548' Informational Unsolicited Response to not
 generate when the Beneficiary was not entitled to Medicare
 Part A at the time the service was rendered.
______________________________________________________________________________
2020 Company, LLC                                           Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 212
______________________________________________________________________________


  EVENT-RESPONSE LIST:

Event 1.1
An HUOP '12x' Type of Bill record from an IHS hospital is received.
The Dates of Service are the same or overlap a '13x' Type of Bill
from another hospital in history. The Dates of Service are on
or after 04/01/2005. The Beneficiary was not entitled to Medicare
Part A at the time the services were rendered.

Response
A/B Crossover edit '7284' is not set.

Event 1.2
An HUOP '12x' Type of Bill record from an IHS hospital is received.
The Dates of Service are the same or overlap a '72x' Type of Bill
from an RDF in history. The Dates of Service are on or after
04/01/2005. The Beneficiary was not entitled to Medicare Part A at
the time the services were rendered.

Response
A/B Crossover edit '7284' is not set.

Event 1.3
An HUOP '12x' Type of Bill record from an IHS hospital is received.
The Dates of Service are the same or overlap a '13x' Type of Bill
from another hospital in history. The Dates of Service are on
or after 04/01/2005. The Beneficiary was entitled to Medicare
Part A at the time the services were rendered.

Response
A/B Crossover edit '7284' is set and returns Trailer '13' with
the '13x' Type of Bill in history.

Event 1.4
An HUOP '12x' Type of Bill record from an IHS hospital is received.
The Dates of Service are the same or overlap a '72x' Type of Bill
from an RDF in history. The Dates of Service are on or after
04/01/2005. The Beneficiary was entitled to Medicare Part A at
the time the services were rendered.

Response
A/B Crossover edit '7284' is set and returns Trailer '13' with
the '72x' Type of Bill in history.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 213
______________________________________________________________________________

 Event 2.1
 An HUOP '13x' Type of Bill record is received and the Dates of
 Service are the same or overlap a '12x' Type of Bill record from
 an IHS hospital. The Dates of Service are on or after 04/01/2005.
 The Beneficiary was not entitled to Medicare Part A at the time
 the services were rendered.

 Response
 The '13x' Type of Bill record is accepted and an Informational
 Unsolicited Response '7284' is not generated.

 Event 2.2
 An HUOP RDF '72x' Type of Bill record is received and the Dates of
 Service are the same or overlap a '12x' Type of Bill record from
 an IHS hospital. The Dates of Service are on or after 04/01/2005.
 The Beneficiary was not entitled to Medicare Part A at the time
 the services were rendered.

 Response
 The '72x' Type of Bill record is accepted and an Informational
 Unsolicited Response '7284' is not generated.

 Event 2.3
 An HUOP '13x' Type of Bill record is received and the Dates of
 Service are the same or overlap a '12x' Type of Bill record from
 an IHS hospital. The Dates of Service are on or after 04/01/2005.
 The Beneficiary was entitled to Medicare Part A at the time the
 services were rendered.

 Response
 The '13x' Type of Bill record is accepted and an Informational
 Unsolicited Response '7284' is generated to identify the '12x'
 Type of Bill record from an IHS hospital. An 'E' is displayed in
 the Trailer '24' Mask. Trailer '13' is returned for the HUOP
 '13x' Type of Bill record. Trailer '24' is also returned
 identifying the social admission not billable to Medicare. The
 claim in history that generates the Informational Unsolicited
 Response will post an 'E' in the UNSOL IND field in HIMR.

 Event 2.4
 An HUOP RDF '72x' Type of Bill record is received and the Dates of
 Service are the same or overlap a '12x' Type of Bill record from
 an IHS hospital. The Dates of Service are on or after 04/01/2005.
 The Beneficiary was entitled to Medicare Part A at the time the
 services were rendered.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 214
______________________________________________________________________________

 Response
 The '72x' Type of Bill record is accepted and an Informational
 Unsolicited Response '7284' is generated to identify the '12x'
 Type of Bill record from an IHS hospital. An 'E' is displayed in
 the Trailer '24' Mask. Trailer '13' is returned for the HUOP
 '72x' Type of Bill record. Trailer '24' is also returned
 identifying the social admission not billable to Medicare. The
 claim in history that generates the Informational Unsolicited
 Response will post an 'E' in the UNSOL IND field in HIMR.

 Event 3.1
 An HUOP Type of Bill '12x' record from an IHS/Tribal
 hospital is received and a line item Date of Service
 equals or is the following day of the Discharge
 Date of an HUIP record in history with the same
 Provider Number. The LIDOS is on or after 04/01/2005.
 The Beneficiary was not entitled to Medicare Part A at
 the time the services were rendered.

 Response
 The HUOP '12x' Type of Bill record is accepted and an
 Informational Unsolicited Response is not generated.

 Event 3.2
 An HUIP '11x' Type of Bill record from an IHS hospital
 is received where the Discharge Date equals or is the
 previous day of the line item Date of Service for an
 HUOP Type of Bill '12x' for the same IHS/Tribal hospital.
 The LIDOS is on or after 04/01/2005. The Beneficiary
 was not entitled to Medicare Part A at the time the
 services were rendered.

 Response
 The HUIP record is accepted and an Informational
 Unsolicited Response is not generated.

 Event 3.3
 An HUOP Type of Bill '12x' record from an IHS/Tribal
 hospital is received and a line item Date of Service
 equals or is the following day of the Discharge
 Date of an HUIP record in history with the same
 Provider Number. The LIDOS is on or after 04/01/2005.
 The Beneficiary was entitled to Medicare Part A at the time
 the services were rendered.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 215
______________________________________________________________________________

 Response
 The HUOP '12x' Type of Bill record is accepted and an
 Informational Unsolicited Response is generated for
 the HUOP record. The Trailer '24' Mask will be 'P'.
 Trailer '24' will display the Alert Code '7548' with
 the information from the HUOP record. Trailer '13' will
 also be returned to identify the HUIP record causing
 the Informational Unsolicited Response to be returned
 on the HUOP record.

 Event 3.4
 An HUIP '11x' Type of Bill record from an IHS hospital
 is received where the Discharge Date equals or is the
 previous day of the line item Date of Service for an
 HUOP Type of Bill '12x' for the same IHS/Tribal hospital.
 The LIDOS is on or after 04/01/2005. The Beneficiary was
 entitled to Medicare Part A at the time the services
 were rendered.

 Response
 The HUIP record is accepted and an Informational
 Unsolicited Response is generated for the HUOP record
 in history. The Trailer '24' Mask will be 'P'. Trailer
 '24' will display the Alert Code '7548' with the
 information from the HUOP record. Trailer '13' will
 also be returned to identify the HUIP record causing
 the Informational Unsolicited Response to be returned
 on the HUOP record.

 The Entity List includes only NEW acronyms and terminology
 that is currently not in use in CWF.

 Entity List: N/A

 Areas Affected by the Problem.
   1. A/B Crossover - HIABCCR2
   2. Informational Unsolicited Response Process - HIABUNSL

 Solution Criteria: N/A




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 216
______________________________________________________________________________

  EDITS AFFECTED:

a. Error Code:      7284   ( )New (X)Modified ( )Deleted
Disposition: CR

Type of Record: OUTP

Error Message:
IHS/Tribal facility including IHS/Tribal Critical Access
Hospital presumed to represent a social admission.

Set Condition for edit '7284':
When an incoming Outpatient claim (12x) with IHS provider
range and Date of Service equal to or Overlap the Outpatient
claim in History (13x or 72x), set the '7284' error code.

This edit applies to Dates of Service on or after
04/04/2005.

CWF will identify the IHS hospitals by the list of below
Provider Numbers:
'020018', '020019', '020020', '020021', '020026', '020027',
'030071', '030072', '030073', '030074', '030075', '030076',
'370077', '030078', '030079', '030084', '040203', '050643',
'240205', '240206', '250127', '270074', '270075', '271315',
'280119', '290029', '320056', '320057', '320058', '320059',
'320060', '320061', '320062', '320070', '340156', '350063',
'350064', '370170', '370171', '370172', '370173', '370174',
'370180', '430081', '430082', '430083', '430084', '430085',
 or '430086'.

If No-Pay Code 'N' is present on the history or incoming
claim, bypass the edit.

If the Beneficiary was not entitled to Medicare Part A
at the time the service was rendered, bypass the edit.

Trailer Information: 08, 13




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 217
______________________________________________________________________________

 b. Error Code:    7548   ( )New (X)Modified ( )Deleted
 Disposition: 01

 Type of Record:   OUTP

 Error Message:
 An IHS/Tribal Provider Type of Bill '12x' has a LIDOS (line
 item Date of Service) that equals or is the day following the
 Discharge Date of the same Provider for an Inpatient stay.

 Set Condition for edit '7548':

 The Alert Code for the Informational Unsolicited Response
 will be '7548'. This alert code only applies to the
 Informational Unsolicited Response process.

 The Informational Unsolicited Response is to generate on an
 HUOP Type of Bill '12x' from an IHS/Tribal Provider that is
 accepted with a LIDOS (line item Date of Service) that equals
 or is the day following the Discharge Date of the same
 Provider for an HUIP (Inpatient Stay) in history.

 OR

 If the HUOP with Type of Bill '12x' is in history and the
 incoming HUIP record is accepted with the same IHS/Tribal
 hospital number, also generate the Informational Unsolicited
 Response on the HUOP record if the LIDOS equals or is the day
 following the Discharge Date of the incoming HUIP record.

 The LIDOS on the HUOP is on or after 04/01/2005.

 If No-Pay Code 'N' is present on the history or incoming
 record, do not generate the Informational Unsolicited
 Response.

 If the Beneficiary was not entitled to Medicare Part A at the
 time the service was rendered, do not generate the
 Informational Unsolicited Response.

 The HUOP record that generates the IUR will post a 'P' in the
 UNSOL IND field in HIMR.

 The current format for the Informational Unsolicited Response
 on the HUOP will apply.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 218
______________________________________________________________________________

 The Trailer Mask in '24' will be a 'P' to identify the Type
 of Bill '12x' for the IHS/Tribal hospital.

 The Trailer '24' will identify the HUOP record and will
 indicate alert '7548' in the Trailer '24'.

 In addition, Trailer '13' will be returned to identify the
 hospital stay for the same IHS/Tribal hospital.

 Trailer Information: '13', '24'

   INSTALLATION INSTRUCTIONS:   None

   SYSTEMS DOCUMENTATION AFFECTED:

    EDITABX               BYPASS A/B '7284' IF NO PART A.

    EDITALRT              BYPASS A/B '7548' IF NO PART A.

   SATELLITE SYSTEM MODIFICATIONS:     None




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 219
______________________________________________________________________________

   17. 00025801   5916-ADJUDICATING CLAIMS FOR IMMUNOSUPPRESSIVE DRUGS

   REQUESTOR ID: CWFM2000

   IMPACT:
 (X) Host
 ( ) Satellite Part A Inpatient
 ( ) Satellite Part A Outpatient
 ( ) Satellite Part B
 ( ) Hospice
 ( ) Home Health
 (X) DMERC

   REASON FOR CHANGE:
 Currently Medicare covers immunosuppressive drugs for a
 Beneficiary who has received an organ transplant, provided that
 the Beneficiary receiving the drug was enrolled in Medicare Part
 A at the time of the organ transplant.

 CWF has been instructed that for DME HUDC claims received on or after
 07/01/2008, contractors shall process claims for immunosuppressive
 drugs submitted with 'KX' Modifier on any immunosuppressive
 drug line item. The 'KX' Modifier will indicate that Medicare will
 make payment for the medically necessary immunosuppressive
 drugs regardless of whether Medicare has made payment for the
 transplant itself.

 CWF edits '5514' and 'D910' will be bypassed when a claim is
 submitted with immunosuppressive drugs and Modifier 'KX'.

 Immunosuppressive Drug HCPCS (Category 11):
 (J0215, J2920, J2930, J7500, J7501, J7502, J7504, J7505, J7506
 J7507, J7510, J7511, J7513, J7515, J7516, J7517, J7518, J7520
 J7525, J7599, J8530, J8610, J9212, J9213, J9214, J9215, J9216.)

 Edit '5514':
 Immunosuppressive drugs billed and no transplant is posted
 on the Bene Master record.

 Edit 'D910':
 Immunosuppressive Drug Claim shows First-Expense Date is less
 than the Discharge Date of a covered transplant hospital
 stay, or is not within the covered period of a transplant
 Discharge Date using the CMN Transplant Discharge Date.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 220
______________________________________________________________________________

  NEW BUSINESS REQUIREMENTS:

Requirement 1
Modify utilization edit '5514' to bypass when the line item contains
an immunosuppressive drug and the 'KX' Modifier is present.

Requirement 2
Modify utilization edit 'D910' to bypass when the line item contains
an immunosuppressive drug and the 'KX' Modifier is present.

  EVENT-RESPONSE LIST:

Event 1.1
Submit a DME HUDC record that contains an immunosuppressive
drug. A 'KX' Modifier is present on any line item that contains
an immunosuppressive drug.

Response
The record is accepted.   Error code '5514' does not set.

Event 1.2
Submit a DME HUDC record that contains an immunosuppressive drug.
A 'KX' Modifier is not present on any line item that contains
the immunosuppressive drug.

Response
The record is rejected.   Error code '5514' is set.

Event 1.3
Submit a DME HUDC record that contains an immunosuppressive
drug. A 'KX' Modifier is not present on any line item that
contains the immunosuppressive drug, '5514' is present
in the override field.

Response
The record is accepted.   Error code '5514' is not set.

Event 2.1
Submit a DME HUDC record that contains an immunosuppressive
drug. A 'KX' Modifier is present on any line item that contains
the immunosuppressive drug.

Response
The record is accepted.   Error code 'D910' does not set.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 221
______________________________________________________________________________

Event 2.2
Submit a DME HUDC record that contains an immunosuppressive
drug. A 'KX' Modifier is not present on any line item that
contains the immunosuppressive drug.

Response
The record is rejected.        Error code 'D910' is set.

The Entity List includes only NEW acronyms and terminology
that is currently not in use in CWF.

Entity List: N/A

Areas Affected by the Problem.
  1. Utilization - HUBCCUT, HUCMNCUT

Solution Criteria: N/A

  EDITS AFFECTED:

a. Error Code: D910          ( )New (X)Modified ( )Deleted
Disposition: UR

Type of Record:     DMEPOS

Error Message:
Immunosuppressive Drug Claim shows First-Expense Date is less
than the Discharge Date of a covered transplant hospital
stay, or is not within the covered period of a transplant
Discharge Date using the CMN Transplant Discharge Date. This
edit will be bypassed for all CHOICES and ESRD Managed Care
Demonstration claims.

NOTE:   For Transplant Discharge Dates on or after 01/01/1997,
         coverage ends after '44' months.

Set Condition for edit 'D910':
When the From Date is less than Immunosuppressive Discharge
Date, set the 'D910' error code.

When the Immuno. Discharge Date is less than the Transplant
From Date from the Immuno. Drug Table and the Immuno.
Discharge Date is greater than the Transplant to date from
the Immuno. Drug Table, set the 'D910' error code.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 222
______________________________________________________________________________

 When the Certificate of Medical Necessity National Drug Claim
 Indicator is equal to high values, bypass this edit.

 When an immunosuppressive drug with 'KX' Modifier is present on
 the line item, bypass this edit.

 When the Certificate of Medical Necessity National Drug Claim
 Indicator is equal to high values, bypass this edit.

 When the HCPCS Edit Category '11' is not true, bypass this
 edit.

 For skeleton, bypass this edit.

 Trailer:   08


 b. Error Code:    5514     ( )New (X)Modified ( )Deleted
 Disposition:

 Type of Record:   DMEPOS

 Error Message:
 Supply fees for immunosuppressive drugs billed and no
 transplant is posted on the Bene Master record.

 Set Condition for edit '5514':
 When DMEPOS claim is submitted with HCPCS code 'G0369' or
 'G0370' prior to 01/01/2006 or with HCPCS 'Q0510', 'Q0511',
 or 'Q0512' after 01/01/2006 along with Category '11'
 immunosuppressive drug HCPCS code CWF checked the
 Beneficiary Master Record to determine if a transplant
 has been allowed. If no transplant is posted on the BENE
 master record, set the '5514' error code.

 For Dates of Service 04/01/2006 and after, CWF will read the
 Beneficiary Master Record to ensure that Dates of Service
 on a DMERC claim are on or after the transplant date for all
 HCPCS in Category '11'. If the Dates of Service are before
 the transplant date or if no transplant date exists, set the
 '5514' error code.

 For Dates of Service 04/01/2006 and after, the following
 HCPCS codes are included in Category '11':
 'J2920', 'J2930', 'J7500', 'J7501', 'J7502', 'J7504',
 'J7505', 'J7506', 'J7507', 'J7509', 'J7510', 'J7511',
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 223
______________________________________________________________________________

 'J7515', 'J7516', 'J7517', 'J7518', 'J7520', 'J7525',
 'J7599', 'J8530', 'J8610'.

 When an immunosuppressive drug with 'KX' Modifier is present on
 the line item, bypass this edit.

 If the incoming HUDC record is submitted with entry
 code '3' or '9', bypass this edit.

 If the incoming HUDC record header Payment/Denial
 indicator '0' is present, bypass this edit.

 If HCPCS code 'G0369' or 'G0370' prior to 01/01/2006
 or HCPCS 'Q0510', 'Q0511', or 'Q0512' after 01/01/2006
 does not have in conjunction a Category '11'
 immunosuppressive drug HCPCS code, bypass this edit.

 When the detail edit override table has '5514' present,
 bypass this edit.

 Trailer:   08, 38

   INSTALLATION INSTRUCTIONS:   None

   SYSTEMS DOCUMENTATION AFFECTED:

     EDITUTIL             MODIFY BYPASS LOGIC FOR EDITS 'D910'
                          TO ADD BYPASS WHEN 'KX' MODIFIER IS
                          PRESENT ON HUDC CLAIMS.

     EDITUTIL             MODIFY BYPASS LOGIC FOR EDITS '5514'
                          TO ADD BYPASS WHEN 'KX' MODIFIER IS
                          PRESENT ON HUDC CLAIMS.

   SATELLITE SYSTEM MODIFICATIONS:     None




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 224
______________________________________________________________________________

  18. 00025803   7259 INCORRECTLY RECD WHEN OVERRIDE CODE IS PRESENT

  REQUESTOR ID: CWFM1000

  IMPACT:
(X) Host
(X) Satellite Part A Inpatient
(X) Satellite Part A Outpatient
(X) Satellite Part B
( ) Hospice
( ) Home Health
(X) DMERC

  REASON FOR CHANGE:
CWF is currently setting SNF Consolidated therapy edits '7258'
and '7259' and A/B Crossover edit '7257' incorrectly when
the incoming Part B/DMERC claim first detail line has an
override code present, and all other detail lines are denied.

  NEW BUSINESS REQUIREMENTS:

Requirement 1
CWF should not set A/B Crossover edit '7259' when an
incoming Part B claim with therapy services is received
and the first detail line has an override code '7259'
present and all other detail lines are denied. All the
detail lines on the Part B claim are within the Admission
and Discharge Date of a posted SNF Inpatient Part A claim
(21x) in history.

Requirement 2
CWF should not set A/B Crossover edit '7258' when an
incoming Part B claim with therapy services is received
and the first detail line has an override code '7258'
present and all other detail lines are denied. All the
detail lines on the Part B claim overlaps the Admission
and Discharge Date of a posted SNF Inpatient Part A claim
(21x) in history.

 Requirement 3
 CWF should not set A/B Crossover edit '7257' when an incoming
 Part B/DMERC claim is received and the first detail line has
 an override code '7257' present and all other detail lines
 are denied. The Part B/DMERC claim has the same HCPCS code(s)
 and the detail line is either within, overlaps or equals the
 posted SNF Inpatient Part B claim (22x).
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 225
______________________________________________________________________________


   EVENT-RESPONSE LIST:

 Event 1.1
 Submit an SNF Inpatient Part A claim (21x) that is accepted
 and posted to history.

 Submit a Part B claim with therapy services with Dates of
 Service that is within the Admission and Discharge Date of
 the posted SNF claim. The first detail line item of the
 Part B claim has an override code '7259' present and all
 other detail lines are denied.

 Response
 The Part B claim does not set A/B Crossover edit '7259'.

 Event 2.1
 Submit an SNF Inpatient Part A claim (21x) that is accepted
 and posted to history.

 Submit a Part B claim with therapy services with Dates of
 Service that overlaps the Admission and Discharge Date of
 the posted SNF claim. The first detail line item of the
 Part B claim has an override code '7258' present and all
 other detail lines are denied.

 Response
 The Part B claim does not set A/B Crossover edit '7258'.

 Event 3.1
 Submit an SNF Inpatient Part B claim (22x) that is accepted
 and posted to history.

 Submit a Part B/DMERC claim with the same HCPCS code and
 the Dates of Service equal, overlaps or is within the posted
 Outpatient claim. The first detail line item of the Part B/DMERC
 claim has an override code '7257' present and all other
 detail lines are denied.

 Response
 The Part B/DMERC claim does not set A/B Crossover edit '7257'.

 The Entity List includes only NEW acronyms and terminology
 that is currently not in use in CWF.

 Entity List: N/A
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 226
______________________________________________________________________________


Areas Affected by the Problem.
  1. A/B Crossover module

Solution Criteria: N/A

  EDITS AFFECTED:   None

  INSTALLATION INSTRUCTIONS:     None

  SYSTEMS DOCUMENTATION AFFECTED:       None

  SATELLITE SYSTEM MODIFICATIONS:       None




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 227
______________________________________________________________________________

  19. 00025804   5872-UPDATE TO CWF TO ALLOW POSTING OF SNF/SB TO SPELL

  REQUESTOR ID: CWFM2000

  IMPACT:
(X) Host
(X) Satellite Part A Inpatient
( ) Satellite Part A Outpatient
( ) Satellite Part B
( ) Hospice
( ) Home Health
( ) DMERC

  REASON FOR CHANGE:
Currently, claims that are denied due to not meeting the
prior qualifying stay criteria are not updating the
Beneficiary's spell of illness in CWF.

CWF will make modification to update the spell of illness
(Earliest and Latest Date) for claims that do not meet the
qualifying stay criteria since a Beneficiary is receiving
skilled care in a SNF, the spell of illness in the CWF should
be updated. CWF will continue not deduct benefit days from
the Beneficiary.

  NEW BUSINESS REQUIREMENTS:

Requirement 1
CWF will update the Inpatient Spell Data when the Admission
Date is on or after 07/01/2008.

CWF will not update the Inpatient Spell Data when the
Admission is prior to 07/01/2008.

CWF must update the Beneficiary Inpatient Spell Data
(spell of illness) on the Beneficiary Master (BENA)
(Inpatient spell data earliest and latest billing)
when an incoming Type of Bill '18x' or '21x' is received
with a No-Pay Code 'N' and with ANSI reason code 'A6' in
the 3rd and 4th position.

CWF must read all four occurrences in the ANSI Code field
to verify if 'A6' is in the 3rd and 4th position of any
of the four occurrences.

 Note: No Benefit Days will apply since the claim is non-covered.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 228
______________________________________________________________________________


 Requirement 2
 CWF must ensure that the rebuild spell process now includes
 originals and adjustments for Type of Bill '18x' or '21x'
 with a No-Pay Code 'N' and ANSI Code 'A6' for Admission
 07/01/2008 and after.

 Requirement 3
 CWF must ensure that when a XREF merge is completed and the spell
 of illness is updated that it is included in the rebuild spell
 processing when Type of Bill '18x' or '21x' has a No-Pay Code equal
 to 'N' and the ANSI code 'A6' for Admission 07/01/2008 and after.

   EVENT-RESPONSE LIST:

 Event 1.1
 An incoming record '18x' or '21x' is received with an
 Admission Date on or after 07/01/2008. The No-Pay Code
 equals 'N' and the ANSI Code 'A6' is in any of the four
 occurrences in the ANSI Code field.

 Response
 The incoming claim (18x or 21x) is posted to history. The
 Beneficiary Master Record is updated to reflect the Earliest
 and Latest Billing.

 Event 1.2
 An incoming record '18x' or '21x' is received with an
 Admission Date on or after 07/01/2008. The No-Pay Code
 equals 'N' and without an ANSI Code 'A6' in any of the
 four occurrences in the ANSI Code field.

 Response
 The incoming claim (18x or 21x) is posted to history. The
 Beneficiary Master Record is not updated to reflect the
 Earliest and Latest Billing.

 Event 1.3
 An incoming record '18x' or '21x' is received with an
 Admission Date prior to 07/01/2008. The No-Pay Code equals
 'N' and ANSI Code 'A6' in the 3rd and 4th position.

 Response
 The incoming claim (18x or 21x) is posted to history. The
 Beneficiary Master Record is not updated to reflect the
 Earliest and Latest Billing.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 229
______________________________________________________________________________


Event 2.1
The Beneficiary Master Record spell data indicates that there
are two spells.

The incoming claim (18x or 21x) is received with an
Admission Date on or after 07/01/2008. The No-Pay Code
equals 'N' and ANSI Code 'A6' is in the 3rd and 4th position.
The incoming claim will link the two spell.

1st spell 08/01/2008 through 08/06/2008
2nd spell 10/15/2008 through 10/21/2008
Incoming claim 09/01/2008 through 09/11/2008

Rebuild Spell:
1st spell 08/01/2008 through 10/21/2008

Response
The incoming claim (18x or 21x) is posted to history. The
Beneficiary Master Record is updated to reflect the Earliest
and Latest Billing. The rebuild spell process links all the
spells together to make one new spell. The benefit days are
not reduced.

Event 2.2
The Beneficiary Master Record spell data indicates that there
are three spells.

The incoming adjusted claim (18x or 21x) is received with an
Admission Date on or after 07/01/2008. The No-Pay Code
equals 'N' and ANSI Code 'A6' is in the 3rd and 4th position.
The incoming claim will link two spell.

1st spell 06/01/2008 through 06/11/2008
2nd spell 08/20/2008 through 08/25/2008
3rd spell 10/27/2008 through 11/01/2008

Incoming adjustment will adjust the 3rd spell.
          10/20/2008 through 10/31/2008

Rebuild Spell:
1st spell 08/20/2008 through 10/31/2008
2nd spell 06/01/2008 through 06/11/2008



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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 230
______________________________________________________________________________

 Response
 The incoming adjusted claim (18x or 21x) is posted to history.
 The Beneficiary Master Record is updated to reflect the Earliest
 and Latest Billing. The rebuild spell process links all the
 spells together to make one new spell. The benefit days are
 not reduced.

 Event 3.1
 An active Beneficiary contains several spell   of illness.
 The inactive Beneficiary contains a spell of   illness that
 includes a SNF claim with a No-Pay Code that   equals 'N'
 and ANSI Code 'A6' that will cause the spell   to be
 rebuild.

 Response
 CWF successfully merge the Beneficiary inactive records to
 the active records and the rebuild spell process completed
 correctly. The Beneficiary Master Inpatient spell data
 reflect all spells.

 The Entity List includes only NEW acronyms and terminology
 that is currently not in use in CWF.

 Entity List: N/A

 Areas Affected by the Problem.
   1. HUIPCUT, HUIPUADJ, HUIPUADS, HUIPUHST, HUIPUOUT, HUIPUPCH,
      HUIPUPCP, HUIPUPSA, HUIPUPSH, HUIPUPSS, HUIPUPST, HUIPUPSY,
      HUIPUSPL

 Solution Criteria: N/A

   EDITS AFFECTED:   None

   INSTALLATION INSTRUCTIONS:   None

   SYSTEMS DOCUMENTATION AFFECTED:     None

   SATELLITE SYSTEM MODIFICATIONS:     None




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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 231
______________________________________________________________________________

   20. 00025805   IUR INCORRECTLY GENERATED WHEN DOS EQUAL FROM OR THRU DATE

   REQUESTOR ID: CWFM1000

   IMPACT:
 (X) Host
 ( ) Satellite Part A Inpatient
 (X) Satellite Part A Outpatient
 (X) Satellite Part B
 ( ) Hospice
 ( ) Home Health
 ( ) DMERC

   REASON FOR CHANGE:
 An informational unsolicited response is being generated
 incorrectly when a posted Part B claim detail From Date
 equals the Thru Date of the incoming SNF Inpatient Part B
 claim (22x). Also, when the posted Part B claim detail Thru
 Date equals the From Date of the incoming SNF Inpatient
 Part B claim (22x).

   NEW BUSINESS REQUIREMENTS:

 Requirement 1
 CWF must not generate an informational unsolicited response
 for A/B Crossover edit '7259' when an incoming SNF Inpatient
 Part B claim (22x) is received and posted to history is a
 Part B claim with therapy services. The Part B detail From
 Date equals the Thru Date of the SNF Inpatient Part B claim
 (22x).

 Requirement 2
 CWF must not generate an informational unsolicited response
 for A/B Crossover edit '7259' when an incoming SNF Inpatient
 Part B claim (22x) is received and posted to history is a
 Part B claim with therapy services. The Part B detail Thru
 Date equals the From Date of the SNF Inpatient Part B claim
 (22x).

   EVENT-RESPONSE LIST:

 Event 1.1
 An incoming SNF Inpatient Part B claim (22x) is received.
 Posted to history is a Part B claim with therapy services.
 The Part B claim detail From Date equals the Thru Date of
 incoming SNF Inpatient Part B claim (22x).
______________________________________________________________________________
2020 Company, LLC                                           Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 232
______________________________________________________________________________


Response
The incoming SNF Inpatient Part B claim (22x) is accepted
and no informational unsolicited response is generated for
A/B Crossover edit '7259' for the Part B claim.

Event 2.1
An incoming SNF Inpatient Part B claim (22x) is received.
Posted to history is a Part B claim with therapy services.
The Part B claim detail Thru Date equals the From Date of
incoming SNF Inpatient Part B claim (22x).

Response
The incoming SNF Inpatient Part B claim (22x) is accepted
and no informational unsolicited response is generated for
A/B Crossover edit '7259' for the Part B claim.

The Entity List includes only NEW acronyms and terminology
that is currently not in use in CWF.

Entity List: N/A

Areas Affected by the Problem.
  1. A/B Crossover module

Solution Criteria: N/A

  EDITS AFFECTED:   None

  INSTALLATION INSTRUCTIONS:     None

  SYSTEMS DOCUMENTATION AFFECTED:       None

  SATELLITE SYSTEM MODIFICATIONS:       None




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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 233
______________________________________________________________________________

      21. 00025815   DOCUMENTATION CHANGES FOR RELEASE R2008300

      REQUESTOR ID: CWFM1000

   IMPACT:
 (X) Host
 (X) Satellite Part A Inpatient
 (X) Satellite Part A Outpatient
 (X) Satellite Part B
 (X) RHHI
 (X) Home Health
 (X) DMERC

   REASON FOR CHANGE:
 Make documentation updates that are not associated with a CR in the
 R2008300 release and communicate them to the users.

   NEW BUSINESS REQUIREMENTS:
 The documentation updates that are not associated with a CR in the
 R2008300 release are listed below:

 1.    DOCUMENTATION UPDATE REQUESTED:
       ASSOCIATED CR:
       ASSOCIATED DOC ONLY:
       ASSOCIATED RELEASE:
       REQUESTED DATE: 04/07/2008
       REQUESTED BY: Debby Kocovinos
       PHONE NUMBER: 443-436-6706
       LOCATION OF CHANGE(S): All Sections

       DESCRIPTION OF CHANGE(S):
       Fix all grammar, punctuation, upper/lower case
       issues throughout the documentation.


 2.    DOCUMENTATION UPDATE REQUESTED:
       ASSOCIATED CR:
       ASSOCIATED DOC ONLY:
       ASSOCIATED RELEASE:
       REQUESTED DATE: 01/22/2008
       REQUESTED BY: Vicki Sommers/Venkat
       PHONE NUMBER: 469-372-7642
       LOCATION OF CHANGE(S): COPYXTNL

     DESCRIPTION OF CHANGE(S):
     Remove incorrect Trailer information.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 234
______________________________________________________________________________



3.   DOCUMENTATION UPDATE REQUESTED:
     ASSOCIATED CR: 00025598
     ASSOCIATED DOC ONLY:
     ASSOCIATED RELEASE: R2008200
     REQUESTED DATE: 03/27/2008
     REQUESTED BY: Sai Batchu/Venkat
     PHONE NUMBER:
     LOCATION OF CHANGE(S): LAYBENE/CIOCPTB

     DESCRIPTION OF CHANGE(S):
     Update PT B/DME full history with new fields.


4.   DOCUMENTATION UPDATE REQUESTED:
     ASSOCIATED PR: 00025929
     ASSOCIATED DOC ONLY:
     ASSOCIATED RELEASE: R20082IP
     REQUESTED DATE: 04/14/2008
     REQUESTED BY:
     PHONE NUMBER:
     LOCATION OF CHANGE(S): EDITCONS

     DESCRIPTION OF CHANGE(S):
     Add HIPPS code 'A9999' to the bypass logic for
     the '61#N' error code.


5.   DOCUMENTATION UPDATE REQUESTED:
     ASSOCIATED CR: 00025921
     ASSOCIATED DOC ONLY:
     ASSOCIATED RELEASE: R20082JS
     REQUESTED DATE: 04/14/2008
     REQUESTED BY: Raju
     PHONE NUMBER:
     LOCATION OF CHANGE(S): EDITCONS, EDITLIST

     DESCRIPTION OF CHANGE(S):
     Disable consistency edit '69xE'.




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 235
______________________________________________________________________________

6.   DOCUMENTATION UPDATE REQUESTED:
     ASSOCIATED CP: 00025921
     ASSOCIATED DOC ONLY:
     ASSOCIATED RELEASE: R20082JS
     REQUESTED DATE: 04/14/2008
     REQUESTED BY:
     PHONE NUMBER:
     LOCATION OF CHANGE(S): EDITCONS, EDITLIST

     DESCRIPTION OF CHANGE(S):
     Disable consistency edit '61#P'.


7.   DOCUMENTATION UPDATE REQUESTED:
     ASSOCIATED CR:
     ASSOCIATED DOC ONLY:
     ASSOCIATED RELEASE:
     REQUESTED DATE: 04/22/2008
     REQUESTED BY: Joe Shanabrough
     PHONE NUMBER:
     LOCATION OF CHANGE(S): COPYXTNL

     DESCRIPTION OF CHANGE(S):
     Change '375' to '598' in the CABEHIID copybook section.


8.   DOCUMENTATION UPDATE REQUESTED:
     ASSOCIATED CR:
     ASSOCIATED DOC ONLY:
     ASSOCIATED RELEASE:
     REQUESTED DATE: 04/22/2008
     REQUESTED BY: Joe Shanabrough
     PHONE NUMBER:
     LOCATION OF CHANGE(S): HOSTJCL

     DESCRIPTION OF CHANGE(S):
     Change CANHICR to CABHICR.




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 236
______________________________________________________________________________

 9.   DOCUMENTATION UPDATE REQUESTED:
      ASSOCIATED CR:
      ASSOCIATED DOC ONLY:
      ASSOCIATED RELEASE:
      REQUESTED DATE: 04/24/2008
      REQUESTED BY: Vicki Sommers
      PHONE NUMBER:
      LOCATION OF CHANGE(S): EDITUTIL

      DESCRIPTION OF CHANGE(S):
      Change "Detail Override Edit Table" to "Header Override Edit
      Table" for edit '5232' under the error message for DME.


 10. DOCUMENTATION UPDATE REQUESTED:
     ASSOCIATED CR:
     ASSOCIATED DOC ONLY:
     ASSOCIATED RELEASE:
     REQUESTED DATE: 04/24/2008
     REQUESTED BY: Vicki Sommers
     PHONE NUMBER:
     LOCATION OF CHANGE(S): EDITUTIL

      DESCRIPTION OF CHANGE(S):
      Change "Detail Override Edit Table" to "Header Override Edit
      Table" for edit '5233'.


 11. DOCUMENTATION UPDATE REQUESTED:
     ASSOCIATED PROB:
     ASSOCIATED DOC ONLY:
     ASSOCIATED RELEASE:
     REQUESTED DATE: 05/01/2008
     REQUESTED BY:    Vicki Sommers
     PHONE NUMBER:
     LOCATION OF CHANGE(S): EDITABX

      DESCRIPTION OF CHANGE(S):
      Modify current bypass condition for edit '7278' to read:

      If Patient Status is '30' on the Thru Date and
      is one day prior to the same Provider's From Date,
      bypass this edit.



______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 237
______________________________________________________________________________

12. DOCUMENTATION UPDATE REQUESTED:
    ASSOCIATED PR: 00025931
    ASSOCIATED DOC ONLY:
    ASSOCIATED RELEASE: R20082KP
    REQUESTED DATE: 05/09/2008
    REQUESTED BY: Raju
    PHONE NUMBER:
    LOCATION OF CHANGE(S): EDITUTIL

    DESCRIPTION OF CHANGE(S):
    Add a bypass condition to edits '524P' and '524Q' to
    bypass when the From Date in the DOS is prior to
    01/01/2008.


13. DOCUMENTATION UPDATE REQUESTED:
    ASSOCIATED CR: 00025090
    ASSOCIATED DOC ONLY:
    ASSOCIATED RELEASE: R2007100
    REQUESTED DATE: 05/27/2008
    REQUESTED BY:    Yvonne Anderson
    PHONE NUMBER:    469-372-5420
    LOCATION OF CHANGE(S): EDITUTIL - PART B Only

    DESCRIPTION OF CHANGE(S):
    Add Trailer '39' to edits, '5709', '5710', '538L',
    and '538M'.


14. DOCUMENTATION UPDATE REQUESTED:
    ASSOCIATED PR:
    ASSOCIATED DOC ONLY:
    ASSOCIATED RELEASE: R20082OE
    REQUESTED DATE: 05/29/2008
    REQUESTED BY:
    PHONE NUMBER:
    LOCATION OF CHANGE(S): EDITCONS, EDITLIST

    DESCRIPTION OF CHANGE(S):
    Deactivate edits '9352' and 9353'.




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 238
______________________________________________________________________________

 15. DOCUMENTATION UPDATE REQUESTED:
     ASSOCIATED CR: 00025717
     ASSOCIATED DOC ONLY:
     ASSOCIATED RELEASE: R20082NS
     REQUESTED DATE: 06/02/2008
     REQUESTED BY:
     PHONE NUMBER:
     LOCATION OF CHANGE(S): EDITCONS

    DESCRIPTION OF CHANGE(S):
    Modify error code '0016' to included Contractor Number
    '04401' to allow VA claims when Demo Number '31' is
    present on Part A, and to include Contractor Number
    '04402' to allow VA claims when Demo Number '31' is
    present on Part B.


 16. DOCUMENTATION UPDATE REQUESTED:
     ASSOCIATED CR: 00025445
     ASSOCIATED DOC ONLY:
     ASSOCIATED RELEASE: R2008200
     REQUESTED DATE: 06/02/2008
     REQUESTED BY:   Yvonne Anderson
     PHONE NUMBER:   469-372-5420
     LOCATION OF CHANGE(S): EDITUTIL

    DESCRIPTION OF CHANGE(S):
    Remove the duplicate error message under '538N' that
    that references '10' hours for HHA, Hospice, Hospital,
    OUTP, SNF.

   EVENT-RESPONSE LIST:

   EDITS AFFECTED:   None

   INSTALLATION INSTRUCTIONS:   None

   SYSTEMS DOCUMENTATION AFFECTED:     None

   SATELLITE SYSTEM MODIFICATIONS:     None




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 239
______________________________________________________________________________

   22. 00025816   R2008300 INSTALLATION INSTRUCTION - ONE-TIMER CONTROL CR

   REQUESTOR ID: CWFM1000

   IMPACT:
 (X) Host
 (X) Satellite Part A Inpatient
 (X) Satellite Part A Outpatient
 (X) Satellite Part B
 (X) RHHI
 (X) Home Health
 (X) DMERC

   REASON FOR CHANGE:
 This CR will track one-timers and Installation Instructions for
 the R2008300 Release. Host and Satellites should refer to the
 R2008300 Release Documentation Appendix A for information
 concerning interdependencies and timing of these jobs.

   NEW BUSINESS REQUIREMENTS:

 Requirement 1
 One-Timer Job Name:   CARTBL
 Originating CR:       00025713
 Run by Host/Satl:     Host/Satl
 Files Prod/Test:      Prod/Test
 Purpose of Job:       Load the Carrier Table.

 Requirement 2
 One-Timer Job Name:   Host Checklist
 Originating CR:       00025713
 Run by Host/Satl:     Host (Mid-Atlantic Host only)
 Files Prod/Test:      Prod
 Purpose of Job:       Host checklist to setup a new Satellite

 Requirement 3
 One-Timer Job Name:   UTLJCATx Utilities
 Originating CR:       00025654
 Run by Host/Satl:     Host
 Files Prod/Test:      Prod/Test
 Purpose of Job:       Utility to create new Bene Master fields




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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 240
______________________________________________________________________________

Requirement 4
One-Timer Job Name:    Hold/Restart XREF
Originating CR:        00025654
Run by Host/Satl:      Host
Files Prod/Test:       Prod/Test
Purpose of Job:        Instructions to Hold/Restart XREF

Requirement 5
One-Timer Job Name:    Drop/Restart OSA
Originating CR:        00025654
Run by Host/Satl:      Host
Files Prod/Test:       Prod/Test
Purpose of Job:        Instructions to Drop/Restart OSA

Requirement 6
One-Timer Job Name:    UTLJ83A1
Originating CR:        00025723
Run by Host/Satl:      HOST
Files Prod/Test:       PROD/TEST
Purpose of Job:        Update SMOK records on the TRNGAUX File

Requirement 7
One-Timer Job Name:    CABHCPC
Originating CR:        00025950,00025937,00025960
Run by Host/Satl:      Host
Files Prod/Test:       Prod/Test
Purpose of Job:        Load the HCPCS Table.

  EVENT-RESPONSE LIST:       None

  EDITS AFFECTED:     None




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 241
______________________________________________________________________________

   INSTALLATION INSTRUCTIONS:

  **********************************************************
  ***********   REQUIREMENT 1 INSTRUCTIONS    **************
  ***********           CR 00025713           **************
  **********************************************************

  The conversion and timing considerations, followed by the requirement,
 important notes, and installation steps are listed below.

  A. Conversion
     This section indicates the type of file affected:
     (Note - Mark ALL that apply with an "X")

     __X_    Production File Conversion
     ____    Test File Conversion

     This section identifies who converts the file:
     (Note - Mark ALL that apply with an "X")

     ____    Beta File Conversion
     __X_    Host File Conversion
     __X_    Satellite File Conversion

  B. Timing Considerations
     Load the Carrier Table prior to the first cycle with the
     release software.

  C. Requirement
     Update the Carrier Table.

  D. Important Notes
     There are separate instructions for Hosts and Satellites.

  E. Steps

     HOSTS
       1. Close CARTBL file in the online regions.
       2. To load the table to the VSAM file CARTBL file, use the
           IDCAMS cards 'CARTBL' to delete and define the file.
           IDCAMS cards are located in '*.RCCYYQST.H.SW.IDCMCARD'.
           NOTE: To execute these IDCAMS cards and load the file, use
                  the utility JCL 'INITCART' found in
                  '*.RCCYYQST.H.SW.UTILLIB'.
       3. Open CARTBL file in the online region.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 242
______________________________________________________________________________

    SATELLITES
      1. Close CARTBL file in the online regions.
      2. To load the table to the VSAM file CARTBL file, use the
         IDCAMS cards 'CARTBL' to delete and define the file.
         IDCAMS cards are located in '*.RCCYYQST.S.SW.IDCMCARD.'
      3. Open CARTBL file in the online region.


  **********************************************************
  ***********   REQUIREMENT 2 INSTRUCTIONS    **************
  ***********         CR 00025713             **************
  **********************************************************

  Note: These instructions applies only to Mid-Atlantic HOST

  CR 00025713 requires a new Satellite setup for Contractor,
  11140, at the Mid-Atlantic Host site. Below are the steps/
  checklist for setting up a new Satellite connection:

  Host/Satellite must coordinate the following:
      Is there already an AT&T connection defined for CICS and NDM?
      CICS and NDM contacts for initial setup
      DSNs incoming and outgoing
      trigger jobs
      unit parameters
      NDM node name
      NDM userid/password
      security changes for DSNs created, read, etc.
      contact person when incoming NDM files are missing
      contact person when outgoing NDMs have problems

  Hosts must make the following CWF software changes:
      HIIN - update CABHOSC with new contractor information
      HISU - update CABSTAS/CABSTAT with claims/batch, batches/time
      IDCMCARD (CABIN**, CABINL**, CABOT**, CABNS**)
      FCT ENTRY (CABIN**, CABINL**, CABOT**, CABNS**)
      JCLCNTL VSAM file - update for AMEN submit jobs
      ELG$OUTP - if satellite will be sending eligibility files
      CARRINFO(0) QSAM file - if satellite will be sending elig files

  Host specific items
      add new GDG bases
      add new files to backup jobs/disaster recovery jobs
      add new files to CICS startup deck
      add new jobs to JCL library
      add new NDM members to JCL library
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 243
______________________________________________________________________________



  **********************************************************
  ***********   REQUIREMENT 3 INSTRUCTIONS    **************
  ***********           CR 00025654           **************
  **********************************************************

  The conversion and timing considerations, followed by the
  requirement, important notes, and installation steps are
  listed below.

 A. Impact to Host
    (Note - Mark Host impact with an "X")

   X__ Yes
   ___ No

 B. Conversion
    This section indicates the type of file affected:
    (Note - Mark ALL that apply with an "X")

   X___      Production File Conversion
   X___      Test File Conversion

   This section identifies who converts the file:
   (Note - Mark ALL that apply with an "X")

   X___      Beta File Conversion
   X___      Host File Conversion
   ____      Satellite File Conversion

 C. Timing Considerations
    The UTLJCATx utility must be run AFTER the installation of
    of R2008300 release software and BEFORE the first cycle
    using the R2008300 release software.

   The ten Beneficiary Master jobs UTLJCAT0 - 9 are read only
   and may be run any time except when the VSAM files are
   being reloaded. The UTLJCATM job will update the Beneficiary
   VSAM files when run in 'PROD' mode.

 D. Requirement
    Modify the UTIL JCL UTLJCAT0-9 and UTLJCATM jobs provided
    with the R2008300 release to meet the requirements of your site.
    The execution JCL can be found in the '*.R2008300.H.SW.UTILLIB',
    members UTLJCAT0-9 and UTLJCATM.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 244
______________________________________________________________________________


E. Important Notes
   The one-timer can be executed in the following modes using
   the RUNTYPE parameter in the UTLJCAT0-9 JCL.

       RUNTYPE=PROD    WRITE BENE MASTER OUTPUT;
                       ONLY REPORT BENES WITH CUTOFF DATES
                       AFTER 1990 OR NEGATIVE PRE-1990 VALUES.

       RUNTYPE=TEST    WRITE BENE MASTER OUTPUT;
                       REPORT ALL NON-DEFAULT PRE-1990 VALUES.

       RUNTYPE=AUDIT   SUPPRESS BENE MASTER OUTPUT;
                       ONLY REPORT BENES WITH CUTOFF DATES
                       AFTER 1990 OR NEGATIVE PRE-1990 VALUES.

   1. Execute the Utility in 'AUDIT' mode during the user
      testing period using the production Beneficiary Master
      files. Beneficiary master files (Sequential and VSAM)
      will not be created. When run in 'AUDIT':
       -PROC UTLPCAT1 step UTLSCAT1 will return condition code '04'.
       -Steps DELBENE and REPRBENE will not be executed.

      Note: Review the two reports and NDM report files to CWFM:
      &QSAM.UTLPCAT2.SYSOUT
      &QSAM.UTLPCAT2.REPORT

   2. Execute the Utility in 'TEST' mode to generate the
      sequential Beneficiary master file with PRE90 fields.
      The Beneficiary Master VSAM files will not be updated.
      When run in 'TEST' mode:
       -Modify &UNIT2 space parameter to accommodate the production
        beneficiary master file volume.
       -PROC UTLPCAT1 step UTLSCAT1 will return condition code '04'.
       -Steps DELBENE and REPRBENE will not be executed.

    3. Execute the Utility in 'PROD' mode to make the updates
       to the VSAM Beneficiary Master file PRE90 fields.
       The Beneficiary Master files must be closed to execute
       the utility in 'PROD' Mode.
       When run in 'PROD' mode:
        -Modify &UNIT2 space parameter to accommodate the production
         beneficiary master file volume.
        -PROC UTLPCAT1 step UTLSCAT1 will return condition code '00'.
        -Steps DELBENE and REPRBENE will be executed creating
         the updated Beneficiary VSAM file.
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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 245
______________________________________________________________________________


 F. Steps

    1.   Run jobs UTLJCAT0-9 to extract data from the ten
         Beneficiary Master files and Inpatient claims history
         to populate the pre-1990 fields.

         A) DELETE step deletes the internal job files.

         B) UTLSCAT1 step reads Beneficiary Master and corresponding
            history claims to create the PRE90 fields.
            When executed in 'PROD' mode, UTLSCAT1 creates the
            sequential datasets for the beneficiary master and
            sets condition code '0' for the step. A condition code
            '04' is set when the job runs in 'AUDIT' or 'TEST' mode.

         C) COUNTS step copies the statistics of UTLSCAT1 to
            a dataset.

         D) DELBENE step deletes and redefines the VSAM beneficiary
            master file only if job is executed in 'PROD' mode.

         E) REPRBENE step repros the sequential beneficiary master
            file created in UTLSCAT1 to the VSAM beneficiary master
            file only if job is executed in 'PROD' mode.

    2.   Run jobs UTLJCATM to produce the reports combining
         data from the ten Beneficiary Master files.

         A) UTLPCAT2 step creates the combined totals and reports
            datasets.

         B) COUNTS step copies the combined statistics for all
            ten Beneficiary Master files.

         C) REPORTS step copies the combined report for all
            ten Beneficiary Master files.




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 246
______________________________________________________________________________

  **********************************************************
  ***********   REQUIREMENT 4 INSTRUCTIONS    **************
  ***********           CR 00025654           **************
  **********************************************************

 CMS CR 5783 - 25654 NEW INPATIENT SPELL & ADJUSTMENT PROCESS
 FOR VA CLAIMS, will require all XREF transactions to be held
 four (4) days prior to the implementation of July R2008300
 Release.

 INSTRUCTIONS TO HOLD XREF TRANSACTIONS

 To ensure no XREF merges are pending all Host sites must
 activate the 'BYPASS XREF PROCESSING PARAMETER' effective
 Tuesday, July 01, 2008 as follows:

 (1) Update the HXDLOPT parameter in the CABHCFA step of the
     CABMDC06 job/CAB$BMP1 Procedure to 'N' (currently set to
     'X'). With this PARM change in CABMDC06 job, no new HXDL
     transactions will be processed, and this will stop the
     creation of HBBM records.

 (2) Delete all prior generations of the HOLDHXDL dataset inputs
     to CABMDC06 job CAB$BMP1 proc CABHCFA step.

 (3) Modify CABMDC06 to override CAB$BMP1 proc CABHCFA step
     DD HOLDHXDL as a DUMMY dataset. This will ensure only
     those XREF HXDL transactions received during the period
     of July 01, 2008 through July 04, 2008 are stored on the
     HOLDHXDL GDG's.

    Example: CABHCFA.HOLDHXDL DD DUMMY

 INSTRUCTIONS TO RESTART XREF PROCESSING

 To ensure all pending XREF merges are processed after the July
 R2008300 Release implementation, all Hosts must remove the
 'BYPASS XREF PROCESSING PARAMETER' effective July 07, 2008 as
 follows:

 (1) Update the HXDLOPT parameter in the CABHCFA Step of the
     CABMDC06 Job/CAB$BMP1 Procedure to 'X' (currently set to 'N').
     With the PARM change in CABMDC06 job, HXDL transactions will
     be re-introduced for processing. HBBM and HBBR transactions
     will be generated with the HICC online transaction and be
     processed effective Monday, July 07, 2008.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 247
______________________________________________________________________________


 (2) Modify CABMDC06 Job/CAB$BMP1 Procedure/CABHCFA Step DD
     HOLDHXDL to take in all the held HXDL datasets received
     during period of July 01, 2008 through July 04, 2008.

    Important Note: There must be five (5) backup HOLDHXDL
    generations, four (4) created during the hold, and one
    for the current day.

    Example: CABHCFA.HOLDHXDL DD DSN=CWF.HOST.HOLDHXDL,DISP=SHR


  **********************************************************
  ***********   REQUIREMENT 5 INSTRUCTIONS    **************
  ***********           CR 00025654           **************
  **********************************************************

 CMS CR 5783 - 25654 NEW INPATIENT SPELL & ADJUSTMENT PROCESS
 FOR VA CLAIMS, requires all OSA transactions to be dropped four
 (4) cycles prior to the implementation of July R2008300 Release.

 The CWF Hosts will drop OSA transactions effective Tuesday,
 July 01, 2008. This means the CABBHXMT run on Monday, June 30,
 2008 is the last CABBHXMT job that will be sent OSA.

 The OSA unsolicited informational responses will continue to
 be sent without interruption.

 OSA transactions received between Tuesday, July 01, 2008 until
 Release installation on Monday, July 07, 2008 will need to be
 recycled when OSA processing resumes on Monday, July 07, 2008.

 INSTRUCTIONS TO DROP OSA TRANSACTIONS

 Modify the PARM in the CABBHMXT job to suppress OSA processing
 of all transactions starting with the July 01, 2008 CABBHXMT Job.
 This will ensure the OSA transactions in the old format are
 flushed from Production prior to the installation of the July
 R2008300 Release.

 //     SKIP='08183000000,08186999999,A,X,X,X,X,X,X,XXX'
 //* A=ALL, B=PARTB/DME, C=CMN, E=ESRD, I=HUIP, O=HUOP/HUHH/HUHC

 Although claims are being dropped for OSA, Hosts are required to
 continue to execute their CABBHXMT/CABBHRCV to load and create
 the unsolicited informational responses.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 248
______________________________________________________________________________


 INSTRUCTIONS TO RESTART OSA PROCESSING

 All the Hosts will have to ensure the CABOS* files are empty
 prior to executing their first cycle after the installation of
 the July R2008300 Release. This will ensure the CABOS* files
 are clear of any old OSA transactions. Failure to do this will
 cause erroneous results.

 No additional changes are required to the PARM in the CABBHXMT
 job, OSA processing will automatically resume based on the Julian
 date placed in the SKIP PARM in the CABBHMXT job defined in the
 Instructions to Drop OSA Transactions.


  **********************************************************
  ***********   REQUIREMENT 6 INSTRUCTIONS    **************
  ***********           CR 00025723           **************
  **********************************************************

  The conversion and timing considerations, followed by the
  requirement, important notes, and installation steps are
  listed below.

 A. Impact to Host
    (Note - Mark Host impact with an "X")

   X__ Yes
   ___ No

 B. Conversion
    This section indicates the type of file affected:
    (Note - Mark ALL that apply with an "X")

   X___      Production File Conversion
   X___      Test File Conversion

   This section identifies who converts the file:
   (Note - Mark ALL that apply with an "X")

   X___      Beta File Conversion
   X___      Host File Conversion
   ____      Satellite File Conversion



______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
    Common Working File                                                   R2008300
    Final Quarterly Release Document                                  July 3, 2008
    Section VII. Detailed Description of Changes                          Page 249
    ______________________________________________________________________________

    C. Timing Considerations
       The UTLJ83A1 utility must be run AFTER the installation of
       of R2008300 release software and BEFORE the first cycle
       using the R2008300 release software.

    D. Requirement
       Modify the UTIL JCL UTLJ83A1 job provided with the R2008300
       release to meet the requirements of your site.
       The execution JCL can be found in the '*.R2008300.H.SW.UTILLIB',
       members UTLJ83A1.

    E. Important Notes
       The UTLJ83A1 utility includes a PROD and TEST RUNTYPE MODE
       parameter and can be run in the following modes:

          MODE='P' - 1. Creates the 'TRNGAUX OUTPUT' file.
                     2. Sets the 'RETURN-CODE' value to a zero which
                        allows the execution of subsequent job steps
                        DELDEF (delete and define) and RELOAD.

          MODE='T' - 1. Does not create the 'TRNGAUX OUTPUT' file.
                     2. Set the 'RETURN-CODE' value to a '4'
                        effectively ending the job and does not
                        execute the DELDEF step and the RELOAD step.

       The files created by this utility are:

          1. &QSAM.UTLJ83A1.TRNGAUX.OUTPUT - an updated version of
                   the TRNGAUX file.

          2. &QSAM.UTLJ83A1.TRNGAUX.DISPLAYS - a report detailing
                   the TRNGAUX records that were modified. The
                   information shown in this file reflect the type of
                   changes applied to the respective records.
                   Examples of the displays typically found in this
                   file follows and contain a descriptive line indicative
                   of the change being applied:

                    Example 1.
                    ******************************************************
                    TRNGAUX HIC NUMBER ..... 026124270A
                    ONLY DATES DIFFER
0                     HCPC CODE .............. G0376
                    ORIGINAL INITIAL DATE .. 00000000
                    UPDATED INITIAL DATE ... 11032005
                    ******************************************************
    ______________________________________________________________________________
    2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 250
______________________________________________________________________________


                 Example 2.
                 ******************************************************
                 TRNGAUX HIC NUMBER ..... 244912001A
                 DATES AND SEGMENTS DIFFER
                 HCPC CODE .............. G0375
                 ORIGINAL INITIAL DATE .. 00000000
                 UPDATED INITIAL DATE ... 10122005

                 SEGMENTS DIFFER
                 HCPC CODE .............. G0375
                 ICN .................... 24491-G0375-2
                 ORIGINAL PERIOD NUMBER . 1
                 UPDATED PERIOD NUMBER .. 0
                 ******************************************************

                 Example 3.
                 ******************************************************
                 TRNGAUX HIC NUMBER ..... 246631026A
                 ONLY SEGMENTS DIFFER
                 HCPC CODE .............. G0375
                 ICN .................... 24663-2.1.4-2
                 ORIGINAL PERIOD NUMBER . 2
                 UPDATED PERIOD NUMBER .. 3
                 ******************************************************

 F. Steps

    1. The following steps detail both the function and process
       of this utility.

       A)   DELETE    - IEFBR14; deletes previously created test
                        files, if any exist.

       A)   BKPTRAN   - IDCAMS; create a backup of the VSAM TRNGAUX
                        file.

       B)   SEQTRAN   - IDCAMS; create a sequential version of the
                        TRNGAUX file for subsequent processing.

       C)   UTLS83A1 - UTLS83A1; this program updates the TRNGAUX
                       'smok period no' field, (when identified),
                       on records that contain a Smoke Cessation
                       HCPCS, i.e. 'G0375', 'G0376', '99406', or
                       '99407'.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 251
______________________________________________________________________________

      D)   SORTTRNG - SORT; insure that the updated TRNGAUX
                      records are sequenced properly for the
                      RELOAD step.

      E)   DELDEF   - IDCAMS; conditionally executed to delete and
                      define the VSAM TRNGAUX file.

      F)   RELOAD   - IDCAMS; conditionally executed to reload the
                      VSAM TRNGAUX file with the output file
                      created in the UTLS83A1 step.


 **********************************************************
 ***********   REQUIREMENT 7 INSTRUCTIONS    **************
 ***********         CR 00025950             **************
 ***********         CR 00025960             **************
 ***********         CR 00025937             **************
 **********************************************************

The conversion and timing considerations, followed by the
requirement, important notes, and installation steps are
listed below.

A. Conversion
   This section indicates the type of file affected:
   (Note - Mark ALL that apply with an "X")

   __X_     Production File Conversion
   __X_     Test File Conversion

   This section identifies who converts the file:
   (Note - Mark ALL that apply with an "X")

   __X_     Beta File Conversion
   __X_     Host File Conversion
   ____     Satellite File Conversion

B. Timing Considerations
   Load the HCPCS Table before the first cycle using the
   Release software.

C. Requirement
   Update the HCPCS Table.

 D. Important Notes
    None.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 252
______________________________________________________________________________


E. Installation Steps
   Load the HCPCS Table using the INITHCPC utility.

  SYSTEMS DOCUMENTATION AFFECTED:   None

  SATELLITE SYSTEM MODIFICATIONS:   None




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 253
______________________________________________________________________________

  23. 00025817   EXTERNAL COPYBOOK CHANGES FOR R2008300

  REQUESTOR ID: CWFM1000

  IMPACT:
(X) Host
(X) Satellite Part A Inpatient
(X) Satellite Part A Outpatient
(X) Satellite Part B
(X) RHHI
(X) DMERC

  REASON FOR CHANGE:
Make external copybook updates that are associated with the
CRs contained in the R2008300 Release, and communicate them
to the Standard System Maintainers.

  NEW BUSINESS REQUIREMENTS:

 Requirement 1

 Copybook Name: CIOCBENE

These changes are associated with CRs 00025654:

==>10 :XXXXXX:-PRE90-DATA.
=====> 15 :XXXXXX:-PRE90-CUTOFF-DATE
=====>                              PIC S9(07)        COMP-3
=====>                                          VALUE ZERO.
=====> 15 :XXXXXX:-PRE90-LIFE-RSV-USED
=====>                              PIC S9(03)        COMP-3
=====>                                          VALUE ZERO.
=====> 15 :XXXXXX:-PRE90-LIFE-PSY-USED
=====>                              PIC S9(03)        COMP-3
=====>                                          VALUE ZERO.
=====>15 :XXXXXX:-PRE90-PREENT-PSY-DAYS
=====>                               PIC S9(03)       COMP-3
=====>                                          VALUE ZERO.
==>10                                   PIC X(05) VALUE SPACE.

   10   :XXXXXX:-MASTER-EXT.
             15 :XXXXXX:-CARR-NU-TABLE    OCCURS 10 TIMES.
                 20 :XXXXXX:-CARR-NU      PIC 9(05) VALUE ZERO.
                 20 :XXXXXX:-HOST-CARR-ID PIC X(01) VALUE SPACE.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 254
______________________________________________________________________________

 Requirement 2

 Copybook Name: CABEHUQA

 These changes are associated with CR 00025739 and 00025765:
   Original line:
       10 WS-OP-HUQA-SMOK-TABLE      OCCURS 02 TIMES.
   Changed line:
 ==>   10 WS-OP-HUQA-SMOK-TABLE      OCCURS 04 TIMES.

   EVENT-RESPONSE LIST:     None

   EDITS AFFECTED:   None

   INSTALLATION INSTRUCTIONS:      None

   SYSTEMS DOCUMENTATION AFFECTED:        None

   SATELLITE SYSTEM MODIFICATIONS:        See Above




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 255
______________________________________________________________________________

  24. 00025818   ARCHIVE MAINTENANCE FOR RELEASE R2008300

  REQUESTOR ID: CWFM1000

  IMPACT:
(X) Host
(X) Satellite Part A Inpatient
(X) Satellite Part A Outpatient
(X) Satellite Part B
( ) RHHI
( ) Home Health
( ) DMERC

  REASON FOR CHANGE:
This CR will record those CWFM configuration items that are
to be archived and/or restored with the R2008300 Release.

  NEW BUSINESS REQUIREMENTS:      None

  EVENT-RESPONSE LIST:     None

  EDITS AFFECTED:   None

  INSTALLATION INSTRUCTIONS:      None

  SYSTEMS DOCUMENTATION AFFECTED:        None

  SATELLITE SYSTEM MODIFICATIONS:        None




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 256
______________________________________________________________________________

   25. 00025824   5888- AMBULANCE SERVICES CWF BYPASS WHEN DOS GREATER DOD

   REQUESTOR ID: CWFM2000

   IMPACT:
 (X) Host
 ( ) Satellite Part A Inpatient
 (X) Satellite Part A Outpatient
 (X) Satellite Part B
 ( ) Hospice
 ( ) Home Health
 ( ) DMERC

   REASON FOR CHANGE:
 Currently, CWF allows for the processing of ambulance claims
 when services are performed on or before, but not later than, the
 Date of Death (DOD). However, in the rare case when a transport
 is provided and it is subsequently determined that the death
 occurred prior to the Date of Service (DOS), the claim is currently
 processed and paid manually outside of the CWF in accordance
 with provisions outlined in IOM Pub. 100-04, Chapter 27, Section
 60. Therefore, this CR implements a bypass procedure within the
 CWF for ambulance service claims provided to process the claim
 according to the provision.

 Contractors shall, upon initial determination on a claim for
 ambulance services provided one or more days after the
 Beneficiary's DOD, continue to deny such a claim. However,
 contractors shall, upon a favorable redetermination wherein the
 supplier has made a satisfactory showing sufficient to prove
 medical necessity of the transport, pay the claim using newly
 created bypass, assuming all other claim edits are satisfied.

 CWF will allow bypass of edit '5211' when HCPCS 'A0425-A0436' or
 'A0999' and override edit is present.

 CWF will modify utilization edit '5211' to not set if the edit is
 present in the header override field and the HCPCS on the
 HUOP or HUBC are 'A0425-A0436' or 'A0999'. If any other HCPCS is
 present and is allowed should not bypass the edit. This
 bypass condition does not include HUIP or HUDC. This is for
 all claims processed on or after 07/07/2008 and not based on
 effective Date of Service.



______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 257
______________________________________________________________________________

  NEW BUSINESS REQUIREMENTS:

Requirement 1
CWF must allow bypass of utilization edit '5211' when the
override edit is present in the header override field and the
HCPCS on the HUBC or HUOP are 'A0425-A0436' or 'A0999'. This
bypass condition does not include HUDC or HUIP. This is for
all claims processed on or after 07/07/2008 and not based on
effective Date of Service. Do not allow override of edit '5211'
for any other HCPCS.

  EVENT-RESPONSE LIST:

Event 1.1
Submit an HUOP/HUBC record after the Beneficiary's Date of Death,
using HCPCS codes 'A0425-A0436' or 'A0999' with a '5211' override
in the header.

Response
The record is accepted, edit '5211' is not set.

Event 1.2
Submit an HUOP/HUBC record after the Beneficiary's Date of Death,
using HCPCS 'A0425-A0436' or 'A0999' and no override present.

Response
The record is rejected with edit '5211'.

The Entity List includes only NEW acronyms and terminology
that is currently not in use in CWF.

Entity List: N/A

Areas Affected by the Problem.
  1. Utilization Module (HUOPCUT)
  2. Utilization Module (HUBCCUT)

Solution Criteria: N/A




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 258
______________________________________________________________________________

   EDITS AFFECTED:

 a. Error Code:      5211   ( )New (X)Modified ( )Deleted
 Disposition: CR

 Type of Record: Pt. B Carrier

 Error Message:
 Services after death.

 Set Condition for edit '5211':
 When the Statement From and Thru Date are after the Beneficiary's
 Date of Death, set the '5211' error code.

 When the claim is denied, bypass this edit.

 When the Payment/Process Denial Indicator is equal to '0',
 bypass this edit.

 When the Entry Code is equal to '3' or '9', bypass this edit.

 When edit '5211' is present in the header override and the
 line item HCPCS 'A0425-A0436' or 'A0999' is present,
 bypass this edit.

 Trailer Information: 08


 b. Error Code:      5211   ( )New (X)Modified ( )Deleted
 Disposition: CR

 Type of Record: Hospital, SNF, HHA, Hospice, OUTP

 Error Message:
 The statement From/Thru Date is greater than the Date of
 Death on Beneficiary Master Record.

 Set Condition for edit '5211':
 The statement Thru Date does not fall within the same month as
 the Beneficiary's Date of Death or the statement Thru Date is
 not within the month after the Date of Death on Beneficiary
 Master Record, set the '5211' error code.

 Hospital, SNF
 When the claim patient Status Code is not equal to '20', and
 the claim stay Thru Date is greater than the Beneficiary Date
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 259
______________________________________________________________________________

 of Death, and the Beneficiary Data Indicator seven is equal to
 one or three, set the '5211' error code.

 When the claim patient Status Code is not equal to '20', and
 the claim stay Thru Date is greater than the Beneficiary Date
 of Death, and the Beneficiary Data Indicator seven is not
 equal to one or three, and the Beneficiary Data Indicator five
 equals one or three, set the '5211' error code.

 When the claim patient Status Code is equal to '20', and the
 claim stay Thru Date is greater than the Beneficiary Date of
 Death, and the Beneficiary Data Indicator seven is equal to
 one or three, set the '5211' error code.

 When the claim patient Status Code is equal to '20', and the
 claim stay Thru Date is greater than the Beneficiary Date of
 Death, and the Beneficiary Data Indicator seven is not equal
 to one or three, and the Beneficiary Data Indicator five
 equals three, set the '5211' error code.

 When the claim Action Code is equal to '2', '4', or '6',
 bypass this edit.

 If the claim is denied, either on the line or on the whole
 claim, bypass this edit.

 OUTP
 When the Date of Death on the Beneficiary Master Record is not
 equal to zero, and the Service Thru Date is greater than the
 Beneficiary Date of Death, set the '5211' error code.

 When edit '5211' is present in the header override and the
 line item HCPCS 'A0425-A0436' or 'A0999' is present,
 bypass this edit.

 Hospice
 When the third position of the bill type is not equal to 'A',
 'B', 'C', or 'D', and when the service Thru Date is greater
 than the Beneficiary Date of Death, and when the seventh
 position of the Beneficiary data indicator is equal to one or
 three, or the fifth position of the Beneficiary data indicator
 is equal to one or three, set the '5211' error code.

 HHA
 When the service Thru Date is greater than the Beneficiary
 Date of Death, and when the service From Date is greater than
______________________________________________________________________________
2020 Company, LLC                                           Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 260
______________________________________________________________________________

 the Beneficiary Date of Death, set the '5211' error code.

 When the Date of Death year is equal to the stay Thru (claim)
 year, and the Date of Death month plus 1 is not equal to the
 stay Thru (claim) month, set the '5211' error code.

 When the Date of Death year is not equal to the service Thru
 (claim) year, and the Date of Death year plus 1 is not equal
 to the service Thru (claim) year, or the Date of Death month
 is not equal to '12', or the stay Thru (claim) month is not
 equal to one, set the '5211' error code.

 When the HHA claim is not an adjustment, and the claim data
 indicator '39' is equal to 'C', set the '5211' error code.

 Trailer Information: 08

   INSTALLATION INSTRUCTIONS:   None

   SYSTEMS DOCUMENTATION AFFECTED:

     EDITUTIL              MODIFY EDIT '5211' TO BYPASS FOR HCPCS
                           'A0425-A0436' AND 'A0999' WHEN OVERRIDE
                           EDIT IS PRESENT FOR PT. B.

     EDITUTIL              MODIFY EDIT '5211' TO BYPASS FOR HCPCS
                           'A0425-A0436' AND 'A0999' WHEN OVERRIDE
                           EDIT IS PRESENT.

   SATELLITE SYSTEM MODIFICATIONS:     None




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 261
______________________________________________________________________________

  26. 00025858   524Q & 524P SETTING INCORRECTLY

  REQUESTOR ID: HCSC1000

  IMPACT:
(X) Host
( ) Satellite Part A Inpatient
( ) Satellite Part A Outpatient
( ) Satellite Part B
( ) Hospice
(X) Home Health
( ) DMERC

  REASON FOR CHANGE:
CWF needs to include Home Health episodes prior to 01/01/2008
to determine the sequence of adjacent episode when a Home
Health Final or LUPA is submitted with a HIPPS code '1', '2',
'3', or '4' to determine if it should be early to late
or if it should be late to early. CWF will need to modify
utilization error code '524P' and '524Q' and the IUR process
for error code '524P' and '524Q'.

  NEW BUSINESS REQUIREMENTS:

Requirement 1
CWF must modify utilization error code '524P' to read Home
Health episodes prior to Dates of Service 01/01/2008 to
determine if the incoming Home Health Final or LUPA is for
an early Home Health episode and should be for a late Home
Health episode.

Requirement 2
CWF must modify the informational unsolicited process
for error code '524P' to read Home Health episodes prior
to Date of Service 01/01/2008 to determine if an IUR
should be generated for a posted Home Health Final or LUPA
claim that was for an early Home Health episode and should
be for a late Home Health episode.

Requirement 3
CWF must modify utilization error code '524Q' to read Home
Health episodes prior to Dates of Service 01/01/2008 to
determine if the incoming Home Health Final or LUPA is for
a late Home Health episode and should be for an early Home
Health episode.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 262
______________________________________________________________________________

 Requirement 4
 CWF must modify the informational unsolicited process
 for error code '524Q' to read Home Health episodes prior
 to Date of Service 01/01/2008 to determine if an IUR
 should be generated for a posted Home Health Final or LUPA
 claim that was for a late Home Health episode and should
 be for an early Home Health episode.

   EVENT-RESPONSE LIST:

 Event 1.1
 Submit a Home Health Final or LUPA claim with a HIPPS code
 '1' or '2' and Revenue Code '0023' has a Date of Service on or
 after 01/01/2008.

 The Home Health episode that applies to the earliest line item
 date for the Revenue Code '0023' will be a late episode on
 the Beneficiary's HHEH Aux file.

 The Beneficiary's has a Home Health episode that is prior to
 01/01/2008 and is within 60 days of the incoming Home Health
 claim.

 Response
 Error code '524P' is set and returns Trailer '08'.

 Event 2.1
 Submit a new RAP or Final LUPA or adjustment to a Final or
 LUPA with Dates of Service prior to 01/01/2008 that will
 cause a posted early Home Health episode to now be a late
 Home Health episode (within 60 days of the prior episode).

 The posted early Home Health episode is on or after 01/01/2008
 and the DOEBA/DOLBA date is present.

 Response
 An informational unsolicited response is generated for the
 Home Health Final or LUPA claim for error code '524P' where
 the HIPPS code is a '1' or '2' and now should be a '3' or '4'.
 Trailer '24' will be returned.

 Event 3.1
 Submit a Home Health Final or LUPA claim with a HIPPS code
 '3' or '4' for Revenue Code '0023' with Dates of Service on or
 after 01/01/2008.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 263
______________________________________________________________________________

 The Home Health episode that applies to the earliest line item
 date for the Revenue Code '0023' will be a early episode on
 the Beneficiary's HHEH Aux file.

 The Beneficiary's has a Home Health episode that is prior to
 01/01/2008 and is not within 60 days of the incoming Home
 Health claim.

 Response
 Error code '524Q' is set and returns Trailer '08'.

 Event 4.1
 Submit an adjustment/cancel on a Final or LUPA that will
 cause a prior or subsequent Home Health episode to now
 be an early Home Health episode (not within 60 days).

 The posted late episode is on or after 01/01/2008 and the
 DOEBA/DOLBA date is present. A Home Health Final or LUPA
 is in history with a HIPPS code of '3' or '4'.

 Response
 An informational unsolicited response is generated for the
 Home Health Final or LUPA claim for error code '524Q' where
 the HIPPS code is '3' or '4' and now should be '1' or '2'.
 Trailer '24' will be returned.

 The Entity List includes only NEW acronyms and terminology
 that is currently not in use in CWF.

 Entity List: N/A

 Areas Affected by the Problem.
   1. Home Health Utilization Module HUOPCUT
   1. IUR Module HHEHUSPL

 Solution Criteria: N/A




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 264
______________________________________________________________________________

  EDITS AFFECTED:

a. Error Code:      524P   ( )New (X)Modified ( )Deleted
Disposition: UR

Type of Record: Home Health

Error Message:
A Home Health Final or LUPA Final has a HIPPS code that is
for an early HH episode and should be a late HH episode.

Set Condition for edit '524P':
When a HH Final or LUPA is received and the earliest date
of the HIPPS code has a '1' or '2' in the first position
and the HHEH Auxiliary File shows the claim should apply
to a late episode, set the '524P' error code.

Note: Effective Date for the edits to set: Episodes beginning
      on or after 01/01/2008

      The earliest Revenue Code '0023' is read to
      determine what HIPPS code is used in the edit.

      The HIPPS code can be found in the HCPCS code field or
      if there is a change in the HRG code can be obtained
      in the HIPPS code field in the detail line for Revenue
      Code '0023'.

When the first position of the HIPPS code is a '1', '2', or
'5' is the early episode.

When the first position of the HIPPS code is a '3', '4', or
'5' is the late episode.

(Note: '5' can be in the early or late episode.)

CWF will define a sequence of adjacent episodes with no more
than 60 days between each HH episode's End and Start Date.

If more than 60 days have elapse between each HH episode
this will start a new early episode. Early episodes are the
1st and 2nd episode, late episode are the 3rd and later.

 When a HH claim is submitted with a From Date prior to
 01/01/2008 and the Revenue Code '0023' is after 01/01/2008,
 bypass the edit.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 265
______________________________________________________________________________


 CWF will read HH episodes prior to 01/01/2008 when determining
 whether an early episode should be a late episode.

 When the Non-Payment Code on the Home Health claim is a
 'B' or 'N', bypass the edit.

 When the Action Code is a '4' Cancel Only on the
 Home Health claim, bypass the edit.

 When the first position of the HIPPS code is a '5',
 bypass the edit.

 Trailer Information: 08


 b. Error Code:    524Q    ( )New (X)Modified ( )Deleted
 Disposition: UR

 Type of Record: Home Health

 Error Message:
 A Home Health Final or LUPA Final has a HIPPS code that is
 for a late HH episode and should be an early HH episode.

 Set Condition for edit '524Q':
 When a HH Final or LUPA is received and the earliest date
 of the HIPPS code has a '3' or '4' in the first position
 and the HHEH Auxiliary File shows the claim should apply
 to an early episode, set the '524Q' error code.

 Note: Effective Date for the edits to set: Episodes beginning
       on or after 01/01/2008.

       The earliest Revenue Code '0023' is read to
       determine what HIPPS code is used in the edit.

       The HIPPS code can be found in the HCPCS code field or
       if there is a change in the HRG code can be obtained
       in the HIPPS code field in the detail line for Revenue
       Code '0023'.

 When the first position of the HIPPS code is a '1', '2', or
 '5' is the early episode.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 266
______________________________________________________________________________

 When the first position of the HIPPS code is a '3', '4', or
 '5' is the late episode.

 (Note: '5' can be in the early or late episode.)

 CWF will define a sequence of adjacent episodes with no more
 than 60 days between each HH episode's End and Start Date.

 If more than 60 days have elapse between each HH episode
 this will start a new early episode. Early episodes are the
 1st and 2nd episode, late episode are the 3rd and later.

 When a HH claim is submitted with a from date prior to
 01/01/2008 and the Revenue Code '0023' is after 01/01/2008,
 bypass the edit.

 CWF will read HH episodes prior to 01/01/2008 when determining
 whether a late episode should be an early episode.

 When the Non-Payment Code on the Home Health claim is a
 'B' or 'N', bypass the edit.

 When the Action Code is a '4' Cancel Only on the
 Home Health claim, bypass the edit.

 When the first position of the HIPPS code is a '5',
 bypass the edit.

 Trailer Information: 08

   INSTALLATION INSTRUCTIONS:   None

   SYSTEMS DOCUMENTATION AFFECTED:

     EDITUTIL              '524P'-READ HH EPISODES PRIOR TO 01/01/2008
                           WHEN DETERMING WHETHER AN EARLY EPISODE
                           SHOULD BE LATE.

     EDITUTIL              '524Q'-READ HH EPISODES PRIOR TO 01/01/2008
                           WHEN DETERMING WHETHER A LATE EPISODE
                           SHOULD BE EARLY.

   SATELLITE SYSTEM MODIFICATIONS:     None



______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 267
______________________________________________________________________________

   27. 00025878   6009 - JULY 2008 QUARTERLY UPDATE OF HCPCS FOR SNF CB

   REQUESTOR ID: CWFM1000

   IMPACT:
 (X) Host
 (X) Satellite Part A Inpatient
 (X) Satellite Part A Outpatient
 (X) Satellite Part B
 ( ) Hospice
 ( ) Home Health
 (X) DMERC

   REASON FOR CHANGE:
 CWF must modify A/B Crossover edits '7252', '7260', '7261'
 and the informational unsolicited process to add a new
 non-therapy HCPCS code for Dates of Service on or after
 01/01/2008 for the July quarterly updates for SNF
 Consolidated Billing.

   NEW BUSINESS REQUIREMENTS:

 Requirement 1
 CWF must add HCPCS code 'J9303' with an Effective Date of
 01/01/2008 to the non-therapy table (Chemotherapy) for an
 incoming Outpatient claim to bypass A/B Crossover edit
 '7252'.

 Requirement 2
 CWF must add HCPCS code 'J9303' with an Effective Date of
 01/01/2008 to the non-therapy table (Chemotherapy) to not
 generate an informational unsolicited response for the
 posted Outpatient claim in history for A/B Crossover edit
 '7252'.

 Requirement 3
 CWF must add HCPCS code 'J9303' with an Effective Date of
 01/01/2008 to the Physician Services (Category 75) file in
 CABCHCCB copybook.

 Note: CWF will ensure that A/B Crossover edits '7260' and
       '7261' are bypass for the above HCPCS code for Part
       B/DME claims.

       Also, CWF will ensure that an informational unsolicited
       response is not generated for the posted Part B/DME
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 268
______________________________________________________________________________

       claim in history for A/B Crossover edits '7260' and
       '7261'.

 Note: There is no system documentation for edits, '7260', and
       '7261', since HCPCS code(s) that bypass the edits are
       not maintained in the set conditions of the edits but
       in the CABCHCCB copybook.

   EVENT-RESPONSE LIST:

 Event 1.1
 Submit an SNF Inpatient Part A claim (21x) that is accepted
 and posted to history with Dates of Service on or after
 01/01/2008.

 Submit an Outpatient claim with HCPCS code 'J9303' and the
 detail line item Date of Service is within the posted SNF
 Inpatient Part A claim in history.

 Response
 A/B Crossover edit '7252' is not set.

 Event 2.1
 Submit an Outpatient claim with HCPCS code 'J9303' that is
 accepted and posted to history with Dates of Service on
 or after 01/01/2008. The detail line item Date of Service
 is within the incoming SNF Inpatient Part A claim (21x).

 Submit an SNF Inpatient Part A claim (21x).

 Response
 The SNF Inpatient Part A claim (21x) is accepted, and no
 informational unsolicited response is generated for the
 Outpatient claim in history for A/B Crossover edit '7252'.

 Event 3.1
 Submit an SNF Inpatient Part A claim (21x) that is accepted
 and posted to history with Dates of Service on or after
 01/01/2008.

 Submit a Part B/DME claim with HCPCS code 'J9303' and the
 detail From and Thru Date overlaps the posted SNF Inpatient
 Part A claim in history.

 Response
 A/B Crossover edit '7260' is not set.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 269
______________________________________________________________________________


 Event 3.2
 Submit an SNF Inpatient Part A claim (21x) that is accepted
 and posted to history with Dates of Service on or after
 01/01/2008.

 Submit a Part B/DME claim with HCPCS code 'J9303' and the
 detail From and Thru Date is within the posted SNF Inpatient
 Part A claim in history.

 Response
 A/B Crossover edit '7261' is not set.

 Event 3.3
 Submit a Part B/DME claim with HCPCS code 'J9303' that is
 accepted and posted to history with Dates of Service on
 or after 01/01/2008. The detail From and Thru Date
 overlaps the incoming SNF Inpatient Part A claim (21x).

 Submit an SNF Inpatient Part A claim (21x).

 Response
 The SNF Inpatient Part A claim (21x) is accepted, and no
 informational unsolicited response is generated for the
 Part B/DME claim in history for A/B Crossover edit '7260'.

 Event 3.4
 Submit a Part B/DME claim with HCPCS code 'J9303' that is
 accepted and posted to history with Dates of Service on
 or after 01/01/2008. The detail From and Thru Date is
 within the incoming SNF Inpatient Part A claim (21x).

 Submit an SNF Inpatient Part A claim (21x).

 Response
 The SNF Inpatient Part A claim (21x) is accepted, and no
 informational unsolicited response is generated for the
 Part B/DME claim in history for A/B Crossover edit '7261'.

 The Entity List includes only NEW acronyms and terminology
 that is currently not in use in CWF.

 Entity List: N/A

 Areas Affected by the Problem.
   1. A/B Crossover module
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 270
______________________________________________________________________________

   2. Informational unsolicited process

 Solution Criteria: N/A

   EDITS AFFECTED:

 a. Error Code:      7252   ( )New (X)Modified ( )Deleted
 Disposition: CR

 Type of Record: OUTP

 Error Message:
 For an Outpatient claim the detail line item Date of
 Service is within the Admission and Discharge Date of a SNF
 Inpatient Part A claim (21x) for non-therapy services.

 If the detail line Date of Service is not present, use the
 From and Thru Date.

 When the From and Thru Date are used the date may overlap
 of be within the posted SNF Inpatient Part A claim (21x) in
 history.

 Set Condition for edit '7252':
 When an Outpatient claim (12x, 13x, 14x, 22x, 23x, 34x,
 74x, 75x, 83x, or 85x) is submitted with a non-therapy
 service and the detail line item Date of Service (or if the
 detail line item Date of Service is not present, use the
 From and Thru Date) is within the Admission and Discharge
 Date of a SNF Inpatient Part A claim (21X), set the '7252'
 error code.

 When an Outpatient claim (12x, 13x, 14x, 22x, 23x, 34x,
 75x, 83x, or 85x) is submitted with a non-therapy HCPCS code
 '90870' and the detail line item Date of Service (or if the
 detail line item Date of Service is not present, use the
 From and Thru Date) is within the Admission and Discharge
 Date of a SNF Inpatient Part A claim (21X), bypass this
 edit.

 Incoming Outpatient claim (bill type 12x, 13x, 14x, 22x,
 23x, 34x, 74x, 75x, 83x, or 85x) detail line item Date of
 Service equals the SNF Inpatient Part A (21x) Admission
 Date in history, bypass this edit.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 271
______________________________________________________________________________

Incoming Outpatient claim (bill type 12x, 13x, 14x, 22x,
23x, 34x, 74x, 75x, 83x, or 85x) detail line item Date
of Service equals the SNF Inpatient Part A (21x) Discharge
Date in history and the Patient Status is other than '30',
bypass this edit.

Incoming Outpatient claim (bill type 12x, 13x, 14x, 22x,
23x, 34x, 74x, 75x, 83x, or 85x) detail line item Date
of Service equals the SNF Inpatient Part A (21x) Discharge
Date in history and the Patient Status is other than '30',
bypass this edit.

Incoming Outpatient claim (bill type 12x, 13x, 14x, 22x,
23x, 34x, 74x, 75x, 83x, or 85x) Thru Date equals the
SNF Inpatient Part A (21x) Admission date in history,
bypass this edit.

Incoming Outpatient claim (bill type 12x, 13x, 14x, 22x,
23x, 34x, 74x, 75x, 83x, or 85x) From Date equals the SNF
Inpatient Part A (21x) Discharge Date in history and the
Patient Status is other than '30', bypass this edit.

Incoming Outpatient claim (bill type 12x, 13x, 14x, 22x,
23x, 34x, 74x, 75x, 83x, or 85x) is submitted with Action
Code '4' (cancel only) or Action Code '7' (add to history),
bypass this edit.

Incoming Outpatient claim (bill type 12x, 13x, 14x, 22x,
23x, 34x, 74x, 75x, 83x, or 85x) is submitted with a No-Pay
Code 'B' or 'N', bypass this edit.

Incoming Outpatient claim (bill type 12x, 13x, 14x, 22x,
23x, 34x, 74x, 75x, 83x, or 85x) is submitted without a No-
Pay Code, but the Total Charge equals the Non-Covered
Charge for the particular Non-Therapy HCPCS code(s), bypass
this edit.

Incoming Outpatient claim (bill type 85x) is received with
Revenue Code(s) '96x', '97x', or '98x' and the Dates of
Service on, or after 07/01/2001, bypass this edit.

When the HCPCS code is equal to 'G9017', 'G9018', 'G9019',
'G9020', 'G9033', 'G9034', 'G9035', or 'G9036', bypass this
edit.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 272
______________________________________________________________________________

 Incoming Outpatient claim (13x or 14x) is submitted with
 'CB' in the Modifier field, bypass this edit.

 Incoming Outpatient claim (bill type 12x, 13x, 14x, 22x,
 23x, 34x, 74x, 75x, 83x, or 85x) is submitted with a CT
 Scans, Cardiac Catheterization, MRI, Radiation Therapy,
 Angiography, and Outpatient Surgery HCPCS code(s), and all
 other Revenue Code(s) lines on the incoming claim that have
 the same detail line item Date of Service, bypass this
 edit.

 CT SCANS   CODE(S):
 'G0131',   'G0132',   '70450',   '70460',   '70470',   '70480',
 '70481',   '70482',   '70486',   '70487',   '70488',   '70490',
 '70491',   '70492',   '70496',   '70498',   '71250',   '71260',
 '71270',   '71275',   '72125',   '72126',   '72127',   '72128',
 '72129',   '72130',   '72131',   '72132',   '72133',   '72191',
 '72192',   '72193',   '72194',   '73200',   '73201',   '73202',
 '73206',   '73700',   '73701',   '73702',   '73706',   '74150',
 '74160',   '74170',   '74175',   '75635',   '76355',   '76360',
 '76362',   '76370',   '76375',   '76380',   '76497',   bypass this
 edit.

 CT Scans Effective 01/01/2007
 '77078', '77079', '77011', '77012', '77013', and '77014',
 bypass this edit.

 CT SCANS Effective Date 04/01/2005
 '76070', '76071', bypass this edit.

 CT SCANS Termination Date 12/31/2006
 '76070', '76071', '76355', '76360', '76362', and '76370',
 set the '7252' error code.

 CT SCANS Termination Date 12/31/2005
 '76375', set the '7252' error code.

 CT SCANS Termination Date 03/31/2005
 'G0131' or 'G0132', set the '7252' error code.

 CARDIAC CATHERTERIZATION CODE(S):
 '33967', '33968', '93501', '93503', '93505', '93508',
 '93510', '93511', '93514', '93524', '93526', '93527',
 '93528', '93529', '93530', '93531', '93532', '93533',
 '93539', '93540', '93541', '93542', '93543', '93544',
 '93545', '93555', '93556', '93561', '93562', '93571',
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 273
______________________________________________________________________________

'93572', bypass this edit.

MRI CODES:
'C8900', 'C8901', 'C8902', 'C8903', 'C8904', 'C8905',
'C8906', 'C8907', 'C8908', 'C8909', 'C8910', 'C8911',
'C8912', 'C8913', 'C8914', 'C8918', 'C8919', 'C8920',
'70336', '70540', '70542', '70543', '70544', '70545',
'70546', '70547', '70548', '70549', '70551', '70552',
'70553', '70557', '70558', '70559', '71550', '71551',
'71552', '71555', '72141', '72142', '72146', '72147',
'72148', '72149', '72156', '72157', '72158', '72195',
'72196', '72197', '73218', '73219', '73220', '73221',
'73222', '73223', '73718', '73719', '73720', '73721',
'73722', '73723', '73725', '74181', '74182', '74183',
'74185', '75552', '75553', '75554', '75555', '75556',
'76093', '76094', '76390', '76394', '76400', '76498',
bypass this edit when billed with Revenue Code '255'.

MRI CODES WITH EFFECTIVE DOS 01/01/2007:
'77058', '77059', '77021', '77022', '77084', '70554',
and '70555' bypass this edit.

MRI CODES WITH EFFECTIVE DOS 04/01/2004:
'72198', bypass this edit.

MRI CODES Termination Date 12/31/2006
'76093', '76094', '76394', and '76400',
set error code '7252'.

RADIATION THERAPY   CODES:
'C1716', 'C1718',   'C1719',   'C1720', 'C2616',   'C2632',
'G0173', 'G0242',   'G0243',   'G0251', 'G0256',   'G0338',
'G0339', 'G0340',   '77261',   '77262', '77263',   '77280',
'77285', '77290',   '77295',   '77299', '77300',   '77301',
'77305', '77310',   '77315',   '77321', '77326',   '77327',
'77328', '77331',   '77332',   '77333', '77334',   '77336',
'77370', '77399',   '77401',   '77402', '77403',   '77404',
'77406', '77407',   '77408',   '77409', '77411',   '77412',
'77413', '77414',   '77416',   '77417', '77418',   '77427',
'77431', '77432',   '77470',   '77499', '77520',   '77522',
'77523', '77525',   '77600',   '77605', '77610',   '77615',
'77620', '77750',   '77761',   '77762', '77763',   '77776',
'77777', '77778',   '77781',   '77782', '77783',   '77784',
'77789', '77790',   '77799',   bypass this edit.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 274
______________________________________________________________________________

 RADIATION THERAPY Effective 01/01/2008
 'A4648' and 'A4650', bypass this edit.

 RADIATION THERAPY Effective 01/01/2007
 '77371', and '77421', bypass this edit.

 RADIATION THERAPY Effective 01/01/2006
 'C9725', 'C2637', bypass this edit.

 RADIATION THERAPY Effective Date 01/01/2005
 '19296' or '19297', bypass this edit.

 RADIATION THERAPY Effective 04/01/2005
 'C1715', 'C1717', 'C1728', 'C2633', 'C2634', 'C2635',
 'C2636', 'C9722', bypass this edit.

 RADIATION THERAPY Termination Date 12/31/2003
 'G0256', set the '7252' error code.

 RADIATION THERAPY Termination Date 12/31/2005
 'C9722', 'G0242', 'G0338', set the '7252' error code.

 RADIATION THERAPY Termination Date 12/31/2006
 'G0243', set the '7252' error code.

 ANGIOGRAPHY CODES:
 'G0278', '75600', '75605',   '75625',   '75630',   '75635',
 '75650', '75658', '75660',   '75662',   '75665',   '75671',
 '75676', '75680', '75685',   '75705',   '75710',   '75716',
 '75722', '75724', '75726',   '75731',   '75733',   '75736',
 '75741', '75743', '75746',   '75756',   '75774',   '75790',
 '75801', '75803', '75805',   '75807',   '75809',   '75810',
 '75820', '75822', '75825',   '75827',   '75831',   '75833',
 '75840', '75842', '75860',   '75870',   '75872',   '75880',
 '75885', '75887', '75889',   '75891',   '75893',   '75894',
 '75896', '75898', '75900',   '75940',   '75960',   '75961',
 '75962', '75964', '75966',   '75968',   '75970',   '75978',
 '75980', '75982', '75992',   '75993',   '75994',   '75995',
 '75996', bypass this edit.

 ANGIOGRAPHY CODES WITH EFFECTIVE DOS 04/01/2006:
 '36598', bypass this edit.

 ANGIOGRAPHY CODES WITH EFFECTIVE DOS 04/01/2004:
 'G0269', 'G0275', bypass this edit.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 275
______________________________________________________________________________

 Outpatient Surgery Excluded Codes
 '0001T-0021T', '0024T-0026T', '10021-69990', bypass this
 edit.

 Outpatient Surgery Excluded Codes Effective 01/01/2007
 'G0186', 'G0289', 'G0290', 'G0291', 'G0297', 'G0298',
 'G0299', 'G0300', 'G0342', 'G0343', and/or 'G0364',
 bypass this edit.

 Non Excluded Surgery Codes   (Except the following codes):
 '10040', '10060', '10080',   '10120', '11040', '11041',
 '11042', '11043', '11044',   '11055', '11056', '11057',
 '11200', '11300', '11305',   '11400', '11719', '11720',
 '11721', '11740', '11900',   '11901', '11920', '11921',
 '11922', '11950', '11951',   '11952', '11954', '11975',
 '11976', '11977', '15780',   '15781', '15782', '15783',
 '15786', '15787', '15788',   '15789', '15792', '15793',
 '15810', '15811', '16000',   '16020', '17000', '17003',
 '17004', '17110', '17111',   '17250', '17340', '17360',
 '17380', '17999', '20000',   '20526', '20551', '20552',
 '20553', '20974', '21084',   '21085', '21497', '26010',
 '29058', '29065', '29075',   '29085', '29086', '29105',
 '29125', '29126', '29130',   '29131', '29200', '29220',
 '29240', '29260', '29280',   '29345', '29355', '29358',
 '29365', '29405', '29425',   '29435', '29440', '29445',
 '29450', '29505', '29515',   '29520', '29540', '29550',
 '29580', '29590', '29700',   '29705', '29710', '29715',
 '29720', '29730', '29740',   '29750', '29799', '30300',
 '30901', '31720', '31725',   '31730', '36000', '36002',
 '36140', '36400', '36405',   '36406', '36430', '36468',
 '36469', '36470', '36471',   '36540', '36550', '36600',
 '36620', '36680', '51772',   '51784', '51785', '51792',
 '51795', '51797', '53660',   '53601', '53661', '54150',
 '54235', '54240', '54250',   '55870', '57160', '57170',
 '58301', '58321', '58323',   '59020', '59025', '59425',
 '59426',
 '69200', '69210', '91123',   '95970', '95971', '95972'
 '59430', '6236
 '95973', '95974', '95975',   '95990', '99183', 'G0168',
 set the '7252' error code.

 Non Excluded Surgery Codes (Except the following codes):
 Effective 01/01/2007
 'G0127', 'G0268', 'G0293', and/or 'G0294', set the '7252'
 error code.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 276
______________________________________________________________________________

 Effective 01/01/2006 (non excluded surgery)
 '20979', 'G0345', '37195', '92977', set the'7252' error
 code.

 Non Excluded Surgery Codes (Except the following code):
 Terminated 12/31/2006
 '38220' and '38221', bypass this edit.

 Terminated 12/31/2005
 '64550', bypass this edit.

 Non Excluded Surgery Codes (Except the following codes):
 Effective 01/01/2005
 (As of 01/01/2005 is now a non-excluded HCPCS codes)
 '11100', '11101', '11201', '11420', '11440', '20550',
 '29530', '32019', '32020', '51701', '51702', '51703', or
 '51798', set the '7252' error code.

 Outpatient Surgery Excluded Codes Termination Date
 12/31/2005
 '15810', '15811', 'G0345' (after 12/31/2005
 these codes are excluded Surgery Codes, bypass this edit
 originally HCPCS codes on the Except table).

 Outpatient Surgery Excluded Codes Termination Date
 12/31/2004
 '36589', '44500' (After 12/31/2004 these codes
 are excluded Surgery Codes, bypass this edit).

 Outpatient Surgery Excluded Codes Termination Date
 12/31/2003
 '36489', '36491' (After 12/31/2003 these codes
 are excluded Surgery Codes, bypass this edit).

 Outpatient Surgery Excluded Codes Termination Date
 12/31/2002 '53670', '53675' (After 12/31/2002
 are excluded Surgery Codes, bypass this edit).

 Incoming Outpatient claim (bill type 12x, 13x, 14x, 22x,
 23x, 34x, 74x, 75x, 83x, or 85x) is submitted with Revenue
 Code '25x' and an excluded Surgery HCPCS code(s). The
 detail line item Date of Service for Revenue Code '25x'
 matches the detail line item Date of Service for the
 Surgery excluded HCPCS code(s) bypass this edit. Also, if
 Revenue Code '25x' is present without a detail line item
 Date of Service also, include in the bypass.
______________________________________________________________________________
2020 Company, LLC                                           Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 277
______________________________________________________________________________


 Note: This includes all other Revenue Code lines on the
       incoming Outpatient claim that have the same detail
       line item Date of Service.

 Outpatient Surgery Excluded Codes
 '0001T-0021T', '0024T-0026T', '10021-69990', bypass this
 edit.

 Outpatient Surgery Excluded Codes Effective 01/01/2007
 'G0186', 'G0289', 'G0290', 'G0291', 'G0297', 'G0298',
 'G0299', 'G0300', 'G0342', 'G0343', and/or 'G0364'
 bypass this edit.

 Non Excluded Surgery Codes   (Except the following codes):
 '10040', '10060', '10080',   '10120', '11040', '11041',
 '11042', '11043', '11044',   '11055', '11056', '11057',
 '11200', '11300', '11305',   '11400', '11719', '11720',
 '11721', '11740', '11900',   '11901', '11920', '11921',
 '11922', '11950', '11951',   '11952', '11954', '11975',
 '11976', '11977', '15780',   '15781', '15782', '15783',
 '15786', '15787', '15788',   '15789', '15792', '15793',
 '15810', '15811', '16000',   '16020', '17000', '17003',
 '17004', '17110', '17111',   '17250', '17340', '17360',
 '17380', '17999', '20000',   '20526', '20551', '20552',
 '20553', '20974', '21084',   '21085', '21497', '26010',
 '29058', '29065', '29075',   '29085', '29086', '29105',
 '29125', '29126', '29130',   '29131', '29200', '29220',
 '29240', '29260', '29280',   '29345', '29355', '29358',
 '29365', '29405', '29425',   '29435', '29440', '29445',
 '29450', '29505', '29515',   '29520', '29540', '29550',
 '29580', '29590', '29700',   '29705', '29710', '29715',
 '29720', '29730', '29740',   '29750', '29799', '30300',
 '30901', '31720', '31725',   '31730', '36000', '36002',
 '36140', '36400', '36405',   '36406', '36430', '36468',
 '36469', '36470', '36471',   '36540', '36550', '36600',
 '36620', '36680', '51772',   '51784', '51785', '51792',
 '51795', '51797', '53660',   '53601', '53661', '54150',
 '54235', '54240', '54250',   '55870', '57160', '57170',
 '58301', '58321', '58323',   '59020', '59025', '59425',
 '59426', '59430', '62367',   '62368', '65205', '69000',
 '69200', '69210', '91123',   '95970', '95971', '95972',
 '95973', '95974', '95975',   '95990', '99183', 'G0168',
 set the '7252' error code.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 278
______________________________________________________________________________

 Non Excluded Surgery Codes (Except the following codes):
 Effective 01/01/2007
 'G0127', 'G0268', 'G0293', and/or 'G0294' set the '7252'
 error code.

 Effective 01/01/2006 (non-excluded surgery)
 '20979', 'G0345', '37195', '92977', set the '7252' error
 code.

 Non Excluded Surgery Codes (Except the following code):
 Terminated 12/31/2006
 '38220' and '38221', bypass this edit.

 Terminated 12/31/2005
 '64550', bypass this edit.

 Non Excluded Surgery Codes (Except the following codes):
 Effective 01/01/2005
 (As of 01/01/2005 is now a non-excluded HCPCS codes)
 '11100', '11101', '11201', '11420', '11440', '20550',
 '29530', '32019', '32020', '51701', '51702', '51703', or
 '51798', set the '7252' error code.

 Outpatient Surgery Excluded Codes Termination Date
 12/31/2004 '36589', '44500' (After 12/31/2004 these codes
 are excluded Surgery Codes, bypass this edit).

 Outpatient Surgery Excluded Codes Termination Date
 12/31/2003 '36489', '36491' (After 12/31/2003 these codes
 are excluded Surgery Codes, bypass this edit).

 Outpatient Surgery Excluded Codes Termination Date
 12/31/2002 '53670', '53675' (After 12/31/2002 these codes
 are excluded Surgery Codes, bypass this edit).

 Outpatient Surgery Excluded Codes Termination Date
 12/31/2005 '15810', '15811', 'G0345' (after 12/31/2005
 these codes are excluded Surgery Codes, bypass this edit
 originally HCPCS codes on the Except table).

 Incoming Outpatient claim (bill type 12x, 13x, 14x, 22x,
 23x, 34x, 74x, 75x, 83x, or 85x) is submitted with Revenue
 Code '255' and on the same claim one of the excluded SNF
 HCPCS code(s) listed below:


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 279
______________________________________________________________________________

 CT SCANS CODE(S):
 'G0131', 'G0132', '70450', '70460', '70470',   '70480',
 '70481', '70482', '70486', '70487', '70488',   '70490',
 '70491', '70492', '70496', '70498', '71250',   '71260',
 '71270', '71275', '72125', '72126', '72127',   '72128',
 '72129', '72130', '72131', '72132', '72133',   '72191',
 '72192', '72193', '72194', '73200', '73201',   '73202',
 '73206', '73700', '73701', '73702', '73706',   '74150',
 '74160', '74170', '74175', '75635', '76355',   '76360',
 '76362', '76370', '76375', '76380', '76497',   bypass this
 edit when billed with Revenue Code '255'.

 CT Scans Effective 01/01/2007
 '77078', '77079', '77011', '77012', '77013', and '77014'

 CT SCANS Effective Date 04/01/2005
 '76070' or '76071', bypass this edit.

 CT SCANS Termination Date 12/31/2006
 '76070', '76071', '76355', '76360', '76362', '76370',
 set the '7252' error code.

 CT SCANS Termination Date 03/31/2005
 'G0131' or 'G0132', set the '7252' error code.

 CARDIAC CATHERTERIZATION CODE(S):
 '33967', '33968', '93501', '93503', '93505', '93508',
 '93510', '93511', '93514', '93524', '93526', '93527',
 '93528', '93529', '93530', '93531', '93532', '93533',
 '93539', '93540', '93541', '93542', '93543', '93544',
 '93545', '93555', '93556', '93561', '93562', '93571',
 '93572', bypass this edit when billed with Revenue
 Code '255'.

 MRI CODES:
 'C8900', 'C8901', 'C8902', 'C8903', 'C8904', 'C8905',
 'C8906', 'C8907', 'C8908', 'C8909', 'C8910', 'C8911',
 'C8912', 'C8913', 'C8914', 'C8918', 'C8919', 'C8920',
 '70336', '70540', '70542', '70543', '70544', '70545',
 '70546', '70547', '70548', '70549', '70551', '70552',
 '70553', '70557', '70558', '70559', '71550', '71551',
 '71552', '71555', '72141', '72142', '72146', '72147',
 '72148', '72149', '72156', '72157', '72158', '72195',
 '72196', '72197', '73218', '73219', '73220', '73221',
 '73222', '73223', '73718', '73719', '73720', '73721',
 '73722', '73723', '73725', '74181', '74182', '74183',
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 280
______________________________________________________________________________

 '74185', '75552', '75553', '75554', '75555', '75556',
 '76093', '76094', '76390', '76394', '76400', '76498',
 bypass this edit when billed with Revenue Code '255'.

 MRI CODES WITH EFFECTIVE DOS 01/01/2007:
 '77058', '77059', '77021', '77022', '77084', '70554',
 and '70555', bypass this edit when billed with Revenue
 Code '255'.

 MRI CODES WITH EFFECTIVE DOS 04/01/2004:
 '72198', bypass this edit when billed with Revenue Code
 '255'.

 MRI CODES Termination Date 12/31/2006
 '76093', '76094', '76394', and '76400', set '7252' error
 code.

 RADIATION THERAPY   CODES:
 'C1716', 'C1718',   'C1719',   'C1720', 'C2616', 'C2632',
 'G0173', 'G0242',   'G0243',   'G0251', 'G0256', 'G0338',
 'G0339', 'G0340',   '77261',   '77262', '77263', '77280',
 '77285', '77290',   '77295',   '77299', '77300', '77301',
 '77305', '77310',   '77315',   '77321', '77326', '77327',
 '77328', '77331',   '77332',   '77333', '77334', '77336',
 '77370', '77399',   '77401',   '77402', '77403', '77404',
 '77406', '77407',   '77408',   '77409', '77411', '77412',
 '77413', '77414',   '77416',   '77417', '77418', '77427',
 '77431', '77432',   '77470',   '77499', '77520', '77522',
 '77523', '77525',   '77600',   '77605', '77610', '77615',
 '77620', '77750',   '77761',   '77762', '77763', '77776',
 '77777', '77778',   '77781',   '77782', '77783', '77784',
 '77789', '77790',   '77799',   bypass this edit when billed
 with Revenue code   '255'.

 RADIATION THERAPY Effective 01/01/2008
 'A4648' and 'A4650', bypass this edit.

 RADIATION THERAPY Effective 01/01/2007
 '77371', and '77421', bypass this edit.

 RADIATION THERAPY Effective 01/01/2006
 'C9725', 'C2637', bypass this edit.

 RADIATION THERAPY Effective Date 01/01/2005
 '19296' or '19297', bypass this edit.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 281
______________________________________________________________________________

 RADIATION THERAPY Effective 04/01/2005
 'C1715', 'C1717', 'C1728', 'C2633', 'C2634', 'C2635',
 'C2636', 'C9722', bypass this edit.

 RADIATION THERAPY Termination Date 12/31/2006
 'G0243', set the '7252' error code.

 RADIATION THERAPY Termination Date 12/31/2005
 'C9722', 'G0242', 'G0338', set the '7252' error code.

 RADIATION THERAPY Termination Date 12/31/2003
 'G0256', set the '7252' error code.

 ANGIOGRAPHY CODES:
 'G0278', '75600', '75605', '75625', '75630', '75635',
 '75650', '75658', '75660', '75662', '75665', '75671',
 '75676', '75680', '75685', '75705', '75710', '75716',
 '75722', '75724', '75726', '75731', '75733', '75736',
 '75741', '75743', '75746', '75756', '75774', '75790',
 '75801', '75803', '75805', '75807', '75809', '75810',
 '75820', '75822', '75825', '75827', '75831', '75833',
 '75840', '75842', '75860', '75870', '75872', '75880',
 '75885', '75887', '75889', '75891', '75893', '75894',
 '75896', '75898', '75900', '75940', '75960', '75961',
 '75962', '75964', '75966', '75968', '75970', '75978',
 '75980', '75982', '75992', '75993', '75994', '75995',
 '75996', bypass this edit when billed with Revenue Code
 '255'.

 ANGIOGRAPHY CODES WITH EFFECTIVE DOS 04/01/2006:
 '36598', bypass this edit.

 ANGIOGRAPHY CODES WITH EFFECTIVE DOS 04/01/2004:
 'G0269', 'G0275', bypass this edit when billed Revenue Code
 '255'.

 Incoming Outpatient claim (bill type 12x, 13x, 14x, 22x,
 23x, 34x, 74x, 75x, 83x, or 85x) is submitted with Revenue
 Code '27x' and/or '62x' and on the same claim one of the
 excluded SNF HCPCS code(s) listed below:

 Outpatient Surgery Excluded Codes
 '0001T-0021T', '0024T-0026T', '10021-69990', bypass this
 edit.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 282
______________________________________________________________________________

Outpatient Surgery Excluded Codes Effective 01/01/2007
'G0186', 'G0289', 'G0290', 'G0291', 'G0297', 'G0298',
'G0299', 'G0300', 'G0342', 'G0343', and/or 'G0364',
bypass this edit.

Non Excluded Surgery Codes   (Except the following codes):
'10040', '10060', '10080',   '10120', '11040', '11041',
'11042', '11043', '11044',   '11055', '11056', '11057',
'11200', '11300', '11305',   '11400', '11719', '11720',
'11721', '11740', '11900',   '11901', '11920', '11921',
'11922', '11950', '11951',   '11952', '11954', '11975',
'11976', '11977', '15780',   '15781', '15782', '15783',
'15786', '15787', '15788',   '15789', '15792', '15793',
'15810', '15811', '16000',   '16020', '17000', '17003',
'17004', '17110', '17111',   '17250', '17340', '17360',
'17380', '17999', '20000',   '20526', '20551', '20552',
'20553', '20974', '21084',   '21085', '21497', '26010',
'29058', '29065', '29075',   '29085', '29086', '29105',
'29125', '29126', '29130',   '29131', '29200', '29220',
'29240', '29260', '29280',   '29345', '29355', '29358',
'29365', '29405', '29425',   '29435', '29440', '29445',
'29450', '29505',
'29580', '29590', '29700',   '29705',   '29710',   '29715',
'29720', '29730', '29740',   '29750',   '29799',   '30300',
'30901', '31720', '31725',   '31730',   '36000',   '36002',
'36140', '36400', '36405',   '36406',   '36430',   '36468',
'36469', '36470', '36471',   '36540',   '36550',   '36600',
'36620', '36680', '51772',   '51784',   '51785',   '51792',
'51795', '51797', '53660',   '53601',   '53661',   '54150',
'54235', '54240', '54250',   '55870',   '57160',   '57170',
'58301', '58321', '58323',   '59020',   '59025',   '59425',
'59426', '59430', '62367',   '62368',   '65205',   '69000',
'69200', '69210', '91123',   '95970',   '95971',   '95972',
'95973', '95974', '95975',   '95990',   '99183',   'G0168',
set the '7252' error code.

Non Excluded Surgery Codes (Except the following codes):
Effective 01/01/2007
'G0127', 'G0268', 'G0293', and/or 'G0294', set the '7252'
error code.

Effective 01/01/2006
'20979', 'G0345', '37195', '92977', set the '7252' error
code.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 283
______________________________________________________________________________

 Non Excluded Surgery Codes (Except the following code):
 Terminated 12/31/2006
 '38220' and '38221', bypass this edit.

 Terminated 12/31/2005
 '64550', bypass this edit.

 Non Excluded Surgery Codes (Except the following codes:)
 Effective 01/01/2005
 (As of 01/01/2005 is now a non-excluded HCPCS codes)
 '11100', '11101', '11201', '11420', '11440', '20550',
 '29530', '32019', '32020', '51701', '51702', '51703', or
 '51798, set the '7252' error code.

 Outpatient Surgery Excluded Codes Termination Date
 12/31/2005
 '15810', '15811' 'G0345' (after 12/31/2005
 these codes are excluded Surgery Codes, bypass this edit,
 originally HCPCS codes on the Except table).

 Outpatient Surgery Excluded Codes Termination Date
 12/31/2004
 '36589', '44500' (After 12/31/2004 these codes are excluded
 Surgery Codes, bypass this edit).

 Outpatient Surgery Excluded Codes Termination Date
 12/31/2003
 '36489', '36491' (After 12/31/2003 these codes are excluded
 Surgery Codes, bypass this edit).

 Outpatient Surgery Excluded Codes Termination Date
 12/31/2002 these codes are
 '53670', '53675' (After 12/31/2002 these codes are
 Surgery Codes, bypass this edit).

 CT SCANS CODE(S):
 'G0131', 'G0132', '70450', '70460', '70470', '70480',
 '70481', '70482', '70486', '70487', '70488', '70490',
 '70491', '70492', '70496', '70498', '71250', '71260',
 '71270', '71275', '72125', '72126', '72127', '72128',
 '72129', '72130', '72131', '72132', '72133', '72191',
 '72192', '72193', '72194', '73200', '73201', '73202',
 '73206', '73700', '73701', '73702', '73706', '74150',
 '74160', '74170', '74175', '75635', '76355', '76360',
 '76362', '76370', '76375', '76380', '76497', bypass this
 edit.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 284
______________________________________________________________________________


 CT Scans Effective 01/01/2007
 '77078', '77079', '77011', '77012', '77013', and '77014'

 CT SCANS Effective Date 04/01/2005
 '76070' or '76071', bypass this edit.

 CT SCANS Termination Date 12/31/2006
 '76070', '76071', '76355', '76360', '76362', and '76370'
 set the '7252' error code.

 CT SCANS Termination Date 12/31/2005
 '76375', set the '7252' error code.

 CT SCANS Termination Date 03/31/2005
 'G0131' or 'G0132', set the '7252' error code.

 CARDIAC CATHERTERIZATION CODE(S):
 '33967', '33968', '93501', '93503',       '93505',   '93508',
 '93510', '93511', '93514', '93524',       '93526',   '93527',
 '93528', '93529', '93530', '93531',       '93532',   '93533',
 '93539', '93540', '93541', '93542',       '93543',   '93544',
 '93545', '93555', '93556', '93561',       '93562',   '93571',
 '93572', bypass this edit.

 MRI CODES:
 'C8900', 'C8901',   'C8902',   'C8903',   'C8904',   'C8905',
 'C8906', 'C8907',   'C8908',   'C8909',   'C8910',   'C8911',
 'C8912', 'C8913',   'C8914',   'C8918',   'C8919',   'C8920',
 '70336', '70540',   '70542',   '70543',   '70544',   '70545',
 '70546', '70547',   '70548',   '70549',   '70551',   '70552',
 '70553', '70557',   '70558',   '70559',   '71550',   '71551',
 '71552', '71555',   '72141',   '72142',   '72146',   '72147',
 '72148', '72149',   '72156',   '72157',   '72158',   '72195',
 '72196', '72197',   '73218',   '73219',   '73220',   '73221',
 '73222', '73223',   '73718',   '73719',   '73720',   '73721',
 '73722', '73723',   '73725',   '74181',   '74182',   '74183',
 '74185', '75552',   '75553',   '75554',   '75555',   '75556',
 '76093', '76094',   '76390',   '76394',   '76400',   '76498',
 bypass this edit.

 MRI CODES WITH EFFECTIVE DOS 01/01/2007:
 '77058', '77059', '77021', '77022', '77084', '70554',
 and '70555'


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 285
______________________________________________________________________________

MRI CODES WITH EFFECTIVE DOS 04/01/2004:
'72198', bypass this edit.

MRI CODES Termination Date 12/31/2006
'76093', '76094', '76394', and 76400, set the '7252'
error code.

ANGIOGRAPHY CODES:
'G0278', '75600', '75605',   '75625',   '75630',   '75635',
'75650', '75658', '75660',   '75662',   '75665',   '75671',
'75676', '75680', '75685',   '75705',   '75710',   '75716',
'75722', '75724', '75726',   '75731',   '75733',   '75736',
'75741', '75743', '75746',   '75756',   '75774',   '75790',
'75801', '75803', '75805',   '75807',   '75809',   '75810',
'75820', '75822', '75825',   '75827',   '75831',   '75833',
'75840', '75842', '75860',   '75870',   '75872',   '75880',
'75885', '75887', '75889',   '75891',   '75893',   '75894',
'75896', '75898', '75900',   '75940',   '75960',   '75961',
'75962', '75964', '75966',   '75968',   '75970',   '75978',
'75980', '75982', '75992',   '75993',   '75994',   '75995',
'75996', bypass this edit.

ANGIOGRAPHY CODES WITH EFFECTIVE DOS 04/01/2006:
'36598', bypass this edit.

ANGIOGRAPHY CODES WITH EFFECTIVE DOS 04/01/2004:
'G0269', 'G0275', bypass this edit.
Incoming Outpatient claim (bill type 12x, 13x, 14x, 22x,
23x, 34x, 74x, 75x, 83x, or 85x) is submitted with Revenue
Code '30x' and on the same claim one of the excluded SNF
HCPCS code(s) listed below:

Outpatient Surgery Excluded Codes
'0001T-0021T', '0024T-0026T', '10021-69990', bypass this
edit.

Outpatient Surgery Excluded Codes Effective 01/01/2007
'G0186', 'G0289', 'G0290', 'G0291', 'G0297', 'G0298',
'G0299', 'G0300', 'G0342', 'G0343', and/or 'G0364',
bypass this edit.

 Non Excluded Surgery Codes (Except the following codes):
 '10040', '10060', '10080', '10120', '11040', '11041',
 '11042', '11043', '11044', '11055', '11056', '11057',
 '11200', '11300', '11305', '11400', '11719', '11720',
 '11721', '11740', '11900', '11901', '11920', '11921'
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 286
______________________________________________________________________________

 '11922', '11950', '11951',   '11952',   '11954',   '11975',
 '11976', '11977', '15780',   '15781',   '15782',   '15783',
 '15786', '15787', '15788',   '15789',   '15792',   '15793',
 '15810', '15811', '16000',   '16020',   '17000',   '17003',
 '17004', '17110', '17111',   '17250',   '17340',   '17360',
 '17380', '17999', '20000',   '20526',   '20551',   '20552',
 '20553', '20974', '21084',   '21085',   '21497',   '26010',
 '29058', '29065', '29075',   '29085',   '29086',   '29105',
 '29125', '29126', '29130',   '29131',   '29200',   '29220',
 '29240', '29260', '29280',   '29345',   '29355',   '29358',
 '29365', '29405', '29425',   '29435',   '29440',   '29445',
 '29450', '29505', '29515',   '29520',   '29540',   '29550',
 '29580', '29590', '29700',   '29705',   '29710',   '29715',
 '29720', '29730', '29740',   '29750',   '29799',   '30300',
 '30901', '31720', '31725',   '31730',   '36000',   '36002',
 '36140', '36400', '36405',   '36406',   '36430',   '36468',
 '36469', '36470', '36471',   '36540',   '36550',   '36600',
 '36620', '36680', '51772',   '51784',   '51785',   '51792',
 '51795', '51797', '53660',   '53601',   '53661',   '54150',
 '54235', '54240', '54250',   '55870',   '57160',   '57170',
 '58301', '58321', '58323',   '59020',   '59025',   '59425',
 '59426', '59430', '62367',   '62368',   '65205',   '69000',
 '69200', '69210', '91123',   '95970',   '95971',   '95972',
 '95973', '95974', '95975',   '95990',   '99183',   'G0168',
 set the '7252' error code.

 Non excluded Surgery Codes (Except the following codes:
 Effective 01/01/2007
 'G0127', 'G0268', 'G0293', and/or 'G0294', set the '7252'
 error code.

 Effective 01/01/2006
 '20979', 'G0345', '37195', '92977', set the '7252' error
 code.

 Non Excluded Surgery Codes (Except the following code):
 Terminated 12/31/2006
 '38220' and '38221', bypass this edit.

 Terminated 12/31/2005
 '64550' bypass this edit.

 Non Excluded Surgery (except the following Codes):
 (As of 01/01/2005 is now a non-excluded HCPCS codes)
 '11100', '11101', '11201', '11420', '11440', '20550',
 '29530', '32019', '32020', '51701', '51702', '51703', or
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 287
______________________________________________________________________________

 '51798', set the '7252' error code.

 Outpatient Surgery Excluded Codes Termination Date
 12/31/2005
 '15810', '15811' 'G0345' (after 12/31/2005
 these codes are excluded Surgery Codes, bypass this edit
 originally HCPCS codes on the Except table).

 Outpatient Surgery Excluded Codes Termination Date
 12/31/2004
 '36589', '44500' (After 12/31/2004 these codes are excluded
 Surgery Codes, bypass this edit).

 Outpatient Surgery Excluded Codes Termination Date
 12/31/2003
 '36489', '36491' (After 12/31/2003 these codes are excluded
 Surgery Codes, bypass this edit).

 Outpatient Surgery Excluded Codes Termination Date
 12/31/2002
 '53670', '53675' (After 12/31/2002 these codes are excluded
 Surgery Codes, bypass this edit).

 Incoming Outpatient claim (bill type 12x, 13x, 14x, 22x,
 23x, 34x, 74x, 75x, 83x, or 85x) is submitted with Revenue
 Code '37x' and on the same claim one of the excluded SNF
 HCPCS code(s) listed below:

 Outpatient Surgery Excluded Codes
 '0001T-0021T', '0024T-0026T', '10021-69990', bypass this
 edit.

 Outpatient Surgery Excluded Codes Effective 01/01/2007
 'G0186', 'G0289', 'G0290', 'G0291', 'G0297', 'G0298',
 'G0299', 'G0300', 'G0342', 'G0343', and/or 'G0364',
 bypass this edit.

 Non Excluded Surgery Codes (Except the following codes):
 '10040', '10060', '10080', '10120', '11040', '11041',
 '11042', '11043', '11044', '11055', '11056', '11057',
 '11200', '11300', '11305', '11400', '11719', '11720',
 '11721', '11740', '11900', '11901', '11920', '11921',
 '11922', '11950', '11951', '11952', '11954', '11975',
 '11976', '11977', '15780', '15781', '15782', '15783',
 '15786', '15787', '15788', '15789', '15792', '15793',
 '15810', '15811', '16000', '16020', '17000', '17003',
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 288
______________________________________________________________________________

 '17004', '17110', '17111',   '17250',   '17340',   '17360',
 '17380', '17999', '20000',   '20526',   '20551',   '20552',
 '20553', '20974', '21084',   '21085',   '21497',   '26010',
 '29058', '29065', '29075',   '29085',   '29086',   '29105',
 '29125', '29126', '29130',   '29131',   '29200',   '29220',
 '29240', '29260', '29280',   '29345',   '29355',   '29358',
 '29365', '29405', '29425',   '29435',   '29440',   '29445',
 '29450', '29505', '29515',   '29520',   '29540',   '29550',
 '29580', '29590', '29700',   '29705',   '29710',   '29715',
 '29720', '29730', '29740',   '29750',   '29799',   '30300',
 '30901', '31720', '31725',   '31730',   '36000',   '36002',
 '36140', '36400', '36405',   '36406',   '36430',   '36468',
 '36469', '36470', '36471',   '36540',   '36550',   '36600',
 '36620', '36680', '51772',   '51784',   '51785',   '51792',
 '51795', '51797', '53660',   '53601',   '53661',   '54150',
 '54235', '54240', '54250',   '55870',   '57160',   '57170',
 '58301', '58321', '58323',   '59020',   '59025',   '59425',
 '59426', '59430', '62367',   '62368',   '65205',   '69000',
 '69200', '69210', '91123',   '95970',   '95971',   '95972',
 '95973', '95974', '95975',   '95990',   '99183',   'G0168',
 set the '7252' error code.

 Non Excluded Surgery Codes (Except the following codes)
 Effective 01/01/2007
 'G0127', 'G0268', 'G0293', and/or 'G0294' set the '7252'
 error code.

 Effective 01/01/2006
 '20979', 'G0345', '37195', '92977', set the '7252' error
 code.

 Non Excluded Surgery Codes (Except the following code):
 Terminated 12/31/2006
 '38220' and '38221', bypass this edit.

 Terminated 12/31/2005
 '64550', bypass this edit.

 Non Excluded Surgery Codes (Except the following codes:
 (As of 01/01/2005 is now a non-excluded HCPCS codes)
 '29530', '32019', '32020', '51701', '51702', '51703', or
 '51798', set the '7252' error code.

 Outpatient Surgery Excluded Codes Termination Date
 12/31/2005 '15810', '15811', 'G0345' (after 12/31/2005
 these codes are excluded Surgery Codes, bypass this edit
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 289
______________________________________________________________________________

 originally HCPCS codes on the Except table).

 Outpatient Surgery Excluded       Codes Termination Date
 12/31/2004 '36589', '44500'       (After 12/31/2004 these codes
 are excluded Surgery Codes,       bypass this edit).
 Outpatient Surgery Excluded       Codes Termination Date
 12/31/2003 '36489', '36491'       (After 12/31/2003 these codes
 are excluded Surgery Codes,       bypass this edit).

 Outpatient Surgery Excluded Codes Termination Date
 12/31/2002
 '53670', '53675' (After 12/31/2002 these codes are excluded
 Surgery Codes, bypass this edit).

 CT SCANS   CODE(S):
 'G0131',   'G0132',   '70450',   '70460',   '70470',   '70480',
 '70481',   '70482',   '70486',   '70487',   '70488',   '70490',
 '70491',   '70492',   '70496',   '70498',   '71250',   '71260',
 '71270',   '71275',   '72125',   '72126',   '72127',   '72128',
 '72129',   '72130',   '72131',   '72132',   '72133',   '72191',
 '72192',   '72193',   '72194',   '73200',   '73201',   '73202',
 '73206',   '73700',   '73701',   '73702',   '73706',   '74150',
 '74160',   '74170',   '74175',   '75635',   '76355',   '76360',
 '76362',   '76370',   '76375',   '76380',   '76497',   bypass this
 edit.

 CT Scans Effective 01/01/2007
 '77078', '77079', '77011', '77012', '77013', and '77014'

 CT SCANS Effective Date: 04/01/2005
 '76070' or '76071', bypass this edit.

 CT SCANS Termination Date 12/31/2006
 '76070', '76071', '76355', '76360', '76362', and '76370',
 set the '7252' error code.

 CT SCANS Termination Date: 03/31/2005
 'G0131' or 'G0132', set the '7252' error code.

 CARDIAC CATHERTERIZATION CODE(S):
 '33967', '33968', '93501', '93503', '93505', '93508',
 '93510', '93511', '93514', '93524', '93526', '93527',
 '93528', '93529', '93530', '93531', '93532', '93533',
 '93539', '93540', '93541', '93542', '93543', '93544',
 '93545', '93555', '93556', '93561', '93562', '93571',
 '93572', bypass this edit.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 290
______________________________________________________________________________


 MRI CODES:
 'C8900', 'C8901',   'C8902',   'C8903',   'C8904',   'C8905',
 'C8906', 'C8907',   'C8908',   'C8909',   'C8910',   'C8911',
 'C8912', 'C8913',   'C8914',   'C8918',   'C8919',   'C8920',
 '70336', '70540',   '70542',   '70543',   '70544',   '70545',
 '70546', '70547',   '70548',   '70549',   '70551',   '70552',
 '70553', '70557',   '70558',   '70559',   '71550',   '71551',
 '71552', '71555',   '72141',   '72142',   '72146',   '72147',
 '72148', '72149',   '72156',   '72157',   '72158',   '72195',
 '72196', '72197',   '73218',   '73219',   '73220',   '73221',
 '73222', '73223',   '73718',   '73719',   '73720',   '73721',
 '73722', '73723',   '73725',   '74181',   '74182',   '74183',
 '74185', '75552',   '75553',   '75554',   '75555',   '75556',
 '76093', '76094',   '76390',   '76394',   '76400',   '76498',
 bypass this edit.

 MRI CODES WITH EFFECTIVE DOS 01/01/2007:
 '77058', '77059', '77021', '77022', '77084', '70554',
 and '70555'

 MRI CODES WITH EFFECTIVE DOS 04/01/2004:
 '72198', bypass this edit.

 MRI CODES Termination Date 12/31/2006
 '76093', '76094', '76394', and '76400', set the '7252'
 error code.

 RADIATION THERAPY   CODES:
 'C1716', 'C1718',   'C1719',   'C1720', 'C2616',     'C2632',
 'G0173', 'G0242',   'G0243',   'G0251', 'G0256',     'G0338',
 'G0339', 'G0340',   '77261',   '77262', '77263',     '77280',
 '77285', '77290',   '77295',   '77299', '77300',     '77301',
 '77305', '77310',   '77315',   '77321', '77326',     '77327',
 '77328', '77331',   '77332',   '77333', '77334',     '77336',
 '77370', '77399',   '77401',   '77402', '77403',     '77404',
 '77406', '77407',   '77408',   '77409', '77411',     '77412',
 '77413', '77414',   '77416',   '77417', '77418',     '77427',
 '77431', '77432',   '77470',   '77499', '77520',     '77522',
 '77523', '77525',   '77600',   '77605', '77610',     '77615',
 '77620', '77750',   '77761',   '77762', '77763',     '77776',
 '77777', '77778',   '77781',   '77782', '77783',     '77784',
 '77789', '77790',   '77799',   bypass this edit.

 RADIATION THERAPY Effective 01/01/2008
 'A4648' and 'A4650', bypass this edit.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 291
______________________________________________________________________________


 RADIATION THERAPY Effective Date 01/01/2007
 '77371', and '77421', bypass this edit.

 RADIATION THERAPY Effective Date 01/01/2006
 'C9725', 'C2637', bypass this edit.

 RADIATION THERAPY Effective Date 04/01/2005
 'C1715', 'C1717', 'C1728', 'C2633', 'C2634', 'C2635',
 'C2636', 'C9722', bypass this edit.

 RADIATION THERAPY Effective Date 01/01/2005
 '19296' or '19297', bypass this edit.

 RADIATION THERAPY Termination Date 12/31/2006
 'G0243', set the '7252' error code.

 RADIATION THERAPY Termination Date 12/31/2003
 'G0256', set the '7252' error code.

 RADIATION THERAPY Termination Date 12/31/2005
 'C9722', 'G0242', 'G0338', set the '7252' error code.

 ANGIOGRAPHY CODES:
 'G0278', '75600', '75605',   '75625',   '75630',   '75635',
 '75650', '75658', '75660',   '75662',   '75665',   '75671',
 '75676', '75680', '75685',   '75705',   '75710',   '75716',
 '75722', '75724', '75726',   '75731',   '75733',   '75736',
 '75741', '75743', '75746',   '75756',   '75774',   '75790',
 '75801', '75803', '75805',   '75807',   '75809',   '75810',
 '75820', '75822', '75825',   '75827',   '75831',   '75833',
 '75840', '75842', '75860',   '75870',   '75872',   '75880',
 '75885', '75887', '75889',   '75891',   '75893',   '75894',
 '75896', '75898', '75900',   '75940',   '75960',   '75961',
 '75962', '75964', '75966',   '75968',   '75970',   '75978',
 '75980', '75982', '75992',   '75993',   '75994',   '75995',
 '75996', bypass this edit.

 ANGIOGRAPHY CODES WITH EFFECTIVE DOS 04/01/2006:
 '36598', bypass this edit.

 ANGIOGRAPHY CODES WITH EFFECTIVE DOS 04/01/2004:
 'G0269', 'G0275', bypass this edit.

 Incoming Outpatient claim (bill type 12x, 13x, 14x, 22x,
 23x, 34x, 74x, 75x, 83x, or 85x) is submitted with one of
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 292
______________________________________________________________________________

 the following HCPCS code(s): '36489' or '36491' and when
 the line item Date of Service of the above HCPCS code
 equals the line item Date of Service of one of the
 following Chemotherapy Agent and/or Administration:

 CHEMOTHERAPY
 'J9000', 'J9001',   'J9010',   'J9015',   'J9017', 'J9020',
 'J9040', 'J9045',   'J9050',   'J9060',   'J9062', 'J9065',
 'J9070', 'J9080',   'J9090',   'J9091',   'J9092', 'J9093',
 'J9094', 'J9095',   'J9096',   'J9097',   'J9100', 'J9110',
 'J9120', 'J9130',   'J9140',   'J9150',   'J9151', 'J9160',
 'J9170', 'J9178',   'J9181',   'J9182',   'J9185', 'J9200',
 'J9201', 'J9206',   'J9208',   'J9211',   'J9230', 'J9245',
 'J9263', 'J9265',   'J9266',   'J9268',   'J9270', 'J9280',
 'J9290', 'J9291',   'J9293',   'J9300',   'J9310', 'J9320',
 'J9340', 'J9350',   'J9355',   'J9357',   'J9360', 'J9370',
 'J9375', 'J9380',   'J9390',   'J9600',   bypass this edit.

 CHEMOTHERAPY Effective 01/01/2008
 'J9303', bypass this edit.

 CHEMOTHERAPY Effective 01/01/2007
 'J9261', bypass this edit.

 CHEMOTHERAPY Effective 01/01/2006
 'J9025', 'J9027', and 'J9035', bypass this edit.

 CHEMOTHERAPY Effective 01/01/2005
 'J9041', 'J9055', 'J9305', and 'J9395', bypass this edit.

 CHEMOTHERAPY Effective 01/01/2004
 'J9098', bypass this edit.

 CHEMOTHERAPY Termination 12/31/2003
 'J9180' (After 12/31/2003 this code should set error code
 '7252').

 CHEMOTHERAPY ADMINISTRATION SERVICES:
 Note: Chemotherapy Administration must be billed with a
        Chemotherapy if not claim will reject with '7252'.

 '36260', '36261', '36262', '36640', '36823', '96405',
 '96406', '96408', '96410', '96412', '96414', '96420',
 '96422', '96423', '96425', '96440', '96445', '96450',
 '96520', '96530', '96542', 'Q0083', 'Q0084', 'Q0085',
 bypass this edit if billed with chemotherapy.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 293
______________________________________________________________________________


 CHEMOTHERAPY ADMINISTRATION Effective 01/01/2007
 '96521', '96522', '96523', bypass this edit.

 CHEMOTHERAPY ADMINISTRATION Effective 01/01/2006
 '96409', '96411', '96413', '96415', '96416', '96417',
 'C8953', 'C8954', 'C8955', bypass this edit.

 CHEMOTHERAPY ADMINISTRATION Effective 01/01/2005
 '36555', '36556', '36557', '36558', '36560', '36561',
 '36563', '36565', '36566', '36568', '36569', '36570',
 '36571', '36575', '36576', '36578', '36580', '36581',
 '36582', '36583', '36584', '36585', '36589', '36590',
 '36595', '36596', '36597', bypass this edit.

 CHEMOTHERAPY ADMINISTRATION Termination 12/31/2003
 '36489', '36491', '36530', '36531', '36532', '36533',
 '36534', '36535', (After 12/31/2003 these codes
 should set error code '7252').

 CHEMOTHERAPY ADMINISTRATION Termination 12/31/2005
 'G0363', (After 12/31/2005 this code should set error
 code '7252').

 Incoming Outpatient claim (bill type 12x, 13x, 14x, 22x,
 23x, 34x, 74x, 75x, 83x, or 85x) is submitted with one of
 the following HCPCS code(s):

 CHEMOTHERAPY
 'J9000', 'J9001',   'J9010',   'J9015',   'J9017', 'J9020',
 'J9040', 'J9045',   'J9050',   'J9060',   'J9062', 'J9065',
 'J9070', 'J9080',   'J9090',   'J9091',   'J9092', 'J9093',
 'J9094', 'J9095',   'J9096',   'J9097',   'J9100', 'J9110',
 'J9120', 'J9130',   'J9140',   'J9150',   'J9151', 'J9160',
 'J9170', 'J9178',   'J9181',   'J9182',   'J9185', 'J9200',
 'J9201', 'J9206',   'J9208',   'J9211',   'J9230', 'J9245',
 'J9263', 'J9265',   'J9266',   'J9268',   'J9270', 'J9280',
 'J9290', 'J9291',   'J9293',   'J9300',   'J9310', 'J9320',
 'J9340', 'J9350',   'J9355',   'J9357',   'J9360', 'J9370',
 'J9375', 'J9380',   'J9390',   'J9600',   bypass this edit.

 CHEMOTHERAPY Effective 01/01/2007
 'J9261', bypass this edit.

 CHEMOTHERAPY Effective 01/01/2006
 'J9025', 'J9027', and 'J9035', bypass this edit.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 294
______________________________________________________________________________


 CHEMOTHERAPY Effective 01/01/2005
 'J9041', 'J9055', 'J9305', and 'J9395', bypass this edit.

 CHEMOTHERAPY Effective 01/01/2004
 'J9098', bypass this edit.

 CHEMOTHERAPY Termination 12/31/2003
 'J9180' (After 12/31/2003 this code should set error code
 '7252'.

 CHEMOTHERAPY ADMINISTRATION SERVICES:
 Note: Chemotherapy Administration must be billed with a
        Chemotherapy if not claim will reject with '7252'.

 '36260', '36261', '36262',   '36640', '36823', '96405',
 '96406', '96408', '96410',   '96412', '96414', '96420',
 '96422', '96423', '96425',   '96440', '96445', '96450',
 '96520', '96530', '96542',   'Q0083', 'Q0084', 'Q0085',
 bypass this edit if billed   with chemotherapy.

 CHEMOTHERAPY ADMINISTRATION Effective 01/01/2005
 '36555', '36556', '36557', '36558', '36560', '36561',
 '36563', '36565', '36566', '36568', '36569', '36570',
 '36571', '36575', '36576', '36578', '36580', '36581',
 '36582', '36583', '36584', '36585', '36589', '36590',
 '36595', '36596', '36597', bypass this edit.

 CHEMOTHERAPY ADMINISTRATION Effective 01/01/2005
 'G0357', 'G0358', 'G0359', 'G0360', 'G0361', 'G0362',
 'G0363', bypass this edit if billed with chemotherapy
 drugs codes.

 CHEMOTHERAPY ADMINISTRATION Effective 01/01/2006
 '96409', '96411', '96413', '96415', '96416', '96417',
 'C8953', 'C8954', 'C8955', bypass this edit.

 CHEMOTHERAPY ADMINISTRATION Effective 01/01/2007
 '96521', '96522', '96523', bypass this edit.

 CHEMOTHERAPY ADMINISTRATION Termination 12/31/2005
 'G0363', (After 12/31/2005 this code should set error
 code '7252').



______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 295
______________________________________________________________________________

RADIOISOTOPE SERVICES:
'78804', '79200', '79300', '79403', '79440', 'A9530',
'G3001', bypass this edit.

Radioisotope Services Effective Date 01/01/2006
'A9542', 'A9543', 'A9544', 'A9545', bypass this edit.

Radioisotope Services Termination Date 12/31/2003
'G0273', 'G0274' (After 12/31/2003, set the '7252' error
code).

RADIOISOTOPE SERVICES: Termination 12/31/2004
'79030', '79035', '79100', '79400' (After 12/31/2004,
set the '7252' error code).

RADIOISOTOPE SERVICES: Termination 12/31/2005
'C1080', 'C1081', 'C1082', 'C1083' (After 12/31/2005,
set the '7252' error code).

 CUSTOMIZED PROSTHETIC DEVICES:
 'L5050', 'L5060', 'L5100', 'L5105', 'L5150', 'L5160',
 'L5200', 'L5210', 'L5220', 'L5230', 'L5250', 'L5270',
 'L5280', 'L5301', 'L5311', 'L5321', 'L5331', 'L5341',
 'L5500', 'L5505', 'L5510', 'L5520', 'L5530', 'L5535',
 'L5540', 'L5560', 'L5570', 'L5580', 'L5585', 'L5590',
 'L5595', 'L5600', 'L5610', 'L5611', 'L5613', 'L5614',
 'L5616', 'L5617', 'L5618', 'L5620', 'L5622', 'L5624',
 'L5626', 'L5628', 'L5629', 'L5630', 'L5631', 'L5632',
 'L5634', 'L5636',
 'L5642', 'L5643', 'L5644', 'L5645', 'L5646', 'L5647',
 'L5648', 'L5649', 'L5650', 'L5651', 'L5652', 'L5653',
 'L5654', 'L5655', 'L5656', 'L5658', 'L5661', 'L5665',
 'L5666', 'L5668', 'L5670', 'L5671', 'L5672', 'L5676',
 'L5677', 'L5678', 'L5680', 'L5681', 'L5682', 'L5683',
 'L5684', 'L5686', 'L5688', 'L5690', 'L5692', 'L5694',
 'L5695', 'L5696', 'L5697', 'L5698', 'L5699', 'L5700',
 'L5701', 'L5702', 'L5704', 'L5705', 'L5706', 'L5707',
 'L5710', 'L5711', 'L5712', 'L5714', 'L5716', 'L5718',
 'L5722', 'L5724', 'L5726', 'L5728', 'L5780', 'L5782',
 'L5785', 'L5790', 'L5795', 'L5810', 'L5811', 'L5812',
 'L5814', 'L5816', 'L5818', 'L5822', 'L5824', 'L5826',
 'L5828', 'L5830', 'L5840', 'L5845', 'L5848', 'L5850',
 'L5855', 'L5910', 'L5920', 'L5925', 'L5930', 'L5940',
 'L5950', 'L5960', 'L5962', 'L5964', 'L5966', 'L5968',
 'L5970', 'L5972', 'L5974', 'L5975', 'L5976', 'L5978',
 'L5979', 'L5980', 'L5981', 'L5982', 'L5984', 'L5985',
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 296
______________________________________________________________________________

'L5986',   'L5988',   'L5990',   'L5995',   'L6050', 'L6055',
'L6100',   'L6110',   'L6120',   'L6130',   'L6200', 'L6205',
'L6250',   'L6300',   'L6310',   'L6320',   'L6350', 'L6360',
'L6370',   'L6400',   'L6450',   'L6500',   'L6550', 'L6570',
'L6580',   'L6582',   'L6584',   'L6586',   'L6588', 'L6590',
'L6600',   'L6605',   'L6610',   'L6615',   'L6616', 'L6620',
'L6623',   'L6625',   'L6628',   'L6629',   'L6630', 'L6632',
'L6635',   'L6637',   'L6638',   'L6640',   'L6641', 'L6642',
'L6645',   'L6646',   'L6647',   'L6648',   'L6650', 'L6655',
'L6660',   'L6665',   'L6670',   'L6672',   'L6675', 'L6676',
'L6680',   'L6682',   'L6684',   'L6686',   'L6687', 'L6688',
'L6689',   'L6690',   'L6691',   'L6692',   'L6693', 'L6700',
'L6705',   'L6710',   'L6715',   'L6720',   'L6725', 'L6730',
'L6735',   'L6740',   'L6745',   'L6750',   'L6755', 'L6765',
'L6770',   'L6775',   'L6780',   'L6790',   'L6795', 'L6800',
'L6805',   'L6806',   'L6807',   'L6808',   'L6809', 'L6810',
'L6825',   'L6830',   'L6835',   'L6840',   'L6845', 'L6850',
'L6872',   'L6873',   'L6875',   'L6880',   'L6881', 'L6882',
'L6920',   'L6925',   'L6930',   'L6935',   'L6940', 'L6945',
'L6950',   'L6955',   'L6960',   'L6965',   'L6970', 'L6975',
'L7010',   'L7015',   'L7020',   'L7025',   'L7030', 'L7035',
'L7040',   'L7045',   'L7170',   'L7180',   'L7185', 'L7186',
'L7190',   'L7191',   'L7260'    'L7261',   'L7266', 'L7272',
'L7274',   'L7362',   'L7364',   'L7366',   bypass this edit.

CUSTOMIZED PROSTHETIC DEVICES: Effective 01/01/2007
'L5993', 'L5994', 'L6611', 'L6624', 'L6639', 'L6703',
'L6704', 'L6706', 'L6707', 'L6708', 'L6709', 'L6883',
'L6884', 'L6885', 'L7007', 'L7008', and 'L7009',
bypass this edit.

CUSTOMIZED PROSTHETIC DEVICES: Effective 01/01/2006
'L5703', 'L5858', 'L5791', 'L6677', 'L7367', 'L7368',
'L7400', 'L7401', 'L7402', 'L7403', 'L7404', 'L7405',
bypass this edit.

CUSTOMIZED PROSTHETIC DEVICES: Effective 01/01/2005
'L5685', 'L5781', 'L5856', 'L5857', 'L6694', 'L6695',
'L6696', 'L6697', 'L6698', 'L7181', bypass this edit.

CUSTOMIZED PROSTHETIC DEVICES: Effective 01/01/2004
'L5673' and 'L5679', bypass this edit.

 CUSTOMIZED PROSTHETIC DEVICES Termination 12/31/2006
 'L6700', 'L6705', 'L6710', 'L6715', 'L6720', 'L6725',
 'L6730', 'L6735', 'L6740', 'L6745', 'L6750', 'L6755',
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 297
______________________________________________________________________________

 'L6765',   'L6770',   'L6775', 'L6780', 'L6790', 'L6795',
 'L6800',   'L6806',   'L6807', 'L6808', 'L6809', 'L6825',
 'L6830',   'L6835',   'L6840', 'L6845', 'L6850', 'L6855',
 'L6860',   'L6865',   'L6867', 'L6868', 'L6870', 'L6872',
 'L6873',   'L6875',   'L6880', 'L7010', 'L7015', 'L7020',
 'L7025',   'L7030',   and 'L7030', set the '7252' error code.

 CUSTOMIZED PROSTHETIC DEVICES Termination 12/31/2002
 'L5660', 'L5662', 'L5663', 'L5664' (After 12/31/2002, set
 the '7252' error code).

 CUSTOMIZED PROSTHETIC DEVICES Termination 12/31/2003
 'K0556', 'K0557', 'K0558', 'K0559' (After 12/31/2003, set
 the '7252' error code).

 CUSTOMIZED PROSTHETIC DEVICES Termination 12/31/2004
 'L5674', 'L5675', 'L5846', 'L5847', 'L5989' (After
 12/31/2004, set the '7252' error code).

 Incoming Outpatient claim (bill type 13x or 85x) is
 submitted with Revenue Code '45x' and all other Revenue
 Code(s) with the same line item Date of Service should also
 bypass edit '7252'. Also, if Revenue Code(s) '27x', '37x'
 and/or '62x' are present on the claim without a line item
 Date of Service, also include in bypass for edit '7252'.
 Incoming Outpatient claim (bill type 12x, 13x, 14x, 22x,
 23x, 34x, 74x, 75x, 83x, or 85x) is submitted with Revenue
 Code '45x', '25x', and all other Revenue code(s) with the
 same line item Date of Service should bypass edit '7252'.
 Also, if Revenue Code '25x' is present on the claim without
 a line item Date of Service, also include in bypass for
 edit '7252'.

 Incoming Outpatient claim (bill type 13x or 85x) is
 submitted with one of the following HCPCS code(s) listed
 below, and all other Revenue Code(s) with the same line
 item Date of Service should bypass edit '7252'. Also, if
 Revenue Code(s) '27x', '37x', and/or '62x' are present on
 the claim without a line item Date of Service, also include
 in bypass for edit '7252'.

 CT SCANS CODE(S)
 'G0131', 'G0132', '70450', '70460', '70470', '70480'
 '70481', '70482', '70486', '70487', '70488', '70490'
 '70491', '70492', '70496', '70498', '71250', '71260'
 '71270', '71275', '72125', '72126', '72127', '72128'
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 298
______________________________________________________________________________

 '72129',   '72130',   '72131',   '72132',   '72133',   '72191'
 '72192',   '72193',   '72194',   '73200',   '73201',   '73202'
 '73206',   '73700',   '73701',   '73702',   '73706',   '74150'
 '74160',   '74170',   '74175',   '75635',   '76355',   '76360'
 '76362',   '76370',   '76375',   '76380',   '76497',   bypass this
 edit.

 CT Scans Effective 01/01/2007
 '77078', '77079', '77011', '77012', '77013', and '77014'
 bypass this edit.

 CT SCANS: Effective Date of 04/01/2005
 '76070' or '76071', bypass this edit.

 CT SCANS Termination Date 12/31/2006
 '76070', '76071', '76355', '76360', '76362', and '76370',
 set the '7252' error code.

 CT SCANS Termination Date 03/31/2005
 'G0131' or 'G0132', set the '7252' error code.

 CARDIAC CATHERTERIZATION CODE(S):
 '33967', '33968', '93501', '93503',         '93505',   '93508',
 '93510', '93511', '93514', '93524',         '93526',   '93527',
 '93528', '93529', '93530', '93531',         '93532',   '93533',
 '93539', '93540', '93541', '93542',         '93543',   '93544',
 '93545', '93555', '93556', '93561',         '93562',   '93571',
 '93572', bypass this edit.

 MRI CODES:
 'C8900', 'C8901',     'C8902',   'C8903',   'C8904',   'C8905',
 'C8912', 'C8913',     'C8914',   'C8918',   'C8919',   'C8920',
 '70336', '70540',     '70542',   '70543',   '70544',   '70545',
 '70546', '70547',     '70548',   '70549',   '70551',   '70552',
 '70553', '70557',     '70558',   '70559',   '71550',   '71551',
 '71552', '71555',     '72141',   '72142',   '72146',   '72147',
 '72148', '72149',     '72156',   '72157',   '72158',   '72195',
 '72196', '72197',     '73218',   '73219',   '73220',   '73221',
 '73222', '73223',     '73718',   '73719',   '73720',   '73721',
 '73722', '73723',     '73725',   '74181',   '74182',   '74183',
 '74185', '75552',     '75553',   '75554',   '75555',   '75556',
 '76093', '76094',     '76390',   '76394',   '76400',   '76498',
 bypass this edit.



______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 299
______________________________________________________________________________

 MRI CODES WITH EFFECTIVE DOS 01/01/2007:
 '77058', '77059', '77021', '77022', '77084', '70554',
 and '70555', bypass this edit.

 MRI CODES WITH EFFECTIVE DOS 04/01/2004:
 '72198', bypass this edit.

 MRI CODES Termination Date 12/31/2006
 '76093', '76094', '76394', and '76400', set the '7252'
 error code.

 RADIATION THERAPY   CODES:
 'C1716', 'C1718',   'C1719',   'C1720', 'C2616',   'C2632',
 'G0173', 'G0242',   'G0243',   'G0251', 'G0256',   'G0338',
 'G0339', 'G0340',   '77261',   '77262', '77263',   '77280',
 '77285', '77290',   '77295',   '77299', '77300',   '77301',
 '77305', '77310',   '77315',   '77321', '77326',   '77327',
 '77328', '77331',   '77332',   '77333', '77334',   '77336',
 '77370', '77399',   '77401',   '77402', '77403',   '77404',
 '77406', '77407',   '77408',   '77409', '77411',   '77412',
 '77413', '77414',   '77416',   '77417', '77418',   '77427',
 '77431', '77432',   '77470',   '77499', '77520',   '77522',
 '77523', '77525',   '77600',   '77605', '77610',   '77615'
 '77620', '77750',   '77761',   '77762', '77763',   '77776',
 '77777', '77778',   '77781',   '77782', '77783',   '77784',
 '77789', '77790',   '77799',   bypass this edit.

 RADIATION THERAPY Effective 01/01/2008
 'A4648' and 'A4650', bypass this edit.

 RADIATION THERAPY Effective 01/01/2007
 '77371', and '77421', bypass this edit.

 RADIATION THERAPY Effective 01/01/2006
 'C9725', 'C2637', bypass this edit.

 RADIATION THERAPY Effective 04/01/2005
 'C1715', 'C1717', 'C1728', 'C2633', 'C2634', 'C2635',
 'C2636', 'C9722', bypass this edit.

 RADIATION THERAPY Effective 01/01/2005
 '19296' or '19297', bypass this edit.

 RADIATION THERAPY Termination Date 12/31/2003
 'G0256', set the '7252' error code.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 300
______________________________________________________________________________

 RADIATION THERAPY Termination Date 12/31/2005
 'C9722', 'G0242', 'G0338', set the '7252' error code.

 RADIATION THERAPY Termination Date 12/31/2006
 'G0243', set the '7252' error code.

 ANGIOGRAPHY
 'G0278', '75600', '75605',   '75625',   '75630',   '75635',
 '75650', '75658', '75660',   '75662',   '75665',   '75671',
 '75676', '75680', '75685',   '75705',   '75710',   '75716',
 '75722', '75724', '75726',   '75731',   '75733',   '75736',
 '75741', '75743', '75746',   '75756',   '75774',   '75790',
 '75801', '75803', '75805',   '75807',   '75809',   '75810',
 '75820', '75822', '75825',   '75827',   '75831',   '75833',
 '75840', '75842', '75860',   '75870',   '75872',   '75880',
 '75885', '75887', '75889',   '75891',   '75893',   '75894',
 '75896', '75898', '75900',   '75940',   '75960',   '75961',
 '75962', '75964', '75966',   '75968',   '75970',   '75978',
 '75980', '75982', '75992',   '75993',   '75994',   '75995',
 '75996', bypass this edit.

 ANGIOGRAPHY CODES WITH EFFECTIVE DOS 04/01/2006:
 '36598', bypass this edit.

 ANGIOGRAPHY CODES WITH EFFECTIVE DOS 04/01/2004:
 'G0269', 'G0275', bypass this edit.

 Outpatient Surgery Excluded Codes
 '0001T-0021T', '0024T-0026T', '10021-69990', bypass this
 edit.

 Outpatient Surgery Excluded Codes Effective 01/01/2007
 'G0186', 'G0289', 'G0290', 'G0291', 'G0297', 'G0298',
 'G0299', 'G0300', 'G0342', 'G0343', and/or 'G0364',
 bypass this edit.

 Non Excluded Surgery Codes (Except the following codes):
 '10040', '10060', '10080', '10120', '11040', '11041',
 '11042', '11043', '11044', '11055', '11056', '11057',
 '11200', '11300', '11305', '11400', '11719', '11720',
 '11721', '11740', '11900', '11901', '11920', '11921',
 '11922', '11950', '11951', '11952', '11954', '11975',
 '11976', '11977', '15780', '15781', '15782', '15783',
 '15786', '15787', '15788', '15789', '15792', '15793',
 '15810', '15811', '16000', '16020', '17000', '17003',
 '17004', '17110', '17111', '17250', '17340', '17360',
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 301
______________________________________________________________________________

 '17380', '17999', '20000',   '20526',   '20551',   '20552',
 '20553', '20974', '21084',   '21085',   '21497',   '26010',
 '29058', '29065', '29075',   '29085',   '29086',   '29105',
 '29125', '29126', '29130',   '29131',   '29200',   '29220',
 '29240', '29260', '29280',   '29345',   '29355',   '29358',
 '29365', '29405', '29425',   '29435',   '29440',   '29445',
 '29450', '29505', '29515',   '29520',   '29540',   '29550',
 '29580', '29590', '29700',   '29705',   '29710',   '29715',
 '29720', '29730', '29740',   '29750',   '29799',   '30300',
 '30901', '31720', '31725',   '31730',   '36000',   '36002',
 '36140', '36400', '36405',   '36406',   '36430',   '36468',
 '36469', '36470', '36471',   '36540',   '36550',   '36600',
 '36620', '36680', '51772',   '51784',   '51785',   '51792',
 '51795', '51797', '53660',   '53601',   '53661',   '54150',
 '54235', '54240', '54250',   '55870',   '57160',   '57170',
 '58301', '58321', '58323',   '59020',   '59025',   '59425',
 '59426', '59430', '62367',   '62368',   '65205',   '69000',
 '69200', '69210', '91123',   '95970',   '95971',   '95972',
 '95973', '95974', '95975',   '95990',   '99183',   'G0168',
 set the '7252' error code.

 Non Excluded Surgery Codes (Except the following codes):
 Effective 01/01/2007
 'G0127', 'G0268', 'G0293', and/or 'G0294', set the '7252'
 error code.

 Effective 01/01/2006
 '20979', 'G0345', '37195', '92977', set the '7252'
 error code.

 Terminated 12/31/2006
 '38220', '38221', bypass this edit.

 Terminated 12/31/2005
 '64550', bypass this edit.

 Non Excluded Surgery Codes (Except the following codes):
 Effective 01/01/2005
 (As of 01/01/2005 is now a non-excluded HCPCS codes)
 '11100', '11101', '11201', '11420', '11440', '20550',
 '29530', '32019', '32020', '51701', '51702', '51703', or
 '51798', set the '7252' error code.




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 302
______________________________________________________________________________

Outpatient Surgery Excluded Codes Termination Date
12/31/2005
'15810', '15811', 'G0345' (after 12/31/2005
these codes are excluded Surgery Codes, bypass this edit
originally HCPCS codes on the Except table).

Outpatient Surgery Excluded Codes Termination Date
12/31/2004
'36589', '44500' (After 12/31/04 these codes are excluded
Surgery Codes, bypass this edit).

Outpatient Surgery Excluded Codes Termination Date
12/31/2003
'36489', '36491' (After 12/31/03 these codes are excluded
Surgery Codes, bypass this edit).

Outpatient Surgery Excluded Codes Termination Date
12/31/2002
'53670', '53675' (After 12/31/02 these codes are excluded
Surgery Codes, bypass this edit).

Incoming Outpatient claim (bill type 12x, 13x, 14x, 22x,
23x, 34x, 74x, 75x, 83x, or 85x) is submitted with an
excluded Surgery HCPCS code(s) (listed below) and all other
Revenue code(s) with the same line item Date of Service
should also be bypassed. Also, if Revenue Code '25x' is
present on the claim without a line item Date of Service,
also include in the bypass.

Outpatient Surgery Excluded Codes
'0001T-0021T', '0024T-0026T', '10021-69990', bypass this
edit.

Outpatient Surgery Excluded Codes Effective 01/01/2007
'G0186', 'G0289', 'G0290', 'G0291', 'G0297', 'G0298',
'G0299', 'G0300', 'G0342', 'G0343', and/or 'G0364',
bypass this edit.

 Non Excluded Surgery Codes (Except the following codes):
 '10040', '10060', '10080', '10120', '11040', '11041',
 '11042', '11043', '11044', '11055', '11056', '11057',
 '11200', '11300', '11305', '11400', '11719', '11720',
 '11721', '11740', '11900', '11901', '11920', '11921',
 '11922', '11950', '11951', '11952', '11954', '11975',
 '11976', '11977', '15780', '15781', '15782', '15783',
 '15786', '15787', '15788', '15789', '15792', '15793',
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 303
______________________________________________________________________________

'15810', '15811', '16000',   '16020',   '17000',   '17003',
'17004', '17110', '17111',   '17250',   '17340',   '17360',
'17380', '17999', '20000',   '20526',   '20551',
'20553', '20974', '21084',   '21085',   '21497',   '26010',
'29058', '29065', '29075',   '29085',   '29086',   '29105',
'29125', '29126', '29130',   '29131',   '29200',   '29220',
'29240', '29260', '29280',   '29345',   '29355',   '29358',
'29365', '29405', '29425',   '29435',   '29440',   '29445',
'29450', '29505', '29515',   '29520',   '29540',   '29550',
'29580', '29590', '29700',   '29705',   '29710',   '29715',
'29720', '29730', '29740',   '29750',   '29799',   '30300',
'30901', '31720', '31725',   '31730',   '36000',   '36002',
'36140', '36400', '36405',   '36406',   '36430',   '36468',
'36469', '36470', '36471',   '36540',   '36550',   '36600',
'36620', '36680', '51772',   '51784',   '51785',   '51792',
'51795', '51797', '53660',   '53601',   '53661',   '54150',
'54235', '54240', '54250',   '55870',   '57160',   '57170',
'58301', '58321', '58323',   '59020',   '59025',   '59425',
'59426', '59430', '62367',   '62368',   '65205',   '69000',
'69200', '69210', '91123',   '95970',   '95971',   '95972',
'95973', '95974', '95975',   '95990',   '99183',   'G0168',
set the '7252' error code.

Non Excluded Surgery Codes (Except the following codes)
Effective 01/01/2007
'G0127', 'G0268', 'G0293', and/or 'G0294' set the '7252'
error code.

Effective 01/01/2006
'20979', 'G0345', '37195', '92977', set the '7252'
error code.

Non Excluded Surgery Codes (Except the following code):
Terminated 12/31/2006
'38220' and '38221', bypass this edit.

Terminated 12/31/2005
'64550', bypass this edit.

Non Excluded Surgery Codes (Except the following codes):
Effective 01/01/2005
(As of 01/01/2005 is now a non-excluded HCPCS codes)
'11100', '11101', '11201', '11420', '11440', '20550',
'29530', '32019', '32020', '51701', '51702', '51703', or
'51798', set the '7252' error code.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 304
______________________________________________________________________________

 Outpatient Surgery Excluded Codes Termination Date
 12/31/2004
 '36589', '44500' (After 12/31/2004 these codes
 are excluded Surgery Codes, bypass this edit).

 Outpatient Surgery Excluded Codes Termination Date
 12/31/2003 '36489', '36491' (After 12/31/
 are excluded Surgery Codes, bypass this edit).

 Outpatient Surgery Excluded Codes Termination Date
 12/31/2002
 '53670', '53675' (After 12/31/2002 these codes
 are excluded Surgery Codes, bypass this edit).

 Incoming Outpatient claim (bill type 12x, 13x, 14x, 22x,
 23x, 34x, 74x, 75x, 83x, or 85x) is submitted with one of
 the following EPO Revenue Code(s):
 '634' or '635', bypass this edit.

 Incoming Outpatient claim (bill type 22x) is submitted with
 Revenue Code '403' with one of the following HCPCS code(s)
 listed below and the Provider Number is the same as the SNF
 Inpatient Part A (21x) claim in history.
 'G0202', 'G0203', '76090', '76091', or '76092', bypass this
 edit.

 Mammography Effective Date 01/01/2007
 '77052' and '77057', bypass this edit.

 Mammography Effective Date 01/01/2004
 '76083', bypass this edit.

 Mammography Termination Date 12/31/2006
 '76083', '76090', '76091', and '76092', set the '7252' error
 code.

 Mammography Termination Date 12/31/2001
 'G0203', set the '7252' error code.

 Incoming Outpatient claim (bill type 22x) is submitted with
 Revenue Code '636' with one of the following HCPCS code(s)
 listed below and the Provider Number is the same as the SNF
 Inpatient Part A (21x) claim in history.

 Vaccines (Pneumococcal, Flu or Hepatitis B)
 '90657', '90658', '90660', '90732', '90740', '90743', '90744',
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 305
______________________________________________________________________________

 '90746', '90747', bypass this edit.

 Vaccines Effective 01/01/2005
 '90656', bypass this edit.

 Vaccines Termination 12/31/2003
 '90659' (After 12/31/2003 this code should set the '7252'
 error code).

 Incoming Outpatient claim (bill type 22x) is submitted with
 Revenue Code '771' with one of the following HCPCS code(s)
 listed below and the Provider Number is the same as the SNF
 Inpatient Part A (21x) claim in history.

 Vaccine Administration
 'G0008', 'G0009', 'G0010', bypass this edit.

 Vaccine Administration Effective 01/01/2005
 '90465', '90466', '90467', '90468', bypass this edit.

 Incoming Outpatient claim (bill type 22x) is submitted with
 Diagnosis Code 'V762', 'V7647', 'V7649' or 'V1589' with one
 of the following HCPCS code(s) listed below and the
 Provider Number is the same as the SNF Inpatient
 Part A (21x) claim in history
 'G0101', 'G0123', 'G0143', 'G0144', 'G0145', 'G0147',
 'G0148', 'P3000', or 'Q0091' bypass this edit.

 Incoming Outpatient claim (bill type 22x, 23x) is submitted
 with Diagnosis Code 'V1005', 'V1006', '5550', '5551', '5552',
 '5559', '5560', '5561', '5562', '5563', '5568', '5569',
 '5582', or '5589', with one of the following HCPCS code(s)
 listed below and the Provider Number is the same as the SNF
 Inpatient Part A (21x) claim in history.
 'G0104', 'G0106', 'G0107', 'G0120', 'G0122', or '82270',
 bypass this edit.

 Colorectal Screening Effective 01/01/2007
 '82270'

 Colorectal Screening Effective 01/01/2004
 'G0328', bypass this edit.

 Colorectal Screening Termination Date 12/31/2006
 'G0107', set the '7252' error code.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 306
______________________________________________________________________________

 Abdominal Aortic Aneurysms (AAA) Screening Effective 01/01/2007
 'G0389', bypass this edit.

 Incoming Outpatient claim (bill type 22x) is submitted with
 Revenue Code '770' with HCPCS code and the Provider Number
 is the same as the SNF Inpatient Part A (21x) claim in
 history.
 'G0102', bypass this edit.

 Incoming Outpatient claim (bill type 22x) is submitted with
 Revenue Code '30x' with HCPCS code and the Provider Number
 is the same as the SNF Inpatient Part A (21x) claim in
 history.
 'G0103', bypass this edit.

 Incoming Outpatient claim (bill type 22x) is submitted with
 one of the following HCPCS code(s) listed below and the
 Provider Number is the same as the SNF Inpatient Part A
 (21x) claim in history.
 'G0117' or 'G0118', bypass this edit.

 Incoming Outpatient claim (bill type 22x) is submitted with
 Diagnosis Code 'V771' with one of the following HCPCS
 code(s) listed below and the Provider Number is the same as
 the SNF Inpatient claim in history
 Diabetic Screening (Effective Date: 01/01/2005)
 '82947', '82951', bypass this edit.

 Diabetic Screening Effective Date 04/01/2005
 '82950', bypass this edit.

 Incoming Outpatient claim (bill type 22x) is submitted with
 Diagnosis Code '810', '811' or '812' with one of the
 following HCPCS code(s) listed below and the Provider
 Number is the same as the SNF Inpatient Part A (21x) claim
 in history.

 Cardiovascular Screening (Effective Date: 01/01/2005)
 '80061', '82465', '83718', '84478', bypass this edit.

 Incoming Outpatient claim (bill type 22x) is submitted with
 one of the following HCPCS code(s) listed below and the
 Provider Numbers is the same as the SNF Inpatient claim in
 history.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 307
______________________________________________________________________________

 Preventive Benefit: Effective 01/01/2005
 'G0367', bypass this edit.

 Preventive Benefit: Effective 04/01/2005
 'G0344', bypass this edit.

 Incoming Outpatient claim (bill type 12x, 13x, 14x, 22x,
 23x, 34x, 74x, 75x, 83x, or 85x) is submitted and the
 detail line item Date of Service is greater than the
 Occurrence Code (A3, B3, or C3) of the SNF Inpatient Part A
 (21x) claim in history, bypass this edit.

 Incoming Outpatient claim (bill type 12x, 13x, 14x, 22x,
 23x, 34x, 74x, 75x, 83x, or 85x) is submitted and the
 detail line item Date of Service is within the Occurrence
 Span Code '74', '76', '77', '79' and/or 'M1' Date of the
 SNF Inpatient Part A (21x) claim in history.

 Incoming Outpatient claim (bill type 12x, 13x, 14x, 22x,
 23x, 34x, 74x, 83x, or 85x) is submitted with Revenue
 Code '54x' with one of the following HPCCS code(s) listed
 below and the Modifier is not equal to 'NN':
 'A0425', A0426', 'A0427', 'A0428', 'A0429', 'A0430',
 'A0431', A0432', 'A0433', 'A0434', 'A0435', 'A0436',
 or 'A0999', bypass this edit.

 Effective Date 01/01/2003
 'Q3019', 'Q3020', bypass this edit.

 Termination 03/31/2002
 'A3080', 'A0390', set the '7252' error code.

 Terminated 12/31/2005
 'Q3019', 'Q3020', set the '7252' error code.

 Incoming Outpatient claim (bill type 13x or 85x) is
 submitted with Revenue Code '0510', and HCPCS range
 '99201-99245', with Date of Service on or after
 01/01/2006, bypass this edit.

 Incoming Outpatient claim (bill type '13x' or '85x')
 is submitted with '45x' Revenue Code and other 'ER'
 related services with 'ET' Modifier. If the detail
 line item has a '45x' Revenue Code and has a date of
 service greater than or equal to 10/01/2005 and does
 not match the history detail line item date of
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 308
______________________________________________________________________________

 service for other 'ER' services with 'ET' Modifier,
 bypass this edit.

 When the detail Edit Override Table has '7252' present,
 bypass this edit.

 History SNF Inpatient Part A (21x) claim Cancel Date is
 greater than zero, bypass this edit.

 History SNF Inpatient Part A (21x) claim has a No-Pay Code
 equal to 'B', 'C', 'N', or 'R', bypass this edit.

 Trailer Information: 08, 13, 31

   INSTALLATION INSTRUCTIONS:   None

   SYSTEMS DOCUMENTATION AFFECTED:

    EDITABX               MODIFY EDIT '7252' TO ADD HCPCS CODE
                          'J9303' TO THE CHEMOTHERAPY TABLE WITH
                          DATES OF SERVICE 01/01/2008.

   SATELLITE SYSTEM MODIFICATIONS:     None




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 309
______________________________________________________________________________

  28. 00025937   6060 - NEW WAIVED TESTS

  REQUESTOR ID: CWFM1000

  IMPACT:
(X) Host
( ) Satellite Part A Inpatient
( ) Satellite Part A Outpatient
(X) Satellite Part B
( ) Hospice
( ) Home Health
( ) DMERC

  REASON FOR CHANGE:
The Clinical Laboratory Improvement Amendments of 1988 (CLIA)
regulations require a facility to be appropriately certified
for each test performed. To ensure that Medicare and Medicaid
only pay for laboratory tests categorized as waived complexity
under CLIA in facilities with a CLIA certificate of waiver,
laboratory claims are currently edited at the CLIA certificate
level.

CWF shall add a Termination Date of 03/13/2007 to the existing
iteration for HCPCS '84550', then create a new iteration with an
Effective Date of 03/14/2007 with CWF Categories '12', '57', '72',
and '69'.

CWF shall add a Termination Date of 09/20/2007 to the existing
iteration for HCPCS codes '82330', '82374', '82435', '84132', and
'84295', then create a new iteration with an Effective Date of
09/21/2007 and CWF Categories '12', '57', '72', and '69'.

HCPCS codes '80048' and '80053' shall have the Termination Date
on the second iteration changed to 10/29/2007. The Effective
Date on the first iteration shall be changed to 10/30/2007.
All CWF Categories remain the same.

  NEW BUSINESS REQUIREMENTS:

 Requirement 1
 CWF must terminate the iteration for HCPCS '84550', effective
 03/13/2007. A new iteration must be created with an Effective
 Date of 03/14/2007. Existing CWF Categories '12', '57', and
 '72' shall be carried over. Category '69' (CLIA waived tests)
 shall be added. Existing TOS and Lab Cert values must be
 carried over to new iteration.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 310
______________________________________________________________________________


 Requirement 2
 CWF must terminate the iteration for HCPCS '82330' effective
 09/20/2007. A new iteration must be created with an Effective
 Date of 09/21/2007. Existing CWF Categories '12', '57', and
 '72' shall be carried over. Category '69' (CLIA waived tests)
 shall be added. Existing TOS and Lab Cert values must be
 carried over to new iteration.

 Requirement 3
 CWF must terminate the iteration for HCPCS '82374' effective
 09/20/2007. A new iteration must be created with an Effective
 Date of 09/21/2007. Existing CWF Categories '12', '57', and
 '72' shall be carried over. Category '69' (CLIA waived tests)
 shall be added. Existing TOS and Lab Cert values must be
 carried over to new iteration.

 Requirement 4
 CWF must terminate the iteration for HCPCS '82435' effective
 09/20/2007. A new iteration must be created with an Effective
 Date of 09/21/2007. Existing CWF Categories '12', '57', and
 '72' shall be carried over. Category '69' (CLIA waived tests)
 shall be added. Existing TOS and Lab Cert values must be
 carried over to new iteration.

 Requirement 5
 CWF must terminate the iteration for HCPCS '84132' effective
 09/20/2007. A new iteration must be created with an Effective
 Date of 09/21/2007. Existing CWF Categories '12', '57', and
 '72' shall be carried over. Category '69' (CLIA waived tests)
 shall be added. Existing TOS and Lab Cert values must be
 carried over to new iteration.

 Requirement 6
 CWF must terminate the iteration for HCPCS '84295' effective
 09/20/2007. A new iteration must be created with an Effective
 Date of 09/21/2007. Existing CWF Categories '12', '57', and
 '72' shall be carried over. Category '69' (CLIA waived tests)
 shall be added. Existing TOS and Lab Cert values must be
 carried over to new iteration.

 Requirement 7
 CWF must change the Termination Date on the second iteration
 for HCPCS '80048' to 10/29/2007. The Effective Date on the
 first iteration must be changed to 10/30/2007. Existing CWF
 Category '012' should remain. Category '69' (CLIA waived
______________________________________________________________________________
2020 Company, LLC                                           Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 311
______________________________________________________________________________

tests) shall be added. Existing TOS and Lab Cert values must
be carried over to new iteration.

Requirement 8
CWF must change the Termination Date on the second iteration
for HCPCS '80053' to 10/29/2007. The Effective Date on the
first iteration must be changed to 10/30/2007. Existing CWF
Categories '012' and '057' should remain. Category '69' (CLIA
waived tests) shall be added. Existing TOS and Lab Cert values
must be carried over to new iteration.

  EVENT-RESPONSE LIST:

Event 1.1
Access the HCPI file in HIMR for HCPCS '84550'.

Response
The existing iteration has been terminated effective 03/13/2007.
A new iteration has been created with an Effective Date of
03/14/2007 and CWF Categories '12', '57', '72', and '69' are shown.

Event 2.1
Access the HCPI file in HIMR for HCPCS '82330'.

Response
The existing iteration has been terminated effective 09/20/2007.
A new iteration has been created with an Effective Date of
09/21/2007 and CWF Categories '12', '57', '72', and '69' are shown.

Event 3.1
Access the HCPI file in HIMR for HCPCS '82374'.

Response
The existing iteration has been terminated effective 09/20/2007.
A new iteration has been created with an Effective Date of
09/21/2007 and CWF Categories '12', '57', '72', and '69' are shown.

Event 4.1
Access the HCPI file in HIMR for HCPCS '82435'.

Response
The existing iteration has been terminated effective 09/20/2007.
A new iteration has been created with an Effective Date of
09/21/2007 and CWF Categories '12', '57', '72', and '69' are shown.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 312
______________________________________________________________________________

 Event 5.1
 Access the HCPI file in HIMR for HCPCS '84132'.

 Response
 The existing iteration has been terminated effective 09/20/2007.
 A new iteration has been created with an Effective Date of
 09/21/2007 and CWF Categories '12', '57', '72', and '69' are shown.

 Event 6.1
 Access the HCPI file in HIMR for HCPCS '84295'.

 Response
 The existing iteration has been terminated effective 09/20/2007.
 A new iteration has been created with an Effective Date of
 09/21/2007 and CWF Categories '12', '57', '72', and '69' are shown.

 Event 7.1
 Access the HCPI file in HIMR for HCPCS '80048'.

 Response
 The first iteration shows an Effective Date of 10/30/2007. The
 second iteration shows a Termination Date of 10/29/2007. All
 Categories have remained the same.

 Event 8.1
 Access the HCPI file in HIMR for HCPCS '80053'.

 Response
 The first iteration shows an Effective Date of 10/30/2007. The
 second iteration shows a Termination Date of 10/29/2007. All
 Categories have remained the same.

 The Entity List includes only NEW acronyms and terminology
 that is currently not in use in CWF.

 Entity List: N/A

 Areas Affected by the Problem.
   1. HCPCS table

 Solution Criteria: N/A

   EDITS AFFECTED:   None



______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 313
______________________________________________________________________________

   INSTALLATION INSTRUCTIONS:

 **Refer to CR 00025816 for the Installation Instructions for this CR.**

   SYSTEMS DOCUMENTATION AFFECTED:   None

   SATELLITE SYSTEM MODIFICATIONS:   None




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 314
______________________________________________________________________________

  29. 00025950    6087 - JULY 2008 MPFSDB UPDATES

  REQUESTOR ID: CWFM1000

  IMPACT:
(X) Host
( ) Satellite Part A Inpatient
( ) Satellite Part A Outpatient
(X) Satellite Part B
( ) Hospice
( ) Home Health
( ) DMERC

  REASON FOR CHANGE:
Payment files were issued to contractors based upon the 2008
Medicare Physician Fee Schedule (MPPS) Final Rule. This change
request (CR) amends those payment files and includes new codes
for the Physician Quality Reporting Initiative.
Contractors shall manually add the following HCPCS codes to
the procedure code file effective for Dates of Service on
or after 03/13/2008:

G0398- Home sleep test/type 2 Porta
G0399- Home sleep test/type 3 Porta
G0400- Home sleep test/type 4 Porta

CWF will add the following HCPCS codes effective for Dates
of Service on or after 07/01/2008:

G8485-   Report, Diabetes Measures
G8486-   Report, Prev Care Measures
G8487-   Report, Prev CKD Measures
G8488-   Report, Prev ESRD Measures
3351F-   Neg scrn dep symp by deptool
3352F-   No sig dep symp by dep tool
3353F-   Mid mod dep symp by deptool
3354F-   Clin sig dep symp by dep tool
0188T-   Videoconf crit care 74 min
0189T-   Videoconf crit care addl 30
0190T-   Place intraoc radiation src
0191T-   Insert ant segment drain int
0192T-   Insert ant segment drain ext

CWF shall remove the FUD (Follow-up Days) of 090 and CWF category
'13' from HCPCS code '21089'.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 315
______________________________________________________________________________

 CWF must add Type of Service '8' to HCPCS codes '61630'
 and '61635'.

 CMS will send CWF two files to facilitate duplicate billing
 edits: 1) Purchased Diagnostic and 2) Duplicate Radiology
 Editing. CWF shall install these files into their systems.
 CWF will be notified via email when these files have been sent.

   NEW BUSINESS REQUIREMENTS:

 Requirement 1
 CWF will update the internal copybook (CABCDIAG) that will
 store the CPT/HCPCS codes that are applicable to the
 duplicate editing.

 The initial values have been provided by CMS and are
 updated as a replacement file quarterly by CMS.

 The following is an example of the layout of the copybook
 and the HCPCS/CPT values may vary.

    01     LAB-HCPC-CPT-TABLE.
           05 LAB-HCPC-CPT-VALUES.
               10 FILLER    PIC X (05)   VALUE 'G0030'.
               10 FILLER    PIC X (05)   VALUE 'G0031'.
               10 FILLER    PIC X (05)   VALUE 'G0032'.
               10 FILLER    PIC X (05)   VALUE '99185'.
               10 FILLER    PIC X (05)   VALUE '99186'.
               10 FILLER    PIC X (05)   VALUE '99195'.
           05 LAB-HCPC-CPT-LOOKUP    REDEFINES
               LAB-HCPC-CPT-VALUES OCCURS 000001179 TIMES
               ASCENDING KEY IS LAB-HCPC-CPT-LOOKUP
               INDEXED BY CPT-INDEX.
               10 LAB-HCPC-CPT-CODE

 Requirement 2
 CWF will update the internal copybook (CABCRADO) that will
 store the Radiology HCPCS codes that are applicable to the
 duplicate editing.

 The initial values have been provided by CMS and are
 updated as a replacement file quarterly by CMS.

 The following is an example of the layout of the copybook
 and the HCPCS values may vary.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 316
______________________________________________________________________________

    01   RADO-HCPC-CPT-TABLE.
         05 RADO-HCPC-CPT-VALUES.
             10 FILLER PIC X(05) VALUE 'G0106'.
             10 FILLER PIC X(05) VALUE 'G0120'.
             10 FILLER PIC X(05) VALUE 'G0130'.
             10 FILLER PIC X(05) VALUE '93980'.
             10 FILLER PIC X(05) VALUE '93981'.
         05 RADO-HCPC-CPT-LOOKUP REDEFINES
             RADO-HCPC-CPT-VALUES OCCURS 000000673 TIMES
             ASCENDING KEY IS RADO-HCPC-CPT-LOOKUP
             INDEXED BY RADO-INDEX.
             10 RADO-HCPC-CPT-CODE    PIC X(05).

 Requirement 3
 CWF shall remove the FUD (Follow-up Days) '090' and CWF Category
 '13' from HCPCS code '21089'.

 Requirement 4
 CWF shall add to the HCPI file in HIMR the following
 HCPCS codes effective 03/13/2008 with Type of Service '9':

 'G0398' - Home sleep test/type 2 Porta

 'G0399' - Home sleep test/type 3 Porta

 'G0400' - Home sleep test/type 4 Porta

 Requirement 5
 CWF shall add to the HCPI file in HIMR the following
 HCPCS codes effective 07/01/2008 with Type of Service '1':

 'G8485' - Report, Diabetes Measures

 'G8486' - Report, Prev Care Measures

 'G8487' - Report, CKD Measures

 'G8488' - Report, ESRD Measures

 '3351F' - Neg scrn dep symp by deptool

 '3352F' - No sig dep symp by dep tool

 '3353F' - Mild-mod dep symp by deptool

 '3354F' - Clin sig dep sym by dep tool
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 317
______________________________________________________________________________


 '0188T' - Videoconf crit care 74 min

 '0189T' - Videoconf crit care addl 30

 Requirement 6
 CWF shall add to the HCPI file in HIMR the following
 HCPCS codes with effective date 07/01/2008 and Type of
 Service '2':

 '0190T' - Place intraoc radiation src

 '0191T' - Insert ant segment drain int

 '0192T' - Insert ant segment drain ext

 Requirement 7
 CWF must add Type of Service '8' to HCPCS codes '61630'
 and '61635'.

   EVENT-RESPONSE LIST:

 Event 1.1
 Submit an HUBC claim that contains one of the new HCPCS codes
 on the LAB Diagnostic File. Posted to history is an HUBC
 record with the same HCPCS code, same Date of Service and a
 different Carrier Number.

 Response
 The claim is rejected, error code '7282' is set.

 Event 2.1
 Submit an HUBC claim that contains one of the new HCPCS
 codes on the Radiology Diagnostic File. The Date of Service
 on the incoming claim is equal to, or within the Admission
 or Discharge Date of a covered '11x' HUIP record posted to
 history.

 Response
 The claim is rejected, error code '729D' is set.

 Event 2.2
 Submit an HUBC claim that contains one of the new HCPCS
 codes on the Radiology Diagnostic File. The Date of Service
 on the incoming claim is equal to, or within the Admission
 or Discharge Date of a covered LTCH, IPF, or IRF stay
______________________________________________________________________________
2020 Company, LLC                                           Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 318
______________________________________________________________________________

 posted to history. The Dates of Service on the Part B record
 are outside the Occurrence Span Code '74' From and Thru
 Date plus one day.

 Response
 The claim is rejected, error code '729J' is set.

 Event 3.1
 Access the HCPI file in HIMR for HCPCS code '21089'.

 Response
 The FUD (Follow-up Days) '090' and CWF Category '13'
 have been removed.

 Event 4.1
 Access HCPCS codes 'G0398', 'G0399', and 'G0400' on the
 HCPI file in HIMR.

 Response
 The HCPCS codes have been added with the correct descriptors,
 effective 03/13/2008 with Type of Service '9'.

 Event 5.1
 Access the HCPI file in HIMR for HCPCS codes 'G8485', 'G8486',
 'G8487', 'G8488', '3351F', '3352F', '3353F', '3354F', '0188T',
 and '0189T'.

 Response
 The HCPCS codes have been added with the correct descriptors,
 effective 07/01/2008 with Type of Service '1'.

 Event 6.1
 Access the HCPI file in HIMR for HCPCS codes '0190T', '0191T',
 and '0192T'.

 Response
 The HCPCS codes have been added with the correct descriptors,
 effective 07/01/2008 with Type of Service '2'.

 Event 7.1
 Access the HCPI file in HIMR for HCPCS codes '61030' and
 '61635'.

 Response
 The HCPCS codes are shown and Type of Service '8' has been
 added.
______________________________________________________________________________
2020 Company, LLC                                           Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 319
______________________________________________________________________________


The Entity List includes only NEW acronyms and terminology
that is currently not in use in CWF.

Entity List: N/A

Areas Affected by the Problem.
  1. HCPCS Table
  2. CABCDIAG
  3. CABCRADO

Solution Criteria: N/A

  EDITS AFFECTED:   None

  INSTALLATION INSTRUCTIONS:

**Refer to CR 00025816 for the Installation Instructions for this CR.**

  SYSTEMS DOCUMENTATION AFFECTED:   None

  SATELLITE SYSTEM MODIFICATIONS:   None




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 320
______________________________________________________________________________

   30. 00025960   6095 - JULY 2008 UPDATE TO THE ASC PAYMENT SYSTEM SUMMARY

   REQUESTOR ID: CWFM1000

   IMPACT:
 (X) Host
 ( ) Satellite Part A Inpatient
 ( ) Satellite Part A Outpatient
 (X) Satellite Part B
 ( ) Hospice
 ( ) Home Health
 ( ) DMERC

   REASON FOR CHANGE:
 This Recurring Update Notification describes changes to, and
 billing instructions for payment policies implemented in the
 July 2008 ASC update. This update provides payment rates for
 selected separately payable drugs and biologicals, descriptors
 for newly created Level II HCPCS codes for drugs and
 biologicals, and payment rates and descriptors for three
 newly created Category III CPT codes that are added to the
 list of payable procedures. There are no code deletions in
 this notification.

 CWF shall add or update the following HCPCS codes to HIMR effective
 07/01/2008 with Type of Service F:

 C1716-   Brachytx, non-str, Gold-198
 C1719-   Brachytx, NS, Non-HDRIr-192
 C2616-   Brachytx, non-str, Yttrium-90
 C9242-   Injection, fosaprepitant, 1 mg.
 C9356-   TenoGlide Tendon Prot, cm2
 C9357-   Flowable Wound Matrix, 1cc
 C9358-   SurgiMend, 0.5cm2
 0190T-   Place intraoc radiation src
 0191T-   Insert ant segment drain int
 0192T-   Insert ant segment drain ext

   NEW BUSINESS REQUIREMENTS:

 Requirement 1
 CWF shall add a new iteration for HCPCS 'C1716' in HIMR
 with the following description, Type of Service 'F', effective
 07/01/2008:

 C1716- Brachytx, non-str, Gold-198
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 321
______________________________________________________________________________


 Requirement 2
 CWF shall add a new iteration for HCPCS 'C1719' in HIMR
 with the following description, Type of Service 'F', effective
 07/01/2008:

 C1719-   Brachytx, NS, Non-HDRIr-192

 Requirement 3
 CWF shall add a new iteration for HCPCS 'C2616' in HIMR
 with the following description, Type of Service 'F', effective
 07/01/2008:

 C2616-   Brachytx, non-str, Yttrium-90

 Requirement 4
 CWF shall add new HCPCS 'C9242' to the HCPI file in HIMR
 with the following description, Type of Service 'F', effective
 07/01/2008:

 C9242-   Injection, fosaprepitant, 1 mg.

 Requirement 5
 CWF shall add new HCPCS 'C9356' to the HCPI file in HIMR
 with the following description, Type of Service 'F', effective
 07/01/2008:

 C9356-   TenoGlide Tendon Prot, cm2

 Requirement 6
 CWF shall add new HCPCS 'C9357' to the HCPI file in HIMR
 with the following description, Type of Service 'F', effective
 07/01/2008:

 C9357-   Flowable Wound Matrix, 1cc

 Requirement 7
 CWF shall add new HCPCS 'C9358' to the HCPI file in HIMR
 with the following description, Type of Service 'F', effective
 07/01/2008:

 C9358-   SurgiMend, 0.5cm2

 Requirement 8
 CWF shall update HCPCS '0190T' in the HCPI file in HIMR
 and add Type of Service 'F'.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 322
______________________________________________________________________________


 Requirement 9
 CWF shall update HCPCS '0191T' in the HCPI file in HIMR
 and add Type of Service 'F'.

 Requirement 10
 CWF shall update HCPCS '0192T' in the HCPI file in HIMR
 and add Type of Service 'F'.

   EVENT-RESPONSE LIST:

 Event 1.1
 Access the HCPI file in HIMR for HCPCS 'C1716'.

 Response
 The HCPCS 'C1716' is shown with the correct descriptor, Type
 of Service 'F', effective 07/01/2008.

 Event 2.1
 Access the HCPI file in HIMR for HCPCS 'C1719'.

 Response
 The HCPCS 'C1719' is shown with the correct descriptor, Type
 of Service 'F', effective 07/01/2008.

 Event 3.1
 Access the HCPI file in HIMR for HCPCS 'C2616'.

 Response
 The HCPCS 'C2616' is shown with the correct descriptor, Type
 of Service 'F', effective 07/01/2008.

 Event 4.1
 Access the HCPI file in HIMR for HCPCS 'C9242'.

 Response
 The HCPCS 'C9242' is shown with the correct descriptor, Type
 of Service 'F', effective 07/01/2008.

 Event 5.1
 Access the HCPI file in HIMR for HCPCS 'C9356'.

 Response
 The HCPCS 'C9356' is shown with the correct descriptor, Type
 of Service 'F', effective 07/01/2008.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 323
______________________________________________________________________________

Event 6.1
Access the HCPI file in HIMR for HCPCS 'C9357'.

Response
The HCPCS 'C9357' is shown with the correct descriptor, Type
of Service 'F', effective 07/01/2008.

Event 7.1
Access the HCPI file in HIMR for HCPCS 'C9358'.

Response
The HCPCS 'C9358' is shown with the correct descriptor, Type
of Service 'F', effective 07/01/2008.

Event 8.1
Access the HCPI file in HIMR for HCPCS '0190T'.

Response
The HCPCS '0190T' is shown with the correct descriptor, Type
of Service 'F', effective 07/01/2008.

Event 9.1
Access the HCPI file in HIMR for HCPCS '0191T'.

Response
The HCPCS '0191T' is shown with the correct descriptor, Type
of Service 'F', effective 07/01/2008.

Event 10.1
Access the HCPI file in HIMR for HCPCS '0192T'.

Response
The HCPCS '0192T' is shown with the correct descriptor, Type
of Service 'F', effective 07/01/2008.

The Entity List includes only NEW acronyms and terminology
that is currently not in use in CWF.

Entity List: N/A

Areas Affected by the Problem.
  1. HCPCS Table

Solution Criteria: N/A


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 324
______________________________________________________________________________

  EDITS AFFECTED:   None

  INSTALLATION INSTRUCTIONS:

**Refer to CR 00025816 for the Installation Instructions for this CR.**

  SYSTEMS DOCUMENTATION AFFECTED:   None

  SATELLITE SYSTEM MODIFICATIONS:   None




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 325
______________________________________________________________________________

C.        ANALYSIS CHANGE REQUESTS

     1.     00025650   6001/5767 MEDICARE ACUTE CARE EPISODE (ACE) DEMONSTRATION

     REQUESTOR ID: CWFM2000

   IMPACT:
 (X) Host
 (X) Satellite Part A Inpatient
 ( ) Satellite Part A Outpatient
 (X) Satellite Part B
 ( ) Hospice
 ( ) Home Health
 ( ) DMERC

 *** Note: This is an ANALYSIS Only effort for the July Release
           any the software updates will be done in the October
           Release. ***

   REASON FOR CHANGE:
 As a value based purchaser of care, the Centers for Medicare and
 Medicaid Services (CMS) seeks to devise and test new methods of
 paying Providers that will encourage improvements in both the
 efficiency and quality of care provided to Medicare Beneficiaries.
 The Acute Care Episode (ACE) Demonstration is specifically
 designed to align incentives and provide flexibility to hospitals
 and physicians by bundling all related services into an "episode
 of care" and paying a single, global payment that can be used as
 the Providers of care deem most appropriate. Approximately 15
 demonstration sites will be selected to participate in this
 demonstration which is currently projected to start on 10/01/2008.
 Sites will be selected from among states/areas that are covered by MAC
 Jurisdiction #12 and pay claims under the DRG Inpatient Prospective
 Payment System (Delaware, New Jersey, Pennsylvania and
 Washington, D.C.). Individual demonstration projects sites will
 continue for three years from their first date of operation, although
 CMS will have the option to extend them and/or add additional
 demonstration sites.

 The goal of the demonstration is to align hospitals' and physicians'
 incentives to work together to provide coordinated, cost effective
 care, thus achieving savings to the Medicare program and giving
 hospitals and physicians the flexibility to allocate resources as
 they determine is the most appropriate. All proposals will be
 thoroughly reviewed by a technical expert panel to insure the
 organizational capacity to carry out the demonstration.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 326
______________________________________________________________________________

 Participating entities will be required to submit quality data
 relevant to the services being provided under the demonstration.

 Entities may submit proposals for a global payment under the
 demonstration for one or more of the categories listed in
 Attachment II. However, if a demonstration site is selected for
 a particular category of DRGs, all admissions for eligible
 Beneficiaries to the facility for DRGs in that category shall be
 processed under the demonstration payment rules. CMS staff shall
 provide contractors with a list of all demonstration Providers and
 their associated identification numbers (e.g. NPI, Medicare legacy
 Provider identification number, etc) as well as DRGs covered
 under the demonstration for each facility.

 Under this demonstration, it is   intended that the cost reports and
 settlement for disproportionate   share and indirect medical
 education be processed based on   what the A/B MAC would have
 paid for Part A services in the   absence of the demonstration.

 NOTE: Per CMS, CWF is not required to remove existing logic for
       the edits that apply to Demo '07' (Participating Center
       of Excellence) or Demo '08' (Partnership Demonstration).
       However, CWF will be revising the existing CEPP Auxiliary
       File to comply with the new Demo '54' (ACE DEMO) since
       these DEMOS were never implemented. CWF implemented the
       following CRs 00016868, 00020473, and 00020474 for CABG,
       Participating Centers of Excellence and Provider
       Partnership.

 For admissions occurring on or after 10/01/2008, CWF will need
 to do the following to include logic for Demo Number '54'
 for Part A and B and include POS '81' for Part B.

 Modify the following Part A edits:

 Consistency Edit 041A: TOB is '11A' or '11D' and Demonstration
                        Number '07' or '08' is not present.

 Consistency Edit 0013: CABG Demo Number '06' is present but the
                        Admission Date is before 05/01/1997, or
                        Participating Center of Excellence Demo
                        Number '07' is present but the Admission
                        Date is before 10/01/1997.

                        Demo Number '07' or '08' is present and
                        TOB '11A' or '11D' and the Admission Date
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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 327
______________________________________________________________________________

                        is before 01/01/2002.

                        Demo Number '08' is present and other than
                        TOB '11A' or '11D' and Admission Date
                        is before 01/01/2002.

 Consistency Edit 0014: Demo Number other than '03', '05', '06', '07',
                        '08', '15', '30', '31', '37', '38', '39',
                        '40', '44', '46', '48', '49', '51' or '53'
                        are invalid.

 Consistency Edit 0019: Demo Number '07' (Participating Centers of
                        Excellence) or '08' (Provider Partnership)
                        is present with Condition Code 'B1'.

 Consistency Edit 46#7: Value Code '17' - Outlier amount is greater
                        than the reimbursement amount, or the 'Y4'
                        amount with Demo Number '06', '07', or '08';
                        plus the total deductible and primary
                        payer amount.

 Consistency Edit 46#S: Claim contains a CABG '06' or
                        Participating Center of Excellence
                        '07' or Provider Partnership Demonstration
                        Number '08' but Value Code 'Y1', 'Y2', 'Y3',
                        and 'Y4' are not present or the codes are
                        are present without an amount.

 Consistency Edit 46#T: MSP Value Codes are present on a
                        CABG, or Participating Center of
                        Excellence, or Provider Partnership
                        Demonstration claim.

 Consistency Edit 0703: When the Demo Number on the bill is equal
                        to '06' CABG and the Intermediary Number
                        is not equal to '00123', '00130', '00181',
                        '00332', '00400', '00452', or '31143',
                        set the '0703' error code.

                        When the Demo Number on the bill is equal
                        to '07' PCOE and the Intermediary Number
                        is not equal to '00123', '00130', '00181',
                        '00332', '00400', or '31143', set the
                        '0703' error code.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 328
______________________________________________________________________________

 Consistency Edit 9410: Either claim contains a CABG Demo Number and
                        the DRG is not '106', '107' or claim
                        contains a Participating Center of
                        Excellence Demonstration Number and DRG is not
                        one of the following: '104', '105', '106',
                        '107', '109', '112', '124', '125', '209', or
                        '471'.

 Consistency Edit 0413: Claim contains a CABG or Participating
                        Center of Excellence or Provider
                        Partnership Demonstration Number which is
                        only valid for Type of Bill '11x'.

 Utilization Edit 5200: No Entitlement - There is no record of the
                        Beneficiary's Entitlement to the Type of
                        Services shown on the claim.

 Utilization Edit 5243: UMWA Beneficiary contains a Participating
                        Center of Excellence, CABG Demo Number, or
                        Provider Partnership Demonstration Number.

 Utilization Edit 5244: Claim contains a CABG or Participating
                        Center of Excellence Demonstration Number
                        but the Beneficiary does not have both
                        Part A and Part B entitlement.

 Utilization Edit 5245: RRB Beneficiary contains a CABG or
                        Participating Center of Excellence or
                        Provider Partnership Demonstration Number.

 Utilization Edit 5246: GHO/Medicare CHOICES Beneficiary contains
                        a CABG or Participating Center of Excellence
                        or Provider Partnership Demo Number.

 Utilization Edit 524A: A Beneficiary does not have at least one
                        lifetime reserve day remaining on a
                        Participating Centers of Excellence '07'
                        or Provider Demonstration Number '08'.

 Utilization Edit 524B: A Beneficiary has a MSP record on a
                        Participating Centers of Excellence '07'
                        or Provider Partnership Demonstration
                        Number '08'.

 Utilization Edit 524C: Notice of Admission Type of Bill '11A' has
                        an Admit Date that equal an Admit Date on
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 329
______________________________________________________________________________

                        file for a Participating Centers of
                        Excellence '07' or Provider Partnership '08'
                        Demonstration Number.

 Utilization Edit 524D: Notice of Admission Type of Bill '11A' has
                        an Admit Date that overlaps the Admit Date
                        and Discharge Date for a Participating
                        of Excellence '07' or Provider Partnership
                        '08' Demonstration Number.

 Utilization Edit 524E: Cancellation Notice Type of Bill '11D' has
                        an Admit Date that does not match a posted
                        Admit Date or does not have a CEPP file,
                        or does match the Admit Date but the Discharge
                        Date is present for a Participating Centers
                        of Excellence '07' or Provider Partnership
                        '08' Demonstration Number.

 Utilization Edit 524F: Type of Bill '11x' other than '11A' or '11D'
                        with Demonstration Number '07' or '08' and
                        no Participating Centers of Excellence or
                        Provider Partnership Auxiliary File.

 Utilization Edit 524G: Condition Code 'B1' is present and the Admit
                        Date equals a Beneficiary's Participating
                        Centers of Excellence (07), Provider
                        Partnership (08) Admit Date on the Aux File.

 Utilization Edit 524I: Type of Bill '11x' other than '11A, '11D',
                        or '11Z' and no Demo Number '07' or '08' is
                        present and the Admit Date equals the
                        Participating Centers of Excellence or Provider
                        Partnership's Admit Date on the Auxiliary file.

 Utilization Edit 524N: The Provider Number on an Inpatient claim
                        with Demo '07' does not match the Provider
                        Number of the Notice of Admission (NOA).

 Modify the following Part B edits:

 Consistency Edit 0013: CABG Demo '06' is present, but the
                        Admission Date is before 05/01/1997.
                        Participating Center of Excellence
                        Number '07' is present but the Admission
                        Date is before 10/01/1997.
                        Demonstration Number '08' is present and
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 330
______________________________________________________________________________

                        before 01/01/2002.

Consistency Edit 0014: Demonstrative Numbers other than '01', '03',
                       '04', '05', '06', '07', '08', '15', '30',
                       '31', '37', '38', '39', '40', '44', '45',
                       '46', '48', '49', or '51' are invalid.

Consistency Edit 49x1: Claim contains a CABG Participating
                       Center of Excellence or Provider
                       Partnership Demonstration Number but Denial
                       Code 'D' is not present in Field '18'.

Consistency Edit 61x2: Denied claim but line item is not denied.

Consistency Edit 63x2: Deductible and/or coinsurance is present
                       on a CABG or Participating Center of
                       Excellence or Provider Partnership claim.

Consistency Edit 95x7: An MSP Code or Cost Avoid is present on a
                       CABG or Participating Center of Excellence
                       or Provider Partnership Demonstration claim.

Consistency Edit 92x7: Provider Reimbursement greater than '0' but
                       Pay Code indicates otherwise. CABG and
                       Participating Centers of Excellence claims
                       bypass this edit.

Consistency Edit 98x5: Allowed charge is greater than the
                       deductible amount and reimbursement
                       indicator is '0' or '1', then coinsurance
                       must be greater than zero.

Utilization Edit 5243: UMWA Beneficiary contains a Participating
                       Center of Excellence, CABG Demo Number, or
                       Provider Partnership Demonstration Number.

Utilization Edit 5244: Claim contains a CABG or Participating
                       Center of Excellence Demonstration Number
                       but the Beneficiary does not have both
                       Part A and Part B entitlement.

Utilization Edit 5245: RRB Beneficiary contains a CABG or
                       Participating Center of Excellence or
                       Provider Partnership Demonstration Number.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 331
______________________________________________________________________________

Utilization Edit 5246: GHO/Medicare CHOICES Beneficiary contains
                       a CABG or Participating Center of Excellence
                       or Provider Partnership Demo Number.

Utilization Edit 524J: A claim with POS '21', '22', or '23 with
                       no Site of Service ID# and either Service
                       From or Thru Date either matches the
                       Participating Centers of Excellence or Provider
                       Partnership's Admit Date or Discharge Date
                       but on or after the Admit Date on the
                       Auxiliary File.

Utilization Edit 524K: A claim for POS '21', '22', or '23' with
                       no Site of Service ID# and either First
                       Expense Date is between the Participating
                       Centers of Excellence or Provider
                       Partnership's Admit Date or Discharge Date
                       but not equal to the Discharge Date on the
                       Auxiliary file.

                        OR

                        Last Expense Date is between the Participating
                        Centers of Excellence or Provider Partnership's
                        Admit Date or Discharge Date but not equal to
                        the Admit Date on the Auxiliary File.

Utilization Edit 524L: A claim for POS '21', '22', or '23' and the
                       Site of Service ID# on the record does match
                       the Participating Centers of Excellence or
                       Provider Partnership's Provider Number on the
                       Auxiliary file and either First Expense Date
                       is on or between the Participating Centers of
                       Excellence or Provider Partnership's Admit
                       Date or Discharge Date on the Auxiliary file.

                        OR

                        Last Expense Date is on or between the
                        Participating Centers of Excellence or Provider
                        Partnership's Admit Date or Discharge Date on
                        the Auxiliary file.

 Utilization Edit 524M: A claim with POS '21', '22', or '23' and the
                        Site of Service ID# on the record does not
                        match the Participating Centers of Excellence
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 332
______________________________________________________________________________

                        Provider Partnership's Provider Number on the
                        Auxiliary file and either First Expense Date is
                        between the Participating Centers of Excellence
                        or Provider Partnership's Admit Date or
                        Discharge Date but not equal to the Discharge
                        Date on the Auxiliary file,

                        OR

                        Last Expense Date is between the Participating
                        Centers of Excellence or Provider Partnership's
                        Admit Date or Discharge Date but not equal to
                        the Admit Date on the Auxiliary file.

 Utilization Edit 524N: A claim with POS '21' '22', or '23' with
                        no Site of Service ID# and the First and
                        Last Expense Dates overlaps more than one
                        open Admission period on the Participating
                        Centers of Excellence or Provider Partnership's
                        Auxiliary file.

 Modify the IUR process for Part B to include logic for
 Demo Number '54' and add a new IUR Code.

 Modify the IUR process for Part C to include logic for
 Demo Number '54' and add a new IUR Code.

 Ensure the NPI field for the legacy Provider number
 from the NOA is carried on the ACED AUX File
 (previously CEPP).

 Modify the CEPP AUX File to comply with Demo '54'
 and no longer apply to Demo '07' and '08'.

 Modify the Trailer '30' to comply with the revised
 ACED AUX File.

 Modify the XREF Process for the updated ACED AUX File.

 Modify HCPP (HICR) for the updated ACED AUX File.

 Create a new 10 byte field on the transmit record for
 HUBC that will identify the NPI Site of Service ID.
 The modification will also include: HIBC (ITF), Beneficiary's
 Claim History for Part B, HIMR Screen PTBH, and NCH.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 333
______________________________________________________________________________

 CWF will be required to either compare the legacy or NPI
 for Site of Service ID against the ACED AUX File and edits
 that read the Site of Service ID#.

 Modify the following DME edit:

 Consistency Edit 49x2: Claim contains a CABG '06', Participating
                        Center of Excellence '07', or Provider
                        Partnership Demonstration Number '08'
                        is not valid on DME claims.

      NEW BUSINESS REQUIREMENTS:

 Requirement 1
 Ensure the data for the NPI (Legacy Provider Number) is
 carried on the NOA (TOB 11A or 11D) with Demo Number '54' and
 is populated on the ACED Auxiliary File (previously CEPP).
 If the NOA TOB '11A' with Demo Number '54' is accepted (DISP 01),
 create the ACED AUX File or add the Notice of Admission
 to the existing ACED AUX File.

 If Cancellation TOB '11D' with Demo Number '54' is accepted (DISP 01),
 the admission period is removed from the ACED AUX File.

 If this is the only admission period remove the AUX File and
 Indicator from the Beneficiary's Master Record.

 TOB '11A' or '11D' for NOA is not posted to the Claim History.

 This will apply to admissions occurring on or after 10/01/2008.

 Note: NOA format looks exactly like CABEHUIN layout format with
       Demo Number '54'.

 Copybook Name:        CABEHUIN

 Field                            Size   Usage   Location   Remarks

 1.     Record Identifier         4      X       1-4        Constant 'HUIP'

 2.     Filler                    1      X       5          Constant space

 3.     Claim Number              19     X       6-24       Only position 1-12
                                                            will be used for
                                                            editing purposes.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 334
______________________________________________________________________________

4.   Intermediary            23       X           25-47       For Action Code 2 &
      Control Number                                          Control Number 4
      (ICN)                                                   (Cancel, field
                                                              contains ICN of the
                                                              original claim being
                                                              adjusted

                       ---
                       ---
                       ---

30. Medical Record           17       X           197-213
      Number
31. Patient Control          20       X           214-233
      Number
32. Medicaid Info            4        X           234-237
33. Pro Control Number       12       X           238-249
34. Pro PROC Date            7        C3 4        250-253
35. FILLER                   30       X           254-283
36. Demonstration            2        X           284-285     54-ACED demo
      Number

                       ---
                       ---
                       ---

Requirement 2
Revise the CEPP Auxiliary File to comply with the data for
Demo Number '54' (Acute Care Episode) and also post the NPI
from the NOA (TOB 11A) or Discharge claim. The Auxiliary File
name will no longer be 'CEPP' but updated to be 'ACED'.

Copybook Name:   CABCCEPP

Field                        Size         Usage    Location     Remarks

1. Record Key
   a. HIC Number
       i. CAN                9            X       1-9
      ii. Equatable BIC      2            X       10-11
   b. Demonstration          2            X       12-13         54-ACE Demo
      Number
2. Segment Count             4          C 2    14-15
3. Admission Periods                                occurs 1000 times
                                 (changed occur from ==>
                                  1500 to 1000)     depending on
                                                    Segment Count
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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 335
______________________________________________________________________________

   a.   Provider Number    13          X      16-28
   b.   Admit Date         7           C3 4   29-32         CCYYDDD
   c.   Discharge Date     7           C3 4   33-36         CCYYDDD
   d.   NPI                10          x      37-46     <== (New field)

 Requirement 3
 Modify the CEP Indicator on the BENB/BENA HIMR screen
 to ACE indicator.

 Requirement 4
 Modify the HIMR AUXILIARY/OTHER INFORMATION to display
 ACED (Acute Care Episode) and no longer CEPP.

 Requirement 5
 Create a one-timer utility to initialize CEPP AUX indicator on the
 Beneficiary Master record to zero.

 Requirement 6
 Modify Trailer '30' to comply with the information needed
 for Demo '54'.

 Trailer '30' Layout:

   Copybook Name:    CUTELX30

   Field                        Size      Usage   Location    Remarks

    30. ACE Demo Trailer
         a. Trailer Code        2         X       1-2          '30'
         b. Demonstration       2         X       3-4          54-ACE
            Number
         c. Provider Number     13        X       5-17
         d. Admit Date          7         C3 4    18-21        CCYYDDD
         e. Discharge Date      7         C3 4    22-25        CCYYDDD
 (new)==>f. NPI                 10        X       26-35

 Requirement 7
 Modify the transmit record HUBC to add a 10-byte field in the
 header for the NPI to coincide with the Site of Service ID#.
 The new NPI field will be read for the Site of Service ID#
 and the edits for Demo Number '54'.
 CWF will no longer read the legacy Site of Service ID#
 for the edits involving Demo Number '54'.



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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 336
______________________________________________________________________________

 Copybook Name: CABEHUBC

  Field             Size          Usage       Location   Remarks
  1. Record         4             X           1-4        Constant 'HUBC'
    Identifier

  2. Delimiter      1             X           5          Constant Space

  3. Claim Number   12            X           6-17       HICN

  4. Beneficiary Surname                                 First six positions of
                                                         Beneficiary's Surname

   a. Surname       6             X           18-23

   b. First         1             X           24         First Initial of
    Initial                                              Beneficiary's First name

  5. UPIN           6             X           25-30      Unique Physician
                                                         Identification Number Of
                                                         Referring Physician Future
                                                         Use

                        ---
                        ---
                        ---

  52. Mass              1             X       312
       Adjustment
       Indicator
  53. Claim             1             X       313
       Adjustment
       Indicator

  54. CT Registry       8             X       314-321    Clinical Trial Registry

   a. CT Registry       8             9       314-321    8 Digit Numeric
       Num                                               Clinical Trail Registry
  55.
 ==>a. SOS NPI              10            X    322-331   Site of Service NPI
 ==>b. Filler               267           X    332-598    Reserved for future header
                                                         expansion

                    ---
                    ---
                    ---
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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 337
______________________________________________________________________________


 Requirement 8
 Modify HIBC in ITF (Internal Testing Facility) to add a
 10-byte field in the header for the NPI to coincide with
 the Site of Service ID#.

 Requirement 9
 Modify the Full Claim History for HUBC on the Beneficiary's
 Master Record to add a 10-byte field in the header for the
 NPI to coincide with the Site of Service ID#.

 Copybook Name: CIOCPTB

  01   :XB:-RECORD.

       05   :XB:-EXPANDED-LENGTH          PIC S9(04)     COMP.

       05   :XB:-HISTORY-FIXED-DATA.
            10 :XB:-CLMNO                 PIC   X(11).
            10 REDEFINES :XB:-CLMNO.
                15 :XB:-CAN               PIC   X(09).
                15 :XB:-BIC               PIC   X(02).

            10   :XB:-EQUAT-BIC           PIC   X(02).
            10   :XB:-BENE-SURNAME        PIC   X(06).
            10   :XB:-BENE-FINIT          PIC   X(01).
            10   :XB:-SEX-CODE            PIC   X(01).

                       ---
                       ---
                       ---

            10   :XB:-LIAB-IND        PIC X(01).
            10   :XD:-NCPDP-IND       PIC X(01).
            10   :XD:-IHS-IND         PIC X(01).
            10   :XB:-SANCTIONED-IND  PIC X(01).
            10   :XB:-MASS-ADJ-IND    PIC X(01).
                                      VALUE 'M' 'O'
                 88 :XB:-MASS-ADJ-VALID
                                            SPACE.
              88 :XB:-MASS-ADJ-MPFS VALUE 'M'.
              88 :XB:-MASS-ADJ-OTHER VALUE 'O'.
          10 :XB:-CLAIM-ADJ-IND       PIC X(01).
              88 :XB:-CLAIM-ADJ-VALID VALUE 'A' 'N'
                                             SPACE.
              88 :XB:-CLAIM-ADJ       VALUE 'A'.
              88 :XB:-CLAIM-NON-ADJ VALUE 'N'.
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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 338
______________________________________________________________________________

         10   :XB:-CT-REGISTRY.
              15 :XB:-CT-REGISTRY-NUM
                                        PIC   9(08).
(NEW)==> 10 :XB:-SOS-NPI                PIC   X(10).

     ==> 10   FILLER                   PIC    X(280).

                       ---
                       ---
                       ---

Requirement 10
Modify the PTBH in HIMR to add a 10-byte field in the header
for the NPI to coincide with the Site of Service ID#.

Requirement 11
Modify the HUBC record going to NCH to add a 10-byte field
in the header for the NPI to coincide with the Site of
Service ID#.

Requirement 12
Modify Part A consistency edit '041A' (TOB is '11A' or '11D'
and Demo Number '07' or '08' is not present) to include Demo
Number '54' in the logic to set.

Requirement 13
Modify Part A consistency edit '0013' (Demo Number '07' is present
but the Admission Date is before 10/01/1997 or Demo Number '08' is
present but the Admission Date is before 01/01/2002) to include
Demo Number '54' is present but the Admission Date is before
10/01/2008.

Requirement   14
Modify Part   A consistency edit '0014' (Demo Number other than
'03', '05',   '06', '07', '08', '15', '30', '31', '37', '38',
'39', '40',   '44', '46', '48', '49', '51', or '53' are
invalid) to   include Demo number '54' in the logic to set.

Requirement 15
Modify Part A consistency edit '0019' (Demo '07'(Participating
Centers of Excellence) or '08' (Provider Partnership)
is present with Condition Code 'B1') to include Demo Number
'54' in the logic to set.



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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 339
______________________________________________________________________________

Requirement 16
Modify Part A consistency edit '46#7' (Value Code '17' -
Outlier amount is greater than the reimbursement amount,
or the 'Y4' amount with Demo Number '06', '07' or '08'; plus
the total deductible and primary payer amount) to include
Demo Number '54' in the logic to set.

Requirement 17
Modify Part A consistency edit '46#S' (Claim contains Demo
'06', '07', or '08' but Value Code 'Y1', 'Y2', 'Y3', or 'Y4'
are not present or the codes are present without an
amount) to include Demo Number '54' in the logic to set.

Requirement 18
Modify Part A consistency edit '46#T' (MSP Value Code is
present on a CABG or Participating Center of Excellence or
Provider Partnership Demonstration claim) to include Acute
Care Episode Demo Number '54' in the logic to set.

Requirement 19
Modify Part A consistency edit '0703' (When the Demo Number on
the bill is equal to '06' CABG and the Intermediary Number is
not equal to '00123', '00130', '00181', '00332', '00400',
'00452', or '31143', set the edit. When the Demo Number on
the bill is equal to '07' PCOE and the Intermediary
Number is not equal to '00123', '00130', '00181', '00332',
'00400', or '31143', set the edit) to include Demo Number '54'
in the logic to validate the NPI for the Provider.

NOTE: Modify to validate NPI for Provider and not Intermediary
      Number for Demo Number '54' for this edit.

*** Need NPI for Provider ***

 Requirement 20
 Modify Part A consistency edit '9410' (Either claim contains
 a CABG Demo Number and DRG is not '106', '107', or claim contains
 a Participating Center of Excellence Demonstration Number
 and DRG is not one of the following '104', '105', '106',
 '107', '109, '112', '124', '125', '209', or '471') to include
 Acute Care Episode (Demo Number '54') in the logic to set
 and DRG is not one of the following: '216', '217', '218',
 '219', '220', '221', '226', '227', '231', '232', '233', '234',
 '235'. '236', '242', '243', '244', '246', '247', '248', '249',
 '250', '251', '258', '259', '260', '261', '262', '461', '462',
 (exclude ICD-9 code 81.56 if DRG is 462), '466', '467', '468',
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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 340
______________________________________________________________________________

 '469', '470' (exclude ICD-9 code 84.26, 84.27, and 84.28 if
 DRG is 470), '488', and '489'.

 Requirement 21
 Modify Part A consistency edit '0413' (Claim contains a CABG
 or Participating Center of Excellence or Provider Partnership
 Demonstration Number which is only valid for Type of Bill
 '11x') to include Acute Care Episode (Demo Number '54') in the
 logic to set.

 Requirement 22
 Modify Part A utilization edit '5200' (No Entitlement) to
 include Demo Number '54' for TOB '11A' in the logic to set.

 Requirement 23
 Modify Part A utilization edit '5243' (UMWA Beneficiary
 contains a Participating Center of Excellence or CABG or Provider
 Partnership Demonstration) to include Acute Care Episode
 Demo Number '54' in the logic to set.

 Requirement 24
 Modify Part A utilization edit '5244' (Claim contains a CABG
 or Participating Center of Excellence or Provider Partnership
 Demonstration Number but the Beneficiary does not have both
 Part A and Part B entitlement) to include Acute Care
 Episode Demo Number '54' in the logic to set.

 Requirement 25
 Modify Part A utilization edit '5245' (RRB Beneficiary contains
 a CABG or Participating Centers of Excellence or Provider
 Partnership Demonstration Number) to include Acute Care Episode
 Demo Number '54' in the logic to set.

 Requirement 26
 Modify Part A utilization edit '5246' (GHO/Medicare CHOICES
 Beneficiary contains a CABG or Participating Centers of
 Excellence or Provider Partnership Demonstration Number) to
 include Acute Care Episode Demo Number '54' in the logic to
 set.

 Requirement 27
 Modify Part A utilization edit '524A' (A Beneficiary does not
 have at least one lifetime reserve day remaining on a
 Participating Centers of Excellence '07' or Provider
 Partnership Demonstration '08') to include Acute Care
 Episode '54' in the logic to set.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 341
______________________________________________________________________________


 Requirement 28
 Modify Part A utilization edit '524B' (A Beneficiary has a
 MSP record on a Participating Centers of Excellence '07' or
 Provider Partnership Demonstration '08') to set the edit
 when the MSP Type is 'A' (Working Aged) or 'B' (ESRD) or
 'G' (Disabled) is on the MSP AUX File when Acute Care
 Episode Demo Number '54' is present and the Dates
 are during the above MSP Types period.

 Requirement 29
 Modify Part A utilization edit '524C' (Notice of Admission
 Type of Bill '11A' has an Admit Date that equal an Admit Date
 on file for a Participating Centers of Excellence '07'
 or Provider Partnership Demonstration '08') to include
 Acute Care Episode '54' in the logic to set.
 The edit will read the ACED Aux file and no longer read
 the CEPP Aux File.

 Requirement 30
 Modify Part A utilization edit '524D' (Notice of Admission
 Type of Bill '11A' has an Admit Date that overlaps the Admit
 Date and Discharge Date for a Participating Centers of
 Excellence '07' or Provider Partnership Demonstration '08')
 to include Acute Care Episode '54' in the logic to set.
 The edit will read the ACED Aux file and no longer read
 the CEPP Aux File.

 Requirement 31
 Modify Part A utilization edit '524E' (Cancellation Notice
 Type of Bill '11D' has an Admit Date that does not match a
 posted Admit Date or does not have a CEPP File or does
 match the Admit Date but the Discharge Date is present
 for a Participating Centers of Excellence '07' or
 Provider Partnership Demonstration '08') to include
 Acute Care Episode Demo Number '54' in the logic to set.
 The edit will read the ACED Aux file and no longer read
 the CEPP Aux File.

 Requirement 32
 Modify Part A utilization edit '524F' (Type of Bill '11x'
 other than '11A' or '11D' with Demo Number '07' or '08'
 and no Participating Centers of Excellence or Provider
 Partnership Demonstration Auxiliary File) to include
 Acute Care Episode Demo Number '54' in the logic to set.
 The edit will read the ACED Aux file and no longer read
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 342
______________________________________________________________________________

 the CEPP Aux File.

 Requirement 33
 Modify Part A utilization edit '524G' (Condition Code 'B1'
 is present and the Admit Date equals a Beneficiary's
 Participating Centers of Excellence '07' or Provider
 Partnership '08' Admit Date on the auxiliary file) to
 include Acute Care Episode Aux File in the logic to set.
 The edit will read the ACED Aux file and no longer read
 the CEPP Aux File.

 Requirement 34
 Modify Part A utilization edit '524I' (Type of Bill '11x' other
 than '11A', '11D', or '11Z' and no Demo Number '07' or '08' is
 present and the Admit Date equals the Participating Centers of
 Excellence or Provider Partnership's Admit Date on the Auxiliary
 file) to include Acute Care Episode Aux File in the logic to set.
 The edit will read the ACED Aux file and no longer read
 the CEPP Aux File.

 Requirement 35
 Modify Part A utilization edit '524N' (The Provider Number on
 an Inpatient claim with Demo '07' does not match the Provider
 Number of the Notice of Admission NOA) to include Demo '54'
 in the logic to set.
 The edit will read the ACED Aux file and no longer read
 the CEPP Aux File.

 Requirement 36
 Modify Part B consistency edit '0013' (Demo '07' is present
 but the Admission Date is before 10/01/1997 or Demo '08' is
 present but the Admission Date is before 01/01/2002) to
 include Demo '54' is present but the Admission Date is
 before 10/01/2008.

 Requirement 37
 Modify Part B consistency edit '0014' (Demonstration Numbers
 other than '01', '03', '04', '05', '06', '07', '08', '15', '30',
 '31', '37', '38', '39', '40', '44', '45', '46', '48', '49,
 '51', are invalid) to include Demo Number '54' in the logic
 to set.

 Requirement 38
 Modify Part B consistency edit '49x1' (Claim contains a CABG,
 Participating Center of Excellence, or Provider Partnership
 Demonstration Number but Denial Code 'D' is not present)
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 343
______________________________________________________________________________

 to include Acute Care Episode Demo Number '54' in the logic
 to set.

 Requirement 39
 Modify Part B consistency edit '61x2' (Denied claim but line
 item is not denied) to include Demo Number '54' in the bypass
 condition.

 Requirement 40
 Modify Part B consistency edit '63x2' (Deductible and/or
 Coinsurance is present on a CABG or Participating Center of
 Excellence, or Provider Partnership claim) to include Acute
 Care Episode Demo Number '54' in the logic to set.

 Requirement 41
 Modify Part B consistency edit '95x7' (An MSP or Cost Avoid is
 present on a CABG or Participating Center of Excellence or
 Provider Partnership Demonstration claim) to include Acute Care
 Care Episode Demo Number '54' in the logic if the MSP PAY Code is
 present with 'A' or 'G' to set.

 Requirement 42
 Modify Part B consistency edit '92x7' (Provider Reimbursement
 greater than '0' but Pay Code indicates otherwise. CABG,
 Participating Center of Excellence, or Provider Partnership)
 to include Acute Care Episode Demo Number '54' in the bypass
 condition.

 Requirement 43
 Modify Part B consistency edit '98x5' (Allow charge is greater than
 the deductible amount and reimbursement indicator is '0' or '1'
 then coinsurance must be greater than zero) to include Acute
 Care Episode Demo Number '54' in the bypass condition.

 Requirement 44
 Modify Part B utilization edit '5243' (UMWA Beneficiary
 contains a Participating Center of Excellence or CABG or Provider
 Partnership Demonstration) to include Acute Care Episode
 Demo Number '54' in the logic to set.

 Requirement 45
 Modify Part B utilization edit '5244' (Claim contains a CABG
 or Participating Center of Excellence or Provider Partnership
 Demonstration Number but the Beneficiary does not have both
 Part A and Part B entitlement) to include Acute Care
 Episode Demo Number '54' in the logic to set.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 344
______________________________________________________________________________


 Requirement 46
 Modify Part B utilization edit '5245' (RRB Beneficiary contains
 a CABG or Participating Centers of Excellence or Provider
 Partnership Demonstration Number) to include Acute Care Episode
 Demo Number '54' in the logic to set.

 Requirement 47
 Modify Part B utilization edit '5246' (GHO/Medicare CHOICES
 Beneficiary contains a CABG or Participating Centers of
 Excellence or Provider Partnership Demonstration Number) to
 include Acute Care Episode Demo Number '54' in the logic to
 set.

 Requirement 48
 Modify Part B utilization edit '524J' (A claim with POS '21', '22', or
 '23' with no Site of Service ID# and either Service From or Thru
 Date either matches the Participating Centers of Excellence or
 Provider Partnership's Admit Date or Discharge Date or if no Discharge
 Date is on or after the Admit Date on the Auxiliary file) to include
 POS '81' in the logic to set. CWF will read the NPI Site of
 Service ID# field and not the legacy Site of Service ID# on the
 HUBC record.

 The edit will read the ACED Aux file and no longer read
 the CEPP Aux File.

 CWF will read the NPI for Site of Service ID# field and if
 not present will read the Legacy Site of Service ID# field.

 CWF will read the NPI in the Admission Period to compare
 the NPI for Site of Service ID#.

 Trailer '30' will be returned in the response.

 CWF will bypass the edit if Demo Number '54' and Denial Code 'D'
 are present.

 CWF will bypass the edit if Header Denial Code is '0'.

 Requirement 49
 Modify Part B utilization edit '524K' (A claim for POS '21', '22', or
 '23' has no Site of Service ID# and either First Expense Date is between
 the Participating Centers of Excellence or Provider Partnership's
 Admit Date or Discharge Date but not equal to the Discharge
 Date on the Auxiliary file,
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 345
______________________________________________________________________________


OR

Last Expense Date is between the Participating Centers of
Excellence or Provider Partnership's Admit Date or Discharge
Date but not equal to the Admit Date on the Auxiliary file)
to include POS '81' in the logic to set.

The edit will read the ACED Aux file and no longer read
the CEPP Aux File.

CWF will read the NPI for Site of Service ID# field and not
the Legacy Site of Service ID# field on the HUBC Record.

CWF will read the NPI in the Admission Period to compare
the NPI for Site of Service ID#.

Trailer '30' will be returned in the response.
CWF will bypass the edit if Demo Number '54' and Denial Code 'D'
is present.

CWF will bypass the edit if Header Denial Code is '0'.

Requirement 50
Modify utilization edit '524L' (A claim for POS '21', '22', or '23'
and the Site of Service ID# on the record does match the
Participating Centers of Excellence or Provider Partnership's
Provider Number on the Auxiliary file and either First Expense
Date is on or between the Participating Centers of Excellence
or Provider Partnership's Admit Date or Discharge Date on the
Auxiliary File,

OR

Last Expense Date is on or between the Participating Centers
of Excellence or Provider Partnership's Admit Date or
Discharge Date on the Auxiliary file) to include POS '81'
in the logic to set.
The edit will read the ACED Aux file and no longer read
the CEPP Aux File.

CWF will read the NPI for Site of Service ID# field and not
the Legacy Site of Service ID# field on the HUBC Record.

 CWF will read the NPI in the Admission Period to compare
 the NPI for Site of Service ID#.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 346
______________________________________________________________________________


Trailer '30' will be returned in the response.

CWF will bypass the edit if Demo Number '54' and Denial Code 'D'
is present.

CWF will bypass the edit if Header Denial Code is '0'.

Requirement 51
Modify utilization edit '524M' (A claim with POS '21', '22', or '23'
and the Site of Service ID# on the record does not match the
Participating Centers of Excellence or Provider Partnership's
Provider Number on the Auxiliary file and either First Expense
Date is between the Participating Centers of Excellence or
Provider Partnership's Admit Date or Discharge Date but not equal
to the Discharge Date on the Auxiliary File,

OR

Last Expense Date is between the Participating Centers of
Excellence or Provider Partnership's Admit Date or Discharge
Date but not equal to the Admit Date on the Auxiliary file)
to include POS '81' in the logic to set.
The edit will read the ACED Aux file and no longer read
the CEPP Aux File.

CWF will read the NPI for Site of Service ID# field and not
the Legacy Site of Service ID# field on the HUBC Record.

CWF will read the NPI in the Admission Period to compare
the NPI for Site of Service ID#.

Trailer '30' will be returned in the response.

CWF will bypass the edit if Demo '54' and Denial Code 'D'
is present.

CWF will bypass the edit if Header Denial Code is '0'.

 Requirement 52
 Modify utilization edit '524N' (A claim with POS '21', '22', or '23'
 with no Site of Service ID# and the First and Last Expense Dates
 overlaps more than one open Admission period on the Participating
 Centers of Excellence or Provider Partnership's Auxiliary File)
 to include POS '81' in the logic to set.
 The edit will read the ACED Aux file and no longer read
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 347
______________________________________________________________________________

 the CEPP Aux File.

 CWF will read the NPI for Site of Service ID# field and not
 the Legacy Site of Service ID# field on the HUBC Record.

 CWF will read the NPI in the Admission Period to compare
 the NPI for Site of Service ID#.

 Trailer '30' will be returned in the response.

 CWF will bypass the edit if Demo '54' and Denial Code 'D'
 is present.

 CWF will bypass the edit if Header Denial Code is '0'.

 Requirement 53
 Modify IUR process for Trailer Mask 'B' to include POS
 '81' and add new IUR code '7553' to the Trailer '24' of the
 response.

 CWF will read the NPI for Site of Service ID# field and not
 the Legacy Site of Service ID# field on the HUBC Record.

 CWF will read the NPI in the Admission Period to compare
 the NPI for Site of Service ID#.

 CWF will bypass the IUR code if Demo '54' and Denial Code 'D'
 is present.

 CWF will bypass the IUR code if Header Denial Code is '0'.

 Below is the criteria to generate the Informational
 Unsolicited Response:
 Once the Discharge Date is posted on the ACED Auxiliary
 File, CWF will read the Part B History to determine
 if a Fee for Service Paid (Not Denial Code 'D' or Demo Number
 '54' or Denial Code '0') with Dates of Service on or after
 10/01/2008 was processed with POS '21', '22', '23' or '81'.

 OR

 The NPI Site of Service ID# on the claim does not match
 the NPI Provider Number in the Admission Period on the
 ACED Auxiliary File, and the Dates of Service is between,
 but not on, the Admission and Discharge Date.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 348
______________________________________________________________________________

 Requirement 54
 Modify IUR process for 'Trailer Mask 'C' to include logic
 for POS '81' and add new IUR code '7554' to the Trailer '24' of
 the response.

 CWF will read the NPI for Site of Service ID# field for a
 match and not the Legacy Site of Service ID#.
 Service ID# field.

 CWF will read the NPI in the Admission Period to compare
 the NPI for Site of Service ID#.

 CWF will bypass the IUR code if Demo '54' and Denial Code 'D'
 is present.

 CWF will bypass the IUR code if Header Denial Code is '0'.

 Below is the criteria to generate the Informational
 Unsolicited Response:

 Once the Cancellation (TOB 11D) has updated the ACED
 Auxiliary File to remove the Admission Period, CWF
 will read Part B history to determine if a No Pay
 DEMO ('D' in the header Denial Code) with a Demo '54'
 is present with Dates of Service that was during the
 admission of the canceled period.

 If No-Pay Demo '54' claim is posted and the Dates of
 Service are during another Admission Period that is
 still on the ACED Auxiliary File, do not generate an
 Informational Unsolicited Response for that claim.

 Requirement 55
 If the incoming HUIP record is an Inpatient claim other than
 TOB '11A' or '11D' with Demo '54' and the Admit Date does
 match the Admit Date on the ACED AUX file, post the Discharge
 Date in the AUX file once the record is accepted. If the
 Patient Status on the Inpatient Claim is '30' (Still Patient)
 do not update the Discharge Date on the ACED AUX file.

 Requirement 56
 If the incoming HUIP record has Action Code '04' (CANCEL)
 with Demo '54' and the Final Claim (other than TOB '11A'
 or '11D'), update the Admission Notice with the same
 Admit Date by removing the Discharge Date, but not removing
 the Admission period on the ACED AUX file.
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 349
______________________________________________________________________________

Trailer '30' will be returned on the '03' response.

Requirement 57
Carry Demo '54' in the claim history on the Beneficiary
Master Record and also the HIMR screen for HUIP and HUBC.

Requirement 58
Carry Demo'54' in the NCH for HUIP and HUBC records.

Requirement 59
Modify the XREF process for the updated ACE Auxiliary File.

1. If the ACED Aux file is on the inactive number and no ACED
   Aux file is present on the active number merge the AUX file
   to the active number.

2. If the ACED Aux file is on both the inactive and active
   number, do not merge the inactive Aux File.

3. If the ACED Aux file is not on the inactive but on the
   active number, no action is needed and the Aux file is
   maintained on the active number.

Requirement 60
Modify HCPP (HICR) to be renamed 'HCED' for the updated
ACED AUX File and redo the format to coincide with the
new ACED AUX File.

Requirement 61
Modify consistency edit '49x2' (Claim contains a CABG '06',
Participating Center of Excellence '07', or Provider
Partnership Demonstration Number '08' is not valid on DME
claim) to add Acute Care Episode '54' to the logic to
set.

Requirement 62
Bypass First Claim Development when DEMO# '54' is present
on HUIP or HUBC. This will occur when first claim
submitted for a Beneficiary has Demo Number '54'.

Requirement 63
Modify UTLSUTUT program to initialize ACED AUX indicator to zero
and remove Demo '07' and '08' CEPP aux records from UTILMOVE file.



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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 350
______________________________________________________________________________

 Requirement 64
 Create a one timer utility to:
   i) Delete the existing (Demo 07 and 08) records form CEPPAUX file.
  ii) Define new Aux file with length of 31015 bytes.

 Requirement 65
 CWF should crossover claims with DEMO# 54 present as done with
 regular processing.

   EVENT-RESPONSE LIST:

 Event 1.1
 Submit a NOA TOB '11A' with Demo Number '54' and the NPI for the
 legacy Provider Number is present.
 The Admission Date is on or after 10/01/2008.

 Response
 The record returns Disposition Code '01' for the HUIP
 response.

 Event 1.2
 Submit a Cancel NOA TOB '11D' with Demo Number '54' and the NPI
 for the legacy Provider Number is present.
 The Admission Date is on or after 10/01/2008.

 Response
 The record returns Disposition Code '01' for the HUIP
 response.

 Event 2.1
 CWF has accepted a NOA TOB '11A' with Demo Number '54' and the NPI
 for the legacy Provider Number is present.
 The Admission Date is on or after 10/01/2008.

 Response
 The NOA is posted on the 'ACED' Auxiliary File. Demo Number '54',
 NPI and all other data in the Aux record should be populated.

 Event 2.2
 CWF has accepted a Cancel NOA TOB '11D' with Demo Number '54'.
 The Admission Date is on or after 10/01/2008.

 Response
 The Admission is removed from the 'ACED' Auxiliary File.


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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 351
______________________________________________________________________________

Event 3.1
CWF has accepted a NOA TOB '11A' with Demo Number '54'.

Response
The Indicator on the Beneficiary Master Record is 'ACE'.

Event 4.1
Select the Auxiliary/Other Information screen in HIMR.

Response
The ACED (Acute Care Episode) is displayed and no longer
CEPP (PCOE/PP DEMOS) in HIMR.

Event 5.1
Run the conversion.

Response
The aux indicator on the Beneficiary Master Record (position : 219)
is set to zero.

Event 6.1
Review a response where Trailer '30' is returned.

Response
The layout for the Trailer '30' is changed to display
the following: Trailer Code '30', Demonstration
Number '54', Provider Number (13 bytes), Admit Date,
Discharge Date, and NPI (10 bytes).

Event 7.1
Submit an HUBC where the new field for NPI that
coincides with the Site of Service ID# is present.

Response
CWF allows the new field for the NPI Site of Service
ID# on the incoming record to CWF.

Event 8.1
Submit an HIBC in ITF where the new field for NPI that
coincides with the Site of Service ID# is present.

Response
CWF allows the new field for the NPI Site of Service
ID# in ITF.


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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 352
______________________________________________________________________________

Event 9.1
Submit an HUBC that is accepted where the new field for
NPI that coincides with the Site of Service ID# is
present.

Response
CWF displays the NPI on the full claim history on the
Beneficiary Master Record.

Event 10.1
Submit an HUBC that is accepted where the new field for
NPI that coincides with the Site of Service ID# is
present.

Response
The new NPI field in HIMR is displayed on the PTBH.

Event 11.1
Submit an HUBC that is accepted where the new field for
NPI that coincides with the Site of Service ID# is
present.

Response
The new NPI field is carried on the HUBC for NCH.

Event 12.1
Submit an HUIP for TOB '11A' or '11D' with Demo '54' present.

Response
The record does not return edit '041A'.

Event 13.1
Submit an HUIP for TOB '11A' or '11D' with Demo '54' present
and the Admission Date is prior to 10/01/2008.

Response
The record returns edit '0013'.

Event 14.1
Submit an HUIP for TOB '11A' or '11D' with Demo '54' present
and the Admission Date is on or after 10/01/2008.

Response
The record does not return edit '0014'.


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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 353
______________________________________________________________________________

Event 14.2
Submit an HUIP for the Discharge claim with Demo '54'
present and the Admission Date is on or after 10/01/2008.

Response
The record does not return edit '0014'.

Event 14.3
Submit an HUIP for TOB '11A' or '11D' with Demo '54' present
and the Admission Date is prior to 10/01/2008.

Response
The record returns edit '0014'.

Event 14.4
Submit an HUIP for the Discharge claim with Demo '54'
present and the Admission Date is prior to 10/01/2008.

Response
The record returns edit '0014'.

Event 15.1
Submit an HUIP for the Discharge claim with Demo '54' and
Condition Code 'B1' is also present.

Response
The record returns edit '0019'.

Event 16.1
Submit an HUIP for the Discharge claim with Demo '54' and
the Value Code '17' amount is greater than the 'Y4' amount.

Response
The record returns edit '46#7'.

Event 17.1
Submit an HUIP for the Discharge claim with Demo '54' and
not all Value Codes 'Y1', 'Y2', 'Y3', or 'Y4' is present
or is present without the money amount.

Response
The record returns edit '46#S'.

 Event 18.1
 Submit an HUIP for the Discharge claim with Demo '54' and
 the MSP Value Code and amount is also present.
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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 354
______________________________________________________________________________


Response
The record returns edit '46#7'.

Event 19.1
Submit an HUIP with Demo '54' and the NPI is other than:

NOTE: Modify to validate NPI for Provider and not Intermediary
      Number for Demo Number '54' for this edit.

*** Need NPI for Provider ***

Response
The record returns edit '0703'.

Event 20.1
Submit an HUIP for the Discharge claim with Demo '54' and
the DRG is not one of the following: '216', '217', '218',
'219', '220', '221', '226', '227', '231', '232', '233',
'234', '235', '236', '242', '243', '244', '246', '247',
'248', '249', '250', '251', '258', '259', '260', '261',
'262', '461', '462', '466', '467', '468', '469', '470',
'488' and '489'.

Response
The record returns edit '9410'.

Event 21.1
Submit an HUOP, HUHH, HUHC record and Demo '54' is present.

Response
The record returns edit '0413'.

Event 22.1
Submit an HUIP for TOB '11A' with Demo '54' present and
the Beneficiary is not entitled.

Response
The record returns edit '5200'.

Event 23.1
Submit an HUIP for TOB '11A' with Demo '54' present and
the Beneficiary is a UMWA (United Mine Workers).

 Response
 The record returns edit '5243'.
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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 355
______________________________________________________________________________


Event 24.1
Submit an HUIP for TOB '11A' with Demo '54' present and
the Beneficiary is not entitled to both Part A and
Part B.

Response
The record returns edit '5244'.

Event 25.1
Submit an HUIP for TOB '11A' with Demo '54' present and
the Beneficiary is a RRB (Railroad Board).

Response
The record returns edit '5245'.

Event 26.1
Submit an HUIP for TOB '11A' with Demo '54' present and
the Beneficiary is entitled to a Medicare Advantage Plan.
The risk HMO Option Code is 'A', 'B', or 'C'.

Response
The record returns edit '5246'.

Event 27.1
Submit an HUIP for TOB '11A' with Demo '54' present and
the Beneficiary does not have at least one lifetime
reserve day remaining.

Response
The record returns edit '524A'.

Event 28.1
Submit an HUIP for TOB '11A' with Demo '54' present and
the Beneficiary has a MSP record with MSP Type 'A'
(Working Aged) or 'B' (ESRD) or 'G' (Disabled) on the
on the MSP Aux File and the Dates are during the MSP
Period.

Response
The record returns edit '524B'.

Event 29.1
Submit an HUIP for TOB '11A' with Demo '54' present and
the Admit Date equals an Admit Date on the ACED Aux File.

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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 356
______________________________________________________________________________

 Response
 The record returns edit '524C'.

 Event 30.1
 Submit an HUIP for TOB '11A' with Demo '54' present and
 the Admit Date overlaps the Admit Date and Discharge
 Date on the ACED Aux File.

 Response
 The record returns edit '524D'.

 Event 30.2
 Submit an HUIP for TOB '11A' with Demo '54' present and
 the Admit Date is within an existing Admission Period
 without a posted Discharge Date on the ACED Aux File.

 Response
 The record does not return edit '524D'.

 Event 31.1
 Submit an HUIP for TOB '11D' (Cancel) with Demo '54' present
 and the Admit Date does not match a posted Admit Date or
 does not have a ACED Aux File or does match the Admit Date
 but the Discharge Date is present.

 Response
 The record returns edit '524E'.

 Event 32.1
 Submit an HUIP for the Discharge claim with Demo '54' and
 the Beneficiary does not have a ACED Aux File present or
 the Admit Date does not match.

 Response
 The record returns edit '524F'.

 Event 33.1
 Submit an HUIP for a Discharge claim with Condition Code
 'B1' present and the Admit Date matches the Admit Date on
 the Beneficiary's ACED Aux File.

 Response
 The record returns edit '524G'.



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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 357
______________________________________________________________________________

 Event 34.1
 Submit an HUIP for a Discharge claim without Demo '54'
 present and the Admit Date matches the Admit Date on
 the Beneficiary's ACED Aux File.

 Response
 The record returns edit '524I'.

 Event 35.1
 Submit an HUIP for the Discharge claim with Demo '54' and
 the legacy Provider Number does not match the Provider
 Number on the open Admission with the same Admit Date.

 Response
 The record returns edit '524N'.

 Event 36.1
 Submit an HUBC with Demo '54' present.
 The Dates of Service are on or after 10/01/2008.

 Response
 The record does not return edit '0013'.

 Event 36.2
 Submit an HUBC with Demo '54' present.
 The Dates of Service are prior to 10/01/2008.

 Response
 The record returns edit '0013'.

 Event 37.1
 Submit an HUBC with Demo '54' present.
 The Dates of Service are on or after 10/01/2008.

 Response
 The record does not return edit '0014'.

 Event 38.1
 Submit an HUBC with Demo '54' present and the Denial
 Code is not a 'D'.

 Response
 The record returns '49x1'.

 Event 39.1
 Submit an HUBC with Demo '54' present and the line item
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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 358
______________________________________________________________________________

 is not denied.

 Response
 The record does not return '61x2'.

 Event 40.1
 Submit an HUBC with Demo '54' present and deductible and/or
 coinsurance is present.

 Response
 The record returns '63x2'.

 Event 41.1
 Submit an HUBC with Demo '54' present and a MSP Code or
 Cost Avoid Code is present.

 Response
 The record returns '95x7'.

 Event 42.1
 Submit an HUBC with Demo '54' present and Reimbursement
 is greater than '0' but Denial Code indicates otherwise.

 Response
 The record does not return '92x7'.

 Event 43.1
 Submit an HUBC with Demo '54' present and the allow charge
 is greater than the deductible, the reimbursement indicator
 is '0' and coinsurance amount is '0'.

 Response
 The record does not return '98x5'.

 Event 44.1
 Submit an HUBC with Demo '54' present and the Beneficiary
 is a UMWA (United Mine Workers).

 Response
 The record returns edit '5243'.

 Event 45.1
 Submit an HUBC with Demo '54' present and the Beneficiary
 is not entitled to both Part A and Part B.


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 359
______________________________________________________________________________

 Response
 The record returns edit '5244'.

 Event 46.1
 Submit an HUBC with Demo '54' present and the Beneficiary
 is a RRB (Railroad Board).

 Response
 The record returns edit '5245'.

 Event 47.1
 Submit an HUBC with Demo '54' present and the Beneficiary
 is entitled to a Medicare Advantage Plan.
 The risk HMO Option Code is 'A', 'B', or 'C'.

 Response
 The record returns edit '5246'.

 Event 48.1
 Submit an HUBC with POS '21', '22', '23', or '81' as a Fee
 for Service (Not Demo '54' or Denial Code 'D') with no NPI
 for the Site of Service ID# present and the From Date
 matches either the Admit or Discharge Date, or there is
 no Discharge Date on the Admission Period but the From
 Date is on or after the Admit Date in the Admission
 Period on the ACED Aux File.

 Response
 The record returns '524J'.

 Event 48.2
 Submit an HUBC with POS '21', '22', '23', or '81' as a Fee
 for Service (Not Demo '54' or Denial Code 'D') with no NPI
 for the Site of Service ID# present and the Thru Date
 matches either the Admit or Discharge Date, or there is
 no Discharge Date on the Admission Period but the Thru
 Date is on or after the Admit Date in the Admission
 Period on the ACED Aux File.

 Response
 The record returns '524J'.

 Event 49.1
 Submit an HUBC with POS '21', '22', '23', or '81' as a Fee
 for Service (Not Demo '54' or Denial Code 'D') with no NPI
 for the Site of Service ID# present and the From Date is
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2020 Company, LLC                                           Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 360
______________________________________________________________________________

between the Admit and Discharge Date but not equal to the
Discharge Date in the Admission Period on the ACED Aux File.

Response
The record returns '524K'.

Event 49.2
Submit an HUBC with POS '21', '22', '23', or '81' as a Fee
for Service (Not Demo '54' or Denial Code 'D') with no NPI
for the Site of Service ID# present and the Thru Date is
between the Admit and Discharge Date but not equal to the
Admit Date in the Admission Period on the ACED Aux File.

Response
The record returns '524K'.

Event 50.1
Submit an HUBC with POS '21', '22', '23', or '81' as a Fee
for Service (Not Demo '54' or Denial Code 'D') with the NPI
for the Site of Service ID# present and matches the NPI
in the Admission Period and the From Date on the incoming
record is on or between the Admit and Discharge Date in
the Admission Period on the ACED Aux File.

Response
The record returns '524L'.

Event 50.2
Submit an HUBC with POS '21', '22', '23', or '81' as a Fee
for Service (Not Demo '54' or Denial Code 'D') with the NPI
for the Site of Service ID# present and matches the NPI
in the Admission Period and the Thru Date on the incoming
record is on or between the Admit and Discharge Date in
the Admission Period on the ACED Aux File.

Response
The record returns '524L'.

Event 51.1
Submit an HUBC with POS '21', '22', '23', or '81' as a Fee
for Service (Not Demo '54' or Denial Code 'D') with the NPI
for the Site of Service ID# present and does not match the
NPI in the Admission Period and the From Date on the incoming
record is between the Admit and Discharge Date but not equal
to the Discharge in the Admission Period on the ACED Aux File.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 361
______________________________________________________________________________

 Response
 The record returns '524M'.

 Event 51.2
 Submit an HUBC with POS '21', '22', '23', or '81' as a Fee
 for Service (Not Demo '54' or Denial Code 'D') with the NPI
 for the Site of Service ID# present and does not match the
 NPI in the Admission Period and the Thru Date on the incoming
 record is between the Admit and Discharge Date but not equal
 to the Admit Date in the Admission Period on the ACED Aux File.

 Response
 The record returns '524M'.

 Event 51.3
 Submit an HUBC with POS '21', '22', '23', or '81' as a Fee
 for Service (Not Demo '54' or Denial Code 'D') with the NPI
 for the Site of Service ID# present and does not match the
 NPI in the Admission Period and the Dates of Service are after
 the Admit Date but no Discharge Date is present in the
 Admission Period on the ACED Aux File.

 Response
 The record does not return '524M'.

 Event 52.1
 Submit an HUBC with POS '21', '22', '23', or '81' as a Fee
 for Service (Not Demo '54' or Denial Code 'D') with no NPI
 for the Site of Service ID# present and the Date of Service
 overlaps more than one open Admission Period on the ACED
 Aux File.

 Response
 The record returns '524N' and returns two Trailer 30's
 in the response with the two most current Admission Periods.

 Event 53.1
 Submit an Inpatient Discharge claim with Demo '54' that is
 accepted and updates the ACED Aux File with a Discharge Date.
 Posted to history is a Fee for Service Part B claim
 (No Demo '54' or Denial Code 'D') with POS '21', '22', '23',
 or '81'. The Dates of Service on the Part B claim is on
 or between the Admission and Discharge Date on the ACED
 Aux File. The NPI Site of Service ID# is blank or
 matches the NPI in the Admission Period on the ACED
 Aux File.
______________________________________________________________________________
2020 Company, LLC                                           Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 362
______________________________________________________________________________


 Response
 An Informational Unsolicited Response is generated for
 the Part B claim in history. The Trailer '24' mask will
 be 'B' and the Trailer '24' will return code '7553' and
 the claim information. Trailer '30' will also be returned
 with the information from the admission period. The
 Disposition Code will be '01'. Unsol IND will be a 'B'
 on the Part B Claim in history.

 Event 53.2
 Submit an Inpatient Discharge claim with Demo '54' that is
 accepted and updates the ACED Aux File with a Discharge Date.
 Posted to history is a Fee for Service Part B claim
 (No Demo '54' or Denial Code 'D') with POS '21', '22', '23',
 or '81'. The Dates of Service on the Part B claim is between
 but not on, the Admission and Discharge Date on the ACED
 Aux File. The NPI Site of Service ID# on the Part B claim
 does not match the NPI in the Admission Period on the ACED
 Aux File.

 Response
 An Informational Unsolicited Response is generated for
 the Part B claim in history. The Trailer '24' mask will
 be 'B' and the Trailer '24' will return code '7553' and
 the claim information. Trailer '30' will also be returned
 with the information from the admission period. The
 Disposition Code will be '01'. Unsol IND will be a 'B'.

 Event 53.3
 Submit an Inpatient Discharge claim with Demo '54' that is
 accepted and updates the ACED Aux File with a Discharge Date.
 Posted to history is a Demo '54' with a Denial Code 'D'
 for POS '21', '22', '23', or '81'. The Dates of Service on
 the Part B claim is on or between the Admission and Discharge
 Date in the Admission on the ACED Aux File.

 Response
 The Informational Unsolicited Response is not generated for
 code '7553'.

 Event 54.1
 Submit a Cancellation TOB '11D' that is accepted and updates
 the ACED Aux File by removing the Admission Period. Posted
 to history is a Part B Demo '54' with a Denial Code 'D' for
 POS '21', '22', '23', or '81' with Dates of Service that
______________________________________________________________________________
2020 Company, LLC                                           Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 363
______________________________________________________________________________

are during the Admission of the canceled claim.

Response
An Informational Unsolicited Response is generated for
the Part B claim in history. The Trailer '24' mask will
be 'C' and the Trailer '24' will return code '7554' and
the claim information. Trailer '30' will also be returned
with the information from the admission period. The
Disposition Code will be '01'. Unsol IND will be a 'C'.

Event 54.2
Submit a Cancellation TOB '11D' that is accepted and updates
the ACED Aux File by removing the Admission Period. Posted
to history is a Part B Demo '54' with a Denial Code 'D' for
POS '21', '22', '23', or '81' with Dates of Service that
are during the Admission of the canceled period. Another
Admission Period is still on the ACED Aux File and the
Dates of Service on the Part B claim is also during the
remaining Admission Period.

Response
An Informational Unsolicited Response is not generated
for code '7554'.

Event 54.3
Submit a Cancellation TOB '11D' that is accepted and updates
the ACED Aux File by removing the Admission Period. Posted
to history is a Fee for Service (Not Demo '54' or Denial Code
'D') claim with Dates of Service that are during the Admission
of the canceled period.

Response
An Informational Unsolicited Response is not generated
for code '7554'.

Event 55.1
Submit an HUIP (Other than 11A or 11D) with Demo '54' and the
Admit Date matches the Admit Date on the ACED Aux File.
The Patient Status is other than '30' and is accepted in CWF.

Response
The Discharge Date is posted to the Admission Period on the
ACED Aux File.



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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 364
______________________________________________________________________________

 Event 55.2
 Submit an HUIP (Other than 11A or 11D) with Demo '54' and the
 Admit Date matches the Admit Date on the ACED Aux File.
 The Patient Status is '30' and is accepted in CWF.

 Response
 The Discharge Date is not posted to the Admission Period on
 the ACED Aux File.

 Event 56.1
 Submit a Cancel (A/C 4) on HUIP Final (other than TOB
 '11A' or '11D') with Demo '54' and is accepted in CWF.

 Response
 The record returns Disposition Code '03' with Trailer '30'
 and removes the Discharge Date on the ACED Aux File.

 Event 57.1
 Submit a HUBC or HUIP (Final) with Demo '54' and the record
 is accepted.

 Response
 The DEMO# 54 is carried to the full claim history and
 displays on the HIMR screen in claim history.

 Event 58.1
 Submit a HUBC or HUIP (Final) with Demo '54' and the record
 is accepted.

 Response
 The Demo '54' is carried to the NCH file.

 Event 59.1
 Submit a HCDL to merge a Beneficiary's Record where the
 inactive HIC has a ACED Aux File.

 Response
 The merge is successful and displays the ACED Aux File
 correctly.

 Event 59.2
 Submit a HCDL to merge a Beneficiary's Record where the
 active HIC has a ACED Aux File but not the inactive HIC.

 Response
 The merge is successful and displays the ACED Aux File
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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 365
______________________________________________________________________________

 correctly.

 Event 59.3
 Submit a HCDL to merge a Beneficiary's Record where the
 inactive HIC and active both have a ACED Aux File.

 Response
 The merge is successful and displays the ACED Aux File
 from the active HIC and drops the file from the
 inactive HIC.

 Event 60.1
 Submit a HCED HICR transaction for a Beneficiary with a
 ACED Aux File.

 Response
 The HCED screen displays the data from the ACED Aux File.

 Event 61.1
 Submit a HUDC with Demo '54' present.

 Response
 The record returns ER '49x2'.

 Event 62.1
 Submit a HUIP record with Demo '54' present. The Beneficiary
 has no claims posted to the Beneficiary Master Record.

 Response
 CWF does not return the first claim development in the
 response and the MSP Indicator is set with a '4'.

 Event 63.1
 Run UTLSUTUT program.

 Response
 Removes Demo '07' or '08' CEPP Aux File and initialize ACED
 Aux Indicator to zero.

 Event 64.1
 Run one time Utility.

 Response
 Any Beneficiary with existing Demo '07' or '08' record will be
 deleted and the new Aux File will be defined with a length of
 31015 bytes.
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2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Section VII. Detailed Description of Changes                          Page 366
______________________________________________________________________________


 Event 65.1
 Submit HUIP with Demo#54 present that is accepted in CWF.

 Response
 The record is crossed over, and a Trailer '29' is generated.

   EDITS AFFECTED:   None

   INSTALLATION INSTRUCTIONS:   None

   SYSTEMS DOCUMENTATION AFFECTED:     None

   SATELLITE SYSTEM MODIFICATIONS:     None




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix A: Installation Instructions                                 Page 367
______________________________________________________________________________

APPENDIX A:   INSTALLATION INSTRUCTIONS

**********************************************************
*************       I M P O R T A N T       **************
**********************************************************
* THESE INSTALLATION INSTRUCTIONS SUPERCEDE ALL PREVIOUS *
* QUARTERLY RELEASE INSTALLATION INSTRUCTIONS.           *
**********************************************************

The R2008300 Release Installation Instructions have been
Organized into HOST Instructions and Satellite Instructions
With four sections each to assist in the installation process.
Each section contains instructions that should occur during
Each stage of the installation process.

The sections are Pre-Pre-Installation, Pre-Installation,
Installation and Post Installation.




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix A: Installation Instructions                                 Page 368
______________________________________________________________________________

********************************************************
********************************************************
*                HOST INSTRUCTIONS:                    *
********************************************************
********************************************************

********************************************************
*   I.          PRE-PRE-INSTALLATION:             HOST *
********************************************************

I.1. HOLD XREF TRANSACTIONS FOR R2008300 RELEASE

CMS CR 5783 - 25654 NEW INPATIENT SPELL & ADJUSTMENT PROCESS
FOR VA CLAIMS, will require all XREF transactions to be held
four (4) days prior to the implementation of July R2008300
Release.

INSTRUCTIONS TO HOLD XREF TRANSACTIONS

To ensure no XREF merges are pending all Host sites must
activate the 'BYPASS XREF PROCESSING PARAMETER' effective
Tuesday, July 01, 2008 as follows:

(1) Update the HXDLOPT parameter in the CABHCFA step of the
    CABMDC06 job/CAB$BMP1 Procedure to 'N' (currently set to
    'X'). With this PARM change in CABMDC06 job, no new HXDL
    transactions will be processed, and this will stop the
    creation of HBBM records.

(2) Delete all prior generations of the HOLDHXDL dataset inputs
    to CABMDC06 job CAB$BMP1 proc CABHCFA step.

(3) Modify CABMDC06 to override CAB$BMP1 proc CABHCFA step
    DD HOLDHXDL as a DUMMY dataset. This will ensure only
    those XREF HXDL transactions received during the period
    of July 01, 2008 through July 04, 2008 are stored on the
    HOLDHXDL GDG's.

   Example: CABHCFA.HOLDHXDL DD DUMMY


********************************************************




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix A: Installation Instructions                                 Page 369
______________________________________________________________________________


I.2. DROP OSA TRANSACTIONS FOR R2008300 RELEASE

CMS CR 5783 - 25654 NEW INPATIENT SPELL & ADJUSTMENT PROCESS
FOR VA CLAIMS, requires all OSA transactions to be dropped four
(4) cycles prior to the implementation of July R2008300 Release.

The CWF Hosts will drop OSA transactions effective Tuesday,
July 01, 2008. This means the CABBHXMT run on Monday, June 30,
2008 is the last CABBHXMT job that will be sent OSA.

The OSA unsolicited informational responses will continue to
be sent without interruption.

OSA transactions received between Tuesday, July 01, 2008
until Release installation on Monday, July 07, 2008 will need
to be recycled when OSA processing resumes on Monday, July 07,
2008.

INSTRUCTIONS TO DROP OSA TRANSACTIONS

Modify the PARM in the CABBHMXT job to suppress OSA processing
of all transactions starting with the July 01, 2008 CABBHXMT Job.
This will ensure the OSA transactions in the old format are
flushed from Production prior to the installation of the July
R2008300 Release.

//     SKIP='08183000000,08186999999,A,X,X,X,X,X,X,XXX'
//* A=ALL, B=PARTB/DME, C=CMN, E=ESRD, I=HUIP, O=HUOP/HUHH/HUHC

Although claims are being dropped for OSA, Hosts are required to
continue to execute their CABBHXMT/CABBHRCV to load and create
the unsolicited informational responses.


********************************************************




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix A: Installation Instructions                                 Page 370
______________________________________________________________________________


I.3. SPECIAL INSTRUCTIONS

     CR 00025713 (CMS CR 5828)

Note: These instructions applies only to Mid-Atlantic HOST

CR 00025713 requires a new Satellite setup for Contractor,
11140, at the Mid-Atlantic Host site. Below are the steps/
checklist for setting up a new Satellite connection:

Host/Satellite must coordinate the following:
    Is there already an AT&T connection defined for CICS and NDM?
    CICS and NDM contacts for initial setup
    DSNs incoming and outgoing
    trigger jobs
    unit parameters
    NDM node name
    NDM userid/password
    security changes for DSNs created, read, etc.
    contact person when incoming NDM files are missing
    contact person when outgoing NDMs have problems

Hosts must make the following CWF software changes:
    HIIN - update CABHOSC with new contractor information
    HISU - update CABSTAS/CABSTAT with claims/batch, batches/time
    IDCMCARD (CABIN**, CABINL**, CABOT**, CABNS**)
    FCT ENTRY (CABIN**, CABINL**, CABOT**, CABNS**)
    JCLCNTL VSAM file - update for AMEN submit jobs
    ELG$OUTP - if satellite will be sending eligibility files
    CARRINFO(0) QSAM file - if satellite will be sending elig files

Host specific items
    add new GDG bases
    add new files to backup jobs/disaster recovery jobs
    add new files to CICS startup deck
    add new jobs to JCL library


********************************************************




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix A: Installation Instructions                                 Page 371
______________________________________________________________________________


********************************************************
* II.            PRE-INSTALLATION:                HOST *
********************************************************

 Hosts should clear out all previous cycle files prior
 to running the first cycle of the R2008300 Release.


********************************************************




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix A: Installation Instructions                                 Page 372
______________________________________________________________________________


********************************************************
* III.              INSTALLATION:                 HOST *
********************************************************

* Weekend of July 5, 2008

III.1. Install the R2008300 Release Software.

        All CRs


III.2. Hosts must disable the following CICS transactions
       in CWF Production regions:

       HIAB - Beneficiary Accrete Transaction
       HIBC _ Part B Claim Transaction
       HIBI - Add/Update/Delete Beneficiary Other Insurer
              Information Data in the BOI Aux File
       HIBO _ Part B Basic Reply Record Transactions
       HICM - CMN Auxiliary Transaction
       HICN _ CMN Maintenance Response Transaction
       HICO _ Inpatient Basic Reply Record Transaction
       HIDC _ DME Claim Transaction
       HIDO _ DME Basic Reply Record Transaction
       HIHC _ Hospice Claim Transaction
       HIHH _ Home Health Claim Transaction
       HIIP _ Inpatient Claim Transaction
       HIMP _ MSP Maintenance Response Transaction
       HIOO _ Outpatient/Hospice/Home Health Basic Reply
              Record Transaction
       HIOP _ Outpatient Claim Transaction
       HISP _ MSP Maintenance Transaction
       HITF _ Internal Testing Facility Transaction


III.3. CMS sent notification to CWF Hosts dated June 18,
       2008, All Hosts must DISABLE the HIHO inquiry
       effective 07/01/2008. Any plan staff requesting access
       to CWF are to be denied. Tell them to contact the
       CMS Helpdesk (410-786-2580).

       Hosts must disable the following CICS transactions
       In CWF Production regions:


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix A: Installation Instructions                                 Page 373
______________________________________________________________________________

      HIHO _ Beneficiary Information system for Managed
             Care Organizations


********************************************************




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix A: Installation Instructions                                 Page 374
______________________________________________________________________________


III.2.1. HCPCS Table Installation Instructions

          CR 00025937 (CMS CR 6060)
          CR 00025950 (CMS CR 6087)
          CR 00025960 (CMS CR 6095)

The conversion and timing considerations, followed by the
requirement, important notes, and installation steps are
listed below.

A. Conversion
   This section indicates the type of file affected:
   (Note - Mark ALL that apply with an "X")

   __X_     Production File Conversion
   __X_     Test File Conversion

   This section identifies who converts the file:
   (Note - Mark ALL that apply with an "X")

   __X_     Beta File Conversion
   __X_     Host File Conversion
   ____     Satellite File Conversion

B. Timing Considerations
   Load the HCPCS Table before the first cycle using the
   Release software.

C. Requirement
   Update the HCPCS Table.

D. Important Notes
   None.

E. Installation Steps
   Load the HCPCS Table using the INITHCPC utility.


********************************************************




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix A: Installation Instructions                                 Page 375
______________________________________________________________________________


III.2.2. Carrier Table Installation Instructions

           CR 00025713 (CMS CR 5828)

The conversion and timing considerations, followed by the
requirement, important notes, and installation steps are
listed below.

A. Conversion
   This section indicates the type of file affected:
   (Note - Mark ALL that apply with an "X")

   __X_      Production File Conversion
   ____      Test File Conversion

   This section identifies who converts the file:
   (Note - Mark ALL that apply with an "X")

   ____      Beta File Conversion
   __X_      Host File Conversion
   __X_      Satellite File Conversion

B. Timing Considerations
   Load the Carrier Table prior to the first cycle with the
   release software.

C. Requirement
   Update the Carrier Table.

D. Important Notes
   There are separate instructions for Hosts and Satellites.

E. Steps

   HOSTS
     1. Close CARTBL file in the online regions.
     2. To load the table to the VSAM file CARTBL file, use the
         IDCAMS cards 'CARTBL' to delete and define the file.
         IDCAMS cards are located in '*.RCCYYQST.H.SW.IDCMCARD'.
         NOTE: To execute these IDCAMS cards and load the file, use
                the utility JCL 'INITCART' found in
                '*.RCCYYQST.H.SW.UTILLIB'.
     3. Open CARTBL file in the online region.

********************************************************
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix A: Installation Instructions                                 Page 376
______________________________________________________________________________


III.3. CICS Table Changes (HOST)

       CR 00025654 (CMS CR 5783)

********************************************************************
*    ADD THE FOLLOWING ENTRIES TO THE HOST PPT TABLES             **
********************************************************************

       DFHPPT TYPE=ENTRY,PROGRAM=HABWUHST,PGMLANG=COBOL
       DFHPPT TYPE=ENTRY,PROGRAM=HUIPVSPL,PGMLANG=COBOL


********************************************************




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix A: Installation Instructions                                 Page 377
______________________________________________________________________________


III.4.    Host One Timer Jobs

        CR 00025654 (CMS CR 5783)
    and CR 00025723

III.4.1. CR 00025654 (CMS CR 5783)

*******************
U T L J C A T 0 - 9
*******************

 The conversion and timing considerations, followed by the
 requirement, important notes, and installation steps are
 listed below.

A. Impact to Host
   (Note - Mark Host impact with an "X")

   X__ Yes
   ___ No

B. Conversion
   This section indicates the type of file affected:
   (Note - Mark ALL that apply with an "X")

   X___      Production File Conversion
   X___      Test File Conversion

   This section identifies who converts the file:
   (Note - Mark ALL that apply with an "X")

   X___      Beta File Conversion
   X___      Host File Conversion
   ____      Satellite File Conversion

C. Timing Considerations
   The UTLJCATx utility must be run AFTER the installation of
   of R2008300 release software and BEFORE the first cycle
   using the R2008300 release software.

   The ten Beneficiary Master jobs UTLJCAT0 - 9 are read only
   and may be run any time except when the VSAM files are
   being reloaded. The UTLJCATM job will update the Beneficiary
   VSAM files when run in 'PROD' mode.

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix A: Installation Instructions                                 Page 378
______________________________________________________________________________

D. Requirement
   Modify the UTIL JCL UTLJCAT0-9 and UTLJCATM jobs provided
   with the R2008300 release to meet the requirements of your site.
   The execution JCL can be found in the '*.R2008300.H.SW.UTILLIB',
   members UTLJCAT0-9 and UTLJCATM.

E. Important Notes
   The one-timer can be executed in the following modes using
   the RUNTYPE parameter in the UTLJCAT0-9 JCL.

      RUNTYPE=PROD     WRITE BENE MASTER OUTPUT;
                       ONLY REPORT BENES WITH CUTOFF DATES
                       AFTER 1990 OR NEGATIVE PRE-1990 VALUES.

      RUNTYPE=TEST     WRITE BENE MASTER OUTPUT;
                       REPORT ALL NON-DEFAULT PRE-1990 VALUES.

      RUNTYPE=AUDIT    SUPPRESS BENE MASTER OUTPUT;
                       ONLY REPORT BENES WITH CUTOFF DATES
                       AFTER 1990 OR NEGATIVE PRE-1990 VALUES.

   1. Execute the Utility in 'AUDIT' mode during the user
      testing period using the production Beneficiary Master
      files. Beneficiary master files (Sequential and VSAM)
      will not be created. When run in 'AUDIT':
       -PROC UTLPCAT1 step UTLSCAT1 will return condition code 04.
       -Steps DELBENE and REPRBENE will not be executed.

     Note: Review the two reports and NDM report files to CWFM:
     &QSAM.UTLPCAT2.SYSOUT
     &QSAM.UTLPCAT2.REPORT

   2. Execute the Utility in 'TEST' mode to generate the
      sequential Beneficiary master file with PRE90 fields.
      The Beneficiary Master VSAM files will not be updated.
      When run in 'TEST' mode:
       -Modify &UNIT2 space parameter to accommodate the production
        beneficiary master file volume.
       -PROC UTLPCAT1 step UTLSCAT1 will return condition code 04.
       -Steps DELBENE and REPRBENE will not be executed.

   3. Execute the Utility in 'PROD' mode to make the updates
      to the VSAM Beneficiary Master file PRE90 fields.
      The Beneficiary Master files must be closed to execute
      the utility in 'PROD' Mode.
      When run in 'PROD' mode:
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix A: Installation Instructions                                 Page 379
______________________________________________________________________________

        -Modify &UNIT2 space parameter to accommodate the production
         beneficiary master file volume.
        -PROC UTLPCAT1 step UTLSCAT1 will return condition code 00.
        -Steps DELBENE and REPRBENE will be executed creating
         the updated Beneficiary VSAM file.

F. Steps

   1.   Run jobs UTLJCAT0-9 to extract data from the ten
        Beneficiary Master files and Inpatient claims history
        to populate the pre-1990 fields.

        A) DELETE step deletes the internal job files.

        B) UTLSCAT1 step reads Beneficiary Master and corresponding
           history claims to create the PRE90 fields.
           When executed in 'PROD' mode, UTLSCAT1 creates the
           sequential datasets for the beneficiary master and
           sets condition code '0' for the step. A condition code
           '04' is set when the job runs in 'AUDIT' or 'TEST' mode.

        C) COUNTS step copies the statistics of UTLSCAT1 to
           a dataset.

        D) DELBENE step deletes and redefines the VSAM beneficiary
           master file only if job is executed in 'PROD' mode.

        E) REPRBENE step repros the sequential beneficiary master
           file created in UTLSCAT1 to the VSAM beneficiary master
           file only if job is executed in 'PROD' mode.

   2.   Run jobs UTLJCATM to produce the reports combining
        data from the ten Beneficiary Master files.

        A) UTLPCAT2 step creates the combined totals and reports
           datasets.

        B) COUNTS step copies the combined statistics for all
           ten Beneficiary Master files.

        C) REPORTS step copies the combined report for all
           ten Beneficiary Master files.


********************************************************

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix A: Installation Instructions                                 Page 380
______________________________________________________________________________


III.4.2. CR 00025723

***************
U T L J 8 3 A 1
***************

 The conversion and timing considerations, followed by the
 requirement, important notes, and installation steps are
 listed below.

A. Impact to Host
   (Note - Mark Host impact with an "X")

   X__ Yes
   ___ No

B. Conversion
   This section indicates the type of file affected:
   (Note - Mark ALL that apply with an "X")

   X___      Production File Conversion
   X___      Test File Conversion

   This section identifies who converts the file:
   (Note - Mark ALL that apply with an "X")

   X___      Beta File Conversion
   X___      Host File Conversion
   ____      Satellite File Conversion

C. Timing Considerations
   The UTLJ83A1 utility must be run AFTER the installation of
   of R2008300 release software and BEFORE the first cycle
   using the R2008300 release software.

D. Requirement
   Modify the UTIL JCL UTLJ83A1 job provided with the R2008300
   release to meet the requirements of your site.
   The execution JCL can be found in the '*.R2008300.H.SW.UTILLIB',
   members UTLJ83A1.

E. Important Notes
   The UTLJ83A1 utility includes a PROD and TEST RUNTYPE MODE
   parameter and can be run in the following modes:

______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix A: Installation Instructions                                 Page 381
______________________________________________________________________________

     MODE='P' - 1. Creates the 'TRNGAUX OUTPUT' file.
                2. Sets the 'RETURN-CODE' value to a zero
                   which allows the execution of subsequent
                   job steps DELDEF (delete and define) and
                   RELOAD.

     MODE='T' - 1. Does not create the 'TRNGAUX OUTPUT' file.
                2. Set the 'RETURN-CODE' value to a '4'
                   effectively ending the job and does not
                   execute the DELDEF step and the RELOAD
                   step.

   The files created by this utility are:

     1. &QSAM.UTLJ83A1.TRNGAUX.OUTPUT - an updated version of
              the TRNGAUX file.

     2. &QSAM.UTLJ83A1.TRNGAUX.DISPLAYS - a report detailing
              the TRNGAUX records that were modified. The
              information shown in this file reflect the type of
              changes applied to the respective records.
              Examples of the displays typically found in this
              file follows and contain a descriptive line indicative
              of the change being applied:

               Example 1.
               ******************************************************
               TRNGAUX HIC NUMBER ..... 026124270A
               ONLY DATES DIFFER
               HCPC CODE .............. G0376
               ORIGINAL INITIAL DATE .. 00000000
               UPDATED INITIAL DATE ... 11032005
               ******************************************************

               Example 2.
               ******************************************************
               TRNGAUX HIC NUMBER ..... 244912001A
               DATES AND SEGMENTS DIFFER
               HCPC CODE .............. G0375
               ORIGINAL INITIAL DATE .. 00000000
               UPDATED INITIAL DATE ... 10122005

               SEGMENTS DIFFER
               HCPC CODE .............. G0375
               ICN .................... 24491-G0375-2
               ORIGINAL PERIOD NUMBER . 1
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix A: Installation Instructions                                 Page 382
______________________________________________________________________________

                UPDATED PERIOD NUMBER .. 0
                ******************************************************

                Example 3.
                ******************************************************
                TRNGAUX HIC NUMBER ..... 246631026A
                ONLY SEGMENTS DIFFER
                HCPC CODE .............. G0375
                ICN .................... 24663-2.1.4-2
                ORIGINAL PERIOD NUMBER . 2
                UPDATED PERIOD NUMBER .. 3
                ******************************************************

F. Steps

   1. The following steps detail both the function and process
      of this utility.

      A)   DELETE    - IEFBR14; deletes previously created test
                       files, if any exist.

      A)   BKPTRAN   - IDCAMS; create a backup of the VSAM TRNGAUX
                       file.

      B)   SEQTRAN   - IDCAMS; create a sequential version of the
                       TRNGAUX file for subsequent processing.

      C)   UTLS83A1 - UTLS83A1; this program updates the TRNGAUX
                      'smok period no' field, (when identified),
                      on records that contain a Smoke Cessation
                      HCPCS, i.e. 'G0375', 'G0376', '99406', or
                      '99407'.

      D)   SORTTRNG - SORT; insure that the updated TRNGAUX
                      records are sequenced properly for the
                      RELOAD step.

      E)   DELDEF    - IDCAMS; conditionally executed to delete and
                       define the VSAM TRNGAUX file.

      F)   RELOAD    - IDCAMS; conditionally executed to reload the
                       VSAM TRNGAUX file with the output file
                       created in the UTLS83A1 step.


********************************************************
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix A: Installation Instructions                                 Page 383
______________________________________________________________________________


       **************************
III.5. HOST ONE-TIMER JOB SUMMARY
       **************************

       Note: Please be sure to read this entire section before
             attempting to execute the one-timer jobs described.

       HOST ONE-TIMER JOBS

       UTLJCAT0-9 _ Required
       UTLJ83A1   - Required

       UTLSUTUT   - Not Required (Hosts are instructed to not
                    run this job for July Release)


********************************************************




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix A: Installation Instructions                                 Page 384
______________________________________________________________________________


********************************************************
* IV.           POST INSTALLATION:                HOST *
********************************************************

IV.1. INSTRUCTIONS TO RESTART XREF PROCESSING

To ensure all pending XREF merges are processed after the July
R2008300 Release implementation, all Hosts must remove the
'BYPASS XREF PROCESSING PARAMETER' effective July 07, 2008 as
follows:

(1) Update the HXDLOPT parameter in the CABHCFA Step of the
    CABMDC06 Job/CAB$BMP1 Procedure to 'X' (currently set to 'N').
    With the PARM change in CABMDC06 job, HXDL transactions will
    be re-introduced for processing. HBBM and HBBR transactions
    will be generated with the HICC online transaction and be
    processed effective Monday, July 07, 2008.

(2) Modify CABMDC06 Job/CAB$BMP1 Procedure/CABHCFA Step DD
    HOLDHXDL to take in all the held HXDL datasets received
    during period of July 01, 2008 through July 04, 2008.

   Important Note: There must be five (5) backup HOLDHXDL
   generations, four (4) created during the hold, and one
   for the current day.

   Example: CABHCFA.HOLDHXDL DD DSN=CWF.HOST.HOLDHXDL,DISP=SHR


********************************************************




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix A: Installation Instructions                                 Page 385
______________________________________________________________________________


IV.2. INSTRUCTIONS TO RESTART OSA PROCESSING

All the Hosts will have to ensure the CABOS* files are empty
prior to executing their first cycle after the installation of
the July R2008300 Release. This will ensure the CABOS* files
are clear of any old OSA transactions. Failure to do this will
cause erroneous results.

No additional changes are required to the PARM in the CABBHXMT
job, OSA processing will automatically resume based on the Julian
date placed in the SKIP PARM in the CABBHMXT job defined in the
Instructions to Drop OSA Transactions.


********************************************************




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix A: Installation Instructions                                 Page 386
______________________________________________________________________________


********************************************************
********************************************************
********************************************************
*             Satellite INSTRUCTIONS:                  *
********************************************************
********************************************************

********************************************************
*   I.          PRE-PRE-INSTALLATION:        Satellite *
********************************************************

None at this time.


********************************************************




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix A: Installation Instructions                                 Page 387
______________________________________________________________________________


********************************************************
* II.            PRE-INSTALLATION:           Satellite *
********************************************************

None at this time.


********************************************************




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix A: Installation Instructions                                 Page 388
______________________________________________________________________________


********************************************************
* III.              INSTALLATION:            Satellite *
********************************************************

III.1.   Install the R2008300 Release Software.

         All CRs


********************************************************




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix A: Installation Instructions                                 Page 389
______________________________________________________________________________


III.2. Carrier Table Installation Instructions

          CR 00025713 (CMS CR 5828)

The conversion and timing considerations, followed by the
requirement, important notes, and installation steps are
listed below.

A. Conversion
   This section indicates the type of file affected:
   (Note - Mark ALL that apply with an "X")

   __X_       Production File Conversion
   ____       Test File Conversion

   This section identifies who converts the file:
   (Note - Mark ALL that apply with an "X")

   ____       Beta File Conversion
   __X_       Host File Conversion
   __X_       Satellite File Conversion

B. Timing Considerations
   Load the Carrier Table prior to the first cycle with the
   release software.

C. Requirement
   Update the Carrier Table.

D. Important Notes
   There are separate instructions for Hosts and Satellites.

E. Steps

   SATELLITES
     1. Close CARTBL file in the online regions.
     2. To load the table to the VSAM file CARTBL file, use the
        IDCAMS cards 'CARTBL' to delete and define the file.
        IDCAMS cards are located in '*.RCCYYQST.S.SW.IDCMCARD.'
     3. Open CARTBL file in the online region.


********************************************************


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix A: Installation Instructions                                 Page 390
______________________________________________________________________________


III.3. CICS Table Changes (Satellite)

None at this time.


********************************************************




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix A: Installation Instructions                                 Page 391
______________________________________________________________________________


********************************************************
* IV.           POST INSTALLATION:           Satellite *
********************************************************

None at this time.


********************************************************




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                    R2008300
Final Quarterly Release Document                                   July 3, 2008
Appendix B: CICS Table Updates                                         Page 392
______________________________________________________________________________

APPENDIX B:   CICS TABLE UPDATES

  R2008300 HOST CICS TABLE CHANGES:
  --------------------------------

 *********************************************************************
 **    ADD THE FOLLOWING ENTRIES TO THE HOST PPT TABLES             **
 *********************************************************************

         DFHPPT TYPE=ENTRY,PROGRAM=HABWUHST,PGMLANG=COBOL
         DFHPPT TYPE=ENTRY,PROGRAM=HUIPVSPL,PGMLANG=COBOL

 *********************************************************************


  R2008300 SATELLITE CICS TABLE CHANGES:
  -------------------------------------

  NONE AT THIS TIME

 *********************************************************************




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix C: Software Release Files                                    Page 393
______________________________________________________________________________

APPENDIX C:   SOFTWARE RELEASE FILES

 SITE     TYPE OF LIBRARY   MEMBER   VV.LL DATE    TIME TOTAL
 -------- ----------------- -------- ------------------- -----
 HOST     BATCH LOADLIB     ARCBENE 01.20 07APR08 14:29
                            ARCHSTRY 01.07 07APR08 14:29
                            ARCRSLVP 01.16 07APR08 14:29
                            CABALPHA 01.19 07APR08 14:29
                            CABBACHS 01.46 07APR08 14:29
                            CABBEMBD 01.22 05MAY08 15:43
                            CABBLUNG 01.14 07APR08 14:29
                            CABBSPCL 01.30 07APR08 14:29
                            CABDBEME 01.33 07APR08 14:29
                            CABDLMSP 01.23 07APR08 14:30
                            CABHCFA 01.14 16MAY08 12:08
                            CABHMOPR 01.30 07APR08 14:30
                            CABPGMSP 01.24 07APR08 14:30
                            CABPSMSP 01.22 07APR08 14:30
                            CABSIMSP 01.23 07APR08 14:30
                            CAHOSTOT 01.44 01MAY08 13:33
                            CIBBENEC 01.34 07APR08 14:31
                            CIBLBENE 01.05 30APR08 13:30
                            CIBLXREF 01.02 07APR08 14:31
                            CIBPTRNG 01.05 05MAY08 15:43
                            CIBPVISN 01.05 16MAY08 12:08
                            REPPREPT 01.16 07APR08 14:31
                            RRBREPT 01.17 07APR08 14:31
                            SSAXTRCT 01.21 07APR08 14:31
                            UTILBCAR 01.19 07APR08 14:32
                            UTILLOAD 01.39 07APR08 14:32
                            UTILMOVE 01.42 05MAY08 15:43
                            UTILPTRS 01.34 07APR08 14:32
                            UTLSAUX1 01.30 05MAY08 15:43
                            UTLSBDPT 01.11 07APR08 14:33
                            UTLSCAT1 01.05 28MAY08 15:20
                            UTLSCAT2 01.03 07APR08 14:33
                            UTLSCAT3 01.03 07APR08 14:33
                            UTLSCAT4 01.03 07APR08 14:33
                            UTLSCHCD 01.07 07APR08 14:34
                            UTLSSPL1 01.05 29APR08 14:06
                            UTLSSPL2 01.03 07APR08 14:34
                            UTLSSPL3 01.04 20JUN08 14:55
                            UTLSSPL4 01.04 29APR08 14:06
                            UTLSUTUT 01.14 07APR08 14:35
                            UTLS81A0 01.01 07APR08 14:35
                            UTLS81B0 01.02 07APR08 14:35
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix C: Software Release Files                                    Page 394
______________________________________________________________________________

 SITE     TYPE OF LIBRARY   MEMBER   VV.LL DATE    TIME TOTAL
 -------- ----------------- -------- ------------------- -----
                            UTLS82D0 01.01 28MAY08 15:29
                            UTLS82D1 01.00 16MAY08 12:08
                            UTLS83A1 01.01 20JUN08 11:07
                                                            45
 HOST     CNTLCARD          UTLC83A1 01.00 20JUN08 13:00
                                                             1
 HOST     COPYLIB           CABCDIAG 01.11 10JUN08 16:16
                            CABCHCCB 01.27 06JUN08 13:41
                            CABCHIPA 01.05 07APR08 14:26
                            CABCHIST 01.08 10JUN08 16:11
                            CABCIPCA 01.18 20JUN08 14:55
                            CABCRADO 01.05 10JUN08 16:16
                            CABCVSPL 01.01 25JUN08 15:07
                            CABINPCE 01.14 15APR08 11:48
                            CIOCTRNG 01.03 05MAY08 15:43
                            HUTRNGWA 01.05 05MAY08 15:43
                                                            10
 HOST     ONLINE LOAD/COPY HICRMOP 01.20 07APR08 14:26
                                                             1
 HOST     ONLINE LOADLIB    CIOLBENE 01.25 30APR08 13:30
                            CIOLTRNG 01.04 05MAY08 15:44
                            CIOPVISN 01.07 16MAY08 12:08
                            ELGACOP 01.39 05MAY08 15:44
                            ELGACRO 01.23 05MAY08 15:45
                            ELGAHOS1 01.26 07APR08 14:27
                            ELGBCOP 01.33 05MAY08 15:45
                            ELGBCRO 01.21 05MAY08 15:45
                            ELGBHOS1 01.23 07APR08 14:27
                            ELGHCOP 01.34 05MAY08 15:45
                            ELGHCRO 01.23 05MAY08 15:45
                            HABBAUDT 01.11 07APR08 14:28
                            HABBCAPS 01.05 07APR08 14:28
                            HABBDEPO 01.05 07APR08 14:28
                            HABBDLYS 01.05 07APR08 14:28
                            HABBDSMG 01.05 07APR08 14:28
                            HABBHBBM 01.07 16MAY08 12:08
                            HABBHBBR 01.06 07APR08 14:28
                            HABBHCCP 01.05 07APR08 14:28
                            HABBHCHE 01.07 07APR08 14:29
                            HABBHCIT 01.05 07APR08 14:29
                            HABBHCNR 01.06 07APR08 14:29
                            HABBHDEP 01.06 07APR08 14:29
                            HABBHHBU 01.05 07APR08 14:29
                            HABBHHMO 01.13 07APR08 14:29
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix C: Software Release Files                                    Page 395
______________________________________________________________________________

 SITE     TYPE OF LIBRARY   MEMBER   VV.LL DATE    TIME TOTAL
 -------- ----------------- -------- ------------------- -----
                            HABBHIBC 01.10 07APR08 14:29
                            HABBHIBR 01.09 02MAY08 12:40
                            HABBHICA 01.05 07APR08 14:30
                            HABBHICM 01.06 07APR08 14:30
                            HABBHIDL 01.06 07APR08 14:30
                            HABBHIHO 01.06 07APR08 14:30
                            HABBHIHS 01.08 07APR08 14:30
                            HABBHIIB 01.05 07APR08 14:30
                            HABBHIID 01.08 11JUN08 14:55
                            HABBHILP 01.07 07APR08 14:31
                            HABBHINT 01.05 07APR08 14:31
                            HABBHIOH 01.08 07APR08 14:31
                            HABBHIPA 01.05 07APR08 14:31
                            HABBHIPB 01.05 07APR08 14:31
                            HABBHISP 01.05 07APR08 14:32
                            HABBHIXR 01.05 07APR08 14:32
                            HABBHNDM 01.11 05MAY08 15:45
                            HABBUMP 01.05 07APR08 14:32
                            HABDBEME 01.05 07APR08 14:33
                            HABWALIN 01.05 07APR08 14:33
                            HABWBENE 01.05 07APR08 14:33
                            HABWBOI 01.05 07APR08 14:33
                            HABWCEPP 01.05 07APR08 14:33
                            HABWCMN 01.06 07APR08 14:34
                            HABWCOBC 01.05 07APR08 14:34
                            HABWDEPO 01.05 07APR08 14:34
                            HABWDLYS 01.05 07APR08 14:34
                            HABWDRV 01.07 10JUN08 16:11
                            HABWESRD 01.06 02MAY08 14:16
                            HABWHBP 01.08 07APR08 14:35
                            HABWHHEH 01.06 07APR08 14:35
                            HABWHHMO 01.06 07APR08 14:35
                            HABWHOSP 01.08 07APR08 14:36
                            HABWINCR 01.05 07APR08 14:36
                            HABWINPA 01.13 20JUN08 14:55
                            HABWLOPS 01.05 07APR08 14:36
                            HABWMCCD 01.05 07APR08 14:36
                            HABWMSP 01.05 07APR08 14:36
                            HABWOUTH 01.08 07APR08 14:36
                            HABWPCLM 01.09 07APR08 14:37
                            HABWPTBH 01.09 07APR08 14:37
                            HABWRNHC 01.05 07APR08 14:37
                            HABWSURG 01.05 07APR08 14:37
                            HABWTRNG 01.06 05MAY08 15:45
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix C: Software Release Files                                    Page 396
______________________________________________________________________________

 SITE     TYPE OF LIBRARY   MEMBER   VV.LL DATE    TIME TOTAL
 -------- ----------------- -------- ------------------- -----
                            HABWUHST 01.03 20JUN08 14:55
                            HABWVISN 01.06 07APR08 14:37
                            HELGMAIN 01.30 07APR08 14:38
                            HHBPUSPL 01.47 07APR08 14:38
                            HHEHUSPL 01.56 03JUN08 15:13
                            HIABCCR 01.03 10JUN08 16:16
                            HIABCCR2 01.05 16JUN08 11:22
                            HIABC00 01.29 07APR08 14:40
                            HIABNSOL 01.53 19JUN08 12:56
                            HIABUNSL 01.37 10JUN08 16:17
                            HIBCCIP 01.40 07APR08 14:41
                            HICRCAL 01.12 07APR08 14:41
                            HICRCAP 01.04 07APR08 14:41
                            HICRCBC 01.36 07APR08 14:42
                            HICRCBR 01.37 07APR08 14:42
                            HICRCCMN 01.29 07APR08 14:42
                            HICRCDC 01.36 07APR08 14:42
                            HICRCDM 01.07 07APR08 14:42
                            HICRCDY 01.11 07APR08 14:42
                            HICRCHA 01.25 07APR08 14:42
                            HICRCHS 01.35 07APR08 14:43
                            HICRCMSP 01.31 07APR08 14:43
                            HICRCOH 01.37 07APR08 14:43
                            HICRC00 01.44 16MAY08 12:09
                            HICRDEPO 01.15 07APR08 14:43
                            HICRHCIN 01.18 07APR08 14:43
                            HIDCCIP 01.39 07APR08 14:28
                            HIIOCIF 01.15 02MAY08 14:17
                            HIIPCIP 01.40 07APR08 14:29
                            HIIPCOP 01.37 15APR08 11:48
                            HIMCBOI 01.31 01MAY08 13:33
                            HIMCCMN 01.43 07APR08 14:29
                            HIMCESRD 01.28 07APR08 14:29
                            HIMCHUSC 01.22 07APR08 14:29
                            HIMCMSP 01.48 03JUN08 13:45
                            HIMCMSPU 01.11 07APR08 14:30
                            HIOPCIP 01.41 07APR08 14:30
                            HIPHOS1 01.27 07APR08 14:30
                            HIQACOP 01.45 05MAY08 15:45
                            HIQACRO 01.22 05MAY08 15:45
                            HIQHCOP 01.35 05MAY08 15:46
                            HIQHCRO 01.15 05MAY08 15:46
                            HIRDESRD 01.14 07APR08 14:31
                            HITNCOP 01.29 07APR08 14:31
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix C: Software Release Files                                    Page 397
______________________________________________________________________________

 SITE     TYPE OF LIBRARY   MEMBER   VV.LL DATE    TIME TOTAL
 -------- ----------------- -------- ------------------- -----
                            HMRCALIN 01.13 07APR08 14:31
                            HMRCBENA 01.31 07APR08 14:31
                            HMRCBENB 01.30 07APR08 14:31
                            HMRCBOD 01.24 07APR08 14:31
                            HMRCBOI 01.24 07APR08 14:32
                            HMRCCAPS 01.07 07APR08 14:32
                            HMRCCEPP 01.22 07APR08 14:32
                            HMRCCLIA 01.33 05MAY08 15:46
                            HMRCCMNA 01.29 07APR08 14:32
                            HMRCCMND 01.29 07APR08 14:32
                            HMRCCNCR 01.33 07APR08 14:33
                            HMRCDEPO 01.16 07APR08 14:33
                            HMRCDLYS 01.12 07APR08 14:33
                            HMRCDMEC 01.35 07APR08 14:33
                            HMRCDMEH 01.36 07APR08 14:33
                            HMRCDMEL 01.37 07APR08 14:34
                            HMRCDSMG 01.08 07APR08 14:34
                            HMRCESRD 01.30 07APR08 14:34
                            HMRCGHOD 01.32 07APR08 14:34
                            HMRCGPRO 01.30 07APR08 14:35
                            HMRCHCPC 01.33 05MAY08 15:46
                            HMRCHDR 01.34 07APR08 14:35
                            HMRCHHEH 01.26 07APR08 14:35
                            HMRCHMOC 01.32 05MAY08 15:46
                            HMRCHOSC 01.36 07APR08 14:35
                            HMRCHOSD 01.35 07APR08 14:35
                            HMRCHOSH 01.37 07APR08 14:36
                            HMRCHOSL 01.37 07APR08 14:36
                            HMRCHOSP 01.31 16MAY08 12:09
                            HMRCHOS1 01.37 05MAY08 15:46
                            HMRCHOS4 01.31 07APR08 14:36
                            HMRCINCR 01.19 07APR08 14:36
                            HMRCINPA 01.34 07APR08 14:36
                            HMRCINPD 01.33 07APR08 14:36
                            HMRCINPH 01.37 07APR08 14:37
                            HMRCINPL 01.36 07APR08 14:44
                            HMRCLOPS 01.16 07APR08 14:37
                            HMRCLUNG 01.29 07APR08 14:37
                            HMRCMCCD 01.26 07APR08 14:37
                            HMRCMSPA 01.31 07APR08 14:37
                            HMRCMSPD 01.35 07APR08 14:37
                            HMRCOUTD 01.34 07APR08 14:37
                            HMRCOUTH 01.38 07APR08 14:38
                            HMRCOUTL 01.37 07APR08 14:38
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix C: Software Release Files                                    Page 398
______________________________________________________________________________

 SITE     TYPE OF LIBRARY   MEMBER   VV.LL DATE    TIME TOTAL
 -------- ----------------- -------- ------------------- -----
                            HMRCOUTP 01.35 07APR08 14:38
                            HMRCPCHL 01.36 07APR08 14:38
                            HMRCPRVD 01.09 07APR08 14:38
                            HMRCPRVN 01.08 07APR08 14:38
                            HMRCPTBC 01.39 05MAY08 15:46
                            HMRCPTBH 01.40 05MAY08 15:47
                            HMRCPTBL 01.37 07APR08 14:39
                            HMRCRNHC 01.27 07APR08 14:39
                            HMRCSURG 01.32 07APR08 14:39
                            HMRCTRNG 01.23 16JUN08 14:08
                            HMRCVADE 01.14 07APR08 14:39
                            HMRCVISN 01.09 07APR08 14:40
                            HMRCXREF 01.30 07APR08 14:40
                            HUBCCDUP 01.46 17APR08 14:18
                            HUBCCED 01.69 03JUN08 15:13
                            HUBCCUT 01.59 05MAY08 15:47
                            HUCMNCUT 01.36 18APR08 11:14
                            HUCNCRUT 01.53 07APR08 14:40
                            HUCOBACR 01.19 15APR08 12:56
                            HUCUTMSP 01.39 07APR08 14:41
                            HUIPCED 01.56 30JUN08 11:11
                            HUIPCUT 01.79 30JUN08 11:11
                            HUIPUAAD 01.41 20JUN08 14:55
                            HUIPUADC 01.36 20JUN08 14:55
                            HUIPUADJ 01.33 20JUN08 14:55
                            HUIPUADS 01.36 20JUN08 14:55
                            HUIPUBEN 01.39 20JUN08 14:56
                            HUIPUBLD 01.34 20JUN08 14:56
                            HUIPUHMO 01.39 20JUN08 14:56
                            HUIPUHST 01.13 25JUN08 15:07
                            HUIPUOUT 01.34 20JUN08 14:56
                            HUIPUPCA 01.33 20JUN08 14:56
                            HUIPUPCH 01.36 20JUN08 14:56
                            HUIPUPCP 01.33 20JUN08 14:56
                            HUIPUPCS 01.35 20JUN08 14:56
                            HUIPUPSA 01.35 20JUN08 14:56
                            HUIPUPSH 01.39 20JUN08 14:56
                            HUIPUPSS 01.33 20JUN08 14:56
                            HUIPUPST 01.33 20JUN08 14:57
                            HUIPUPSY 01.37 20JUN08 14:57
                            HUIPUSPL 01.44 30JUN08 11:11
                            HUIPUTLR 01.48 20JUN08 14:57
                            HUIPVSPL 01.11 27JUN08 12:24
                            HUOPCDUP 01.36 13MAY08 14:57
______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix C: Software Release Files                                    Page 399
______________________________________________________________________________

 SITE     TYPE OF LIBRARY   MEMBER      VV.LL DATE    TIME TOTAL
 -------- ----------------- --------    ------------------- -----
                            HUOPCED     01.80 03JUN08 15:14
                            HUOPCUT     01.06 03JUN08 15:14
                            HUQACOP     01.30 05MAY08 15:48
                            HUTNCOP     01.20 07APR08 14:47
                            HUTRNGUT    01.31 09MAY08 09:48
                            HUVISNUT    01.12 07APR08 14:47
                                                              207
 HOST     ONLINE/BATCH LOAD CABBMTCH    01.05 07APR08 14:26
                            CABXPRVN    01.07 07APR08 14:26
                                                                2
 HOST     PROC LIBRARY       UTLPCAT1   01.01 16MAY08 11:51
                             UTLP82D0   01.00 27MAY08 13:30
                             UTLP82D1   01.00 27MAY08 13:30
                             UTLP83A1   01.01 20JUN08 13:00
                                                                4
 HOST     TABLES             CABHCPC    01.75 01JUL08 17:21
                                                                1
 HOST     UTILITY JCL        UTLJCAT0   01.01 16MAY08 11:51
                             UTLJCAT1   01.01 16MAY08 11:51
                             UTLJCAT2   01.01 16MAY08 11:51
                             UTLJCAT3   01.01 16MAY08 11:51
                             UTLJCAT4   01.01 16MAY08 11:51
                             UTLJCAT5   01.01 16MAY08 11:51
                             UTLJCAT6   01.01 16MAY08 11:51
                             UTLJCAT7   01.01 16MAY08 11:51
                             UTLJCAT8   01.01 16MAY08 11:51
                             UTLJCAT9   01.01 16MAY08 11:51
                             UTLJTRAN   01.10 06JUN08 13:27
                             UTLJ82D0   01.00 27MAY08 13:30
                             UTLJ82D1   01.00 27MAY08 13:30
                             UTLJ83A1   01.01 20JUN08 13:00
                             UTLMBCAR   01.08 06JUN08 13:27
                                                               15
                                                              286
 SATL     COPYLIB            CABEHUQA   01.11 05MAY08 15:43
                             CIOCBENE   01.21 07APR08 14:26
                             ELGCBUNF   01.08 05MAY08 15:43
                             ELGCUNFO   01.10 05MAY08 15:43
                             HIMRMAP    01.32 05MAY08 15:43
                                                                5
 SATL     ONLINE LOAD/COPY   HMRMSMO    01.03 05MAY08 15:43
                                                                1


______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland
Common Working File                                                   R2008300
Final Quarterly Release Document                                  July 3, 2008
Appendix C: Software Release Files                                    Page 400
______________________________________________________________________________

 SITE     TYPE OF LIBRARY   MEMBER   VV.LL DATE    TIME TOTAL
 -------- ----------------- -------- ------------------- -----
 SATL     ONLINE LOADLIB    ELGASAT2 01.28 05MAY08 15:44
                            ELGBSAT2 01.26 05MAY08 15:44
                            HHBPC00  01.27 07APR08 14:27
                            HIPSAT2  01.18 05MAY08 15:44
                            HMRCCLPG 01.33 05MAY08 15:44
                            HMRCHCPI 01.33 05MAY08 15:44
                            HMRCHMOI 01.33 05MAY08 15:44
                            HMRCSAT1 01.34 05MAY08 15:44
                                                             8
 SATL     ONLINE/BATCH LOAD CABEDMSP 01.04 23APR08 11:34
                                                             1
 SATL     TABLES            CARTBL   01.60 03JUN08 15:15
                                                             1
                                                            16
                                                           302




______________________________________________________________________________
2020 Company, LLC                                          Baltimore, Maryland

								
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