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					Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
                                                                       Page i
_____________________________________________________________________________


TO:        Host sites, STC Beta site, SSMs, and CMS
FROM:      Christopher Sheridan
DATE:      October 3, 2007
SUBJECT:   R2008100 Full Requirements Document

The following release document is being transmitted today, Wednesday, October
3, 2007, via NDM.

Important Notes:

   1. Due to the high number of Group 1 CMS mandate CRs in this release, the
      Group I and Full Requirements documents are being combined for this
      release.

   2. This document contains 29 CRs, 17 of them are Group 1, and the other 12
      are Group 2 CRs.

   3. The Final PMs have not been received, and the Requirement walkthroughs
      have not been completed for the following CRs:

      00025627 - 5725-MEDICARE FRAUD EDIT MODULE
      00025629 - 5728 - MEDICARE FEE FOR SERVICE (FFS) NPI FINAL IMPLEMENTATI
      00025653 - 5775 - ANNUAL 2008 HCPCS UPDATE

   4. The updated HCPCS file has not yet been received, and the Requirement
      walkthrough has not been completed for the following CR:

      00025599 - 5696-2008 ANNUAL UPDATE TO HCPCS FOR SNF CB FOR CWF

   5. The following CRs have not completed their Requirement walkthrough due
      to their late addition to the release on September 11, 2007:

      00025230   -   CWF EXTRACTS REMOVAL FROM DAILY PROCESS
      00025281   -   CABSKIP INCREASE MAX CONTRACTORS DROP OSA (CLAIMS,RESP,IUR)
      00025409   -   RECEIVING ASRA WITH DISPOSITION 01 ON HUHH-REFER TO PL25323
      00025433   -   REMOVE HIQM FROM FUTURE PROVIDER INQUIRY CHANGES
      00025527   -   HCPA TRANSACTION SETTING ZEROS ON HOSPITALS DAYS IN HICR
      00025551   -   CONVERT CWF SOFTWARE TO RUN UNDER CICS TRANS SERVER V2.3
      00025580   -   DELETING CORRUPT BENE RECORDS
      00025636   -   ELIGIBILITY AUDIT PURGE

   6. Written comments/questions are due back to CMS and the CWF Maintainer
      (CSC), via e-mail, no later than 10/10/2007. Responses to those
      comments/questions will be returned to the CWF community no later than
      10/17/2007. As long as they are received by the appropriate date, any
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
                                                                      Page ii
_____________________________________________________________________________


      changes prompted by the responses will be incorporated, as needed, into
      the Pre-Release document, which will be transmitted on 10/23/2007 in
      preparation for the Pre-Release Conference call scheduled for
      10/31/2007.

      Comments/Questions should be sent to the following email addresses:
      jalexa23@csc.com, vvuyyuru@csc.com, dkocovin@csc.com,
      kallen1@cms.hhs.gov, kwoytan@cms.hhs.gov, wolfsheimer@cms.hhs.gov,
      Kathy.Johnson@cms.hhs.gov and cpflaum@cms.hhs.gov

If you have any questions regarding this Release, please contact the Release
Coordinators, John Alexander at (443) 436-6751 (primary contact) or Vinay
Vuyyuru at (443) 436-6719 (secondary contact).

Thank you.

This document includes:

I.   CHANGE REQUESTS ........................................................1

      1.     00025138   5331-UPDATE TO POS TO ADD FOR PRISON/CORRECTIONAL ON DME.1

      2.     00025230   CWF EXTRACTS REMOVAL FROM DAILY PROCESS..................7

      3.     00025281   CABSKIP INCREASE MAX CONTRACTORS DROP OSA (CLAIMS,RESP,IUR)
                          .......................................................9

      4.     00025343   5481-NATIONAL PROCESS TO AUTOMATE THE EXCEPTIONS TO THERAPY
                          ......................................................11

      5.     00025391   HHMO WHERE BENE HAS BOTH HMO AND HOSPICE GENERATING IUR.31

      6.     00025405   UR 5233 SETTING IN ERROR ON NO PAY SNF OVERLAPS HMO PERIOD
                          ......................................................37

      7.     00025409   RECEIVING ASRA WITH DISPOSITION 01 ON HUHH-REFER TO PL25323
                          ......................................................52

      8.     00025433   REMOVE HIQM FROM FUTURE PROVIDER INQUIRY CHANGES........57

      9.     00025466   5560-EXCL SANCTIONED PROVIDERS (PT A/DMERC) FROM COBC PROC.
                          ......................................................61

      10. 00025482      SNF EDIT 7261 SETTING INAPPROPRIATELY...................90

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
                                                                     Page iii
_____________________________________________________________________________


      11. 00025527   HCPA TRANSACTION SETTING ZEROS ON HOSPITALS DAYS IN HICR103

      12. 00025535   5624-ADDITIONAL CWF EDITING FOR SNF CB.................109

      13. 00025551   CONVERT CWF SOFTWARE TO RUN UNDER CICS TRANS SERVER V2.3153

      14. 00025555   HICN 432XXXXXXA RECEIVING ERROR CODE 5248 IN ERROR.....181

      15. 00025559   UR 538E SETTING IN ERROR ON HHA WHEN SUBSEQUENT EPISODE188

      16. 00025562   5648-IMPLEMENT NEW CONTRACTOR ID FOR STC...............193

      17. 00025564   5653-CLARIFICATION OF SNF BILLING REQS FOR BENE ON MA PLANS
                       .....................................................201

      18. 00025566   5663-PHASEII IMPLEMENTATION OF CASE MIX REFINEMENT FOR
                      HHPPS ................................................226

      19. 00025580   DELETING CORRUPT BENE RECORDS..........................247

      20. 00025582   5679-PRESENT ON ADMISSION INDICATOR SYSTEMS IMPLEMENTATION
                       .....................................................252

      21. 00025594   DOCUMENTATION CHANGES FOR RELEASE R2008100.............261

      22. 00025595   EXTERNAL COPYBOOK CHANGES FOR R2008100.................268

      23. 00025596   R2008100 INSTALLATION INSTRUCTION - ONE-TIMER CONTROL CR273

      24. 00025597   ARCHIVE MAINTENANCE FOR RELEASE R2008100...............279

      25. 00025599   5696-2008 ANNUAL UPDATE TO HCPCS FOR SNF CB FOR CWF....290

      26. 00025627   5725-MEDICARE FRAUD EDIT MODULE........................301

      27. 00025629   5728 - MEDICARE FEE FOR SERVICE (FFS) NPI FINAL
                      IMPLEMENTATI .........................................306

      28. 00025636   ELIGIBILITY AUDIT PURGE................................314

      29. 00025653   5775 - ANNUAL 2008 HCPCS UPDATE........................319

II.   ANALYSIS CHANGE REQUESTS .............................................325

      None to report.......................................................325
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                        Page 1
____________________________________________________________________________


I.         CHANGE REQUESTS

      1.     00025138   5331-UPDATE TO POS TO ADD FOR PRISON/CORRECTIONAL ON DME

     DATE ENTERED:      09/14/06

     TITLE:             5331-UPDATE TO POS TO ADD FOR PRISON/CORRECTIONAL ON DME

     PROJECT CODE:      CM01

     PRIORITY:          1

     RELEASE LEVEL: R2008100

     GROUP LEVEL:       1

     HOST SITE ID:      CWFM2000

     STATUS ON CR:      WORK

     DOC. REQUIRED: N

     HOST EVAL:         N/A

     DOC RECEIVED:      N

     ADDENDUM INFO: NONE

     EST. CATEGORY:     1
     EST. HOURS:        0075
     ACT. HOURS:        0055
     CAT/CR EVAL:       N

     COMMENT:           N/A

     DESCRIPTION:
     ------------
     The Medicare fee-for-service POS code set shall be coextensive
     with the CMS-maintained, HIPAA-standard POS code set.
     DMERCs/DME MACs shall accept as valid the POS code "09"
     for a prison/correctional facility.

  CWF REQ:
  CWF shall modify maintenance edit 'C029' to allow POS
  code set the prison/correctional facility (09) for
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                        Page 2
____________________________________________________________________________

  CMNs (HUCM).

  NOTE: CWF will not need to modify consistency edit 77x1
        since the modification to allow POS 09 was
        implemented in the R2007100 release for CWF CR 24670.

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:            __25138__________   WORK TYPE:   ___   Incidental
  SUBSYSTEM:     _________________                _X_   Minor
  FUNCTION:      _________________                ___   Major
  PROGRAM:       _________________                ___   New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                  Kathy Woytan
      Telephone:            410-786-4982
      FAX, CMS:             410-786-0271
      Responsibilities:     REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:      Karen Chaffin
      Telephone:            469-372-0645
      FAX,Richardson,TX:    469-372-0284
      Responsibilities:     DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:        Liz Hayes
       Telephone:           443-436-6899
       FAX,Baltimore,MD:    443-436-0819
       Responsibilities:    ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                            TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *              blank line is found.                               *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *              after a colon. Try to format as it should appear *
  *              in the Release Document.                           *
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                        Page 3
____________________________________________________________________________

  *******************************************************************
    IMPACT:
  (X) Host
  ( ) Satellite Part A Inpatient
  ( ) Satellite Part A Outpatient
  ( ) Satellite Part B
  ( ) Hospice
  ( ) Home Health
  (X) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  The Medicare fee-for-service POS code set shall be coextensive
  with the CMS-maintained, HIPAA-standard POS code set. DMEMACs
  shall accept as valid the POS code "09" for a prison/
  correctional facility.

  CWF shall modify maintenance edit 'C029' (Invalid Patient
  Residence) to allow POS code set the prison/correctional
  facility (09) for CMNs (HUCM).

  Note:   CWF will not need to modify consistency edit '77x1
          since the modification to allow POS 09 was implemented in
          the R2007100 release for CWF CR 00024670.

  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

    NEW BUSINESS REQUIREMENTS:

  Requirement 1
  CWF must modify CMN maintenance edit 'C029' to allow the new
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                        Page 4
____________________________________________________________________________

  POS '09' for prison/correctional facility.

  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  ******************************************************************
  * If you want the EVENT-RESPONSEs printed in the release document*
  * remove the word "None" and delete the delimiter line. Number *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.        *
  * NBR 1, Event would be 1.1, NBR 2,Events would be 2.1, 2.2, etc.*
  ******************************************************************
    EVENT-RESPONSE LIST:
  ***.......This is the width of the Release Document.......***

  Event 1.1
  Perform an HUCM transaction using the new prison/correctional POS
  '09' in the residence field.

  Response
  The transaction is accepted and edit 'C029' does not set.

  ***.......This is the width of the Release Document.......***

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

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1. DME Maintenance

  Solution Criteria: N/A

    EDITS AFFECTED:
  ***.......This is the width of the Release Document......***

  a. Error Code:    C029   ( )New (X)Modified ( )Deleted
  Disposition: CM

  Type of Record: CMN

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                        Page 5
____________________________________________________________________________

  Error Message:
  Invalid Patient Residence.

  Set Condition for edit 'C029': Under Development

  When   the CMN patient residence is not equal to
  '01'   Pharmacy
  '04'   Homeless Shelter
  '09'   Prison/Correctional Facility
  '12'   Home
  '13'   Assisted Living Facility
  '14'   Group Home
  '31'   Skilled Nursing Facility
  '32'   Nursing Facility
  '33'   Custodial Care Facility
  '34'   Hospice
  '54'   Intermediate Care Facility/Mentally Retarded
  '55'   Substance Abuse Treatment Facility
  '56'   Psychiatric Treatment Facility, or
  '61'   Comprehensive Inpatient Rehabilitation Facility

  and the CMN DMEPOS category is not equal to '7', and the CMN
  patient residence is not equal to '21', set the 'C029' error
  code.

  When the CMN transaction type is equal to '3', bypass this
  edit.

  Trailer Information: '08'


  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  Kathy---FYI
  When we created CWF CR 25138 for CMS CR 5331 for DME, CMS also
  created CMS CR 4316 for Part B for the same requirement to allow POS
  '09'. CWF did implement CMS CR 4316 (CR24670) in the R2007100
  release. The consistency edit 77x1 that was modified to allow POS '09'
  for Part B shares the same module for both Part B and DME and it
  appears CWF will allow the new POS 09 for both at this time.
  CWF will only be making a modification to the HUCM (CMN) edit (C029)
  to allow POS '09' for CMS CR 5331.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                        Page 6
____________________________________________________________________________


  Vicki

  ------------

  Yes Vicki, Part B and DME share the same consistency modules
  for edit 77x1.
  Since Position codes are listed as 88 level in the program, the
  code changes for CR 24670 in R2007100 rlse were applied to both
  Part B and DME.

  Thanks
  Gopal


  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                        Page 7
____________________________________________________________________________


   2.   00025230   CWF EXTRACTS REMOVAL FROM DAILY PROCESS

  DATE ENTERED:    10/30/06

  TITLE:           CWF EXTRACTS REMOVAL FROM DAILY PROCESS

  PROJECT CODE:    CM01

  PRIORITY:        3

  RELEASE LEVEL: R2008100

  GROUP LEVEL:     2

  HOST SITE ID:    CWFM1000

  STATUS ON CR:    INIT

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   3
  EST. HOURS:      0300
  ACT. HOURS:      0136
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  10/26/2006
  TO ALL,
  CMS COMPONENT CMM HAS NOTIFIED DIVISION OF SYSTEMS OPERATIONS,
  CWF PRODUCTION, THAT WPS HAS SUCCESSFULLY TRANSITIONED TO THE
  270/271 DATA SOURCE. THEREFORE, EFFECTIVE FRIDAY, OCTOBER 27, 2006
  THE CWF HOSTS SHOULD NOT TRANSMIT THE CWF/WPS EXTRACT FILE ANYMORE.
  CSC (JERRY) PLEASE ADD THIS INFORMATION TO THE CR WHICH MAKES
  CHANGES FOR THE TERMINATION OF THE EXTRACT FILE FOR NHIC. WE CAN
  DO THE CHANGES FOR BOTH NHIC AND WPS AT THE SAME TIME.
  TRAILBLAZER BAS/CSC PLEASE REVIEW CRS SCHEDULED FOR JANUARY AND
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                        Page 8
____________________________________________________________________________

  APRIL 2007 FOR REQUIREMENTS RELATED TO NHIC AND WPS EXTRACT FILES. THE
  REQUIREMENTS SHOULD BE REMOVED.

  ANY QUESTIONS FEEL FREE TO CONTACT ME.

  RICK WOLFSHEIMER
  BUSINESS APPLICATIONS MANAGEMENT GROUP
  DIVISION OF SYSTEMS OPERATIONS
  PRODUCTION SUPPORT TEAM
  10/06/2006
  TO ALL,
  THE EMAIL BELOW WILL BE OUR NOTIFICATION TO TERMINATE THE CWF/NHIC
  EXTRACT PROCESS. I DO UNDERSTAND CURRENTLY WE ARE NOT SENDING NHIC FILES
  BECAUSE THEY MADE A CHANGE ON THEIR END NOT TO ACCEPT THE FILES.
  JERRY,
  PLEASE OPEN A CR FOR A CWF CHANGE TO ELIMINATE THE CREATION OF THE
  NHIC EXTRACT FILE. WE CAN SCHEDULE IN AN UPCOMING PRIORITY RELEASE.
  RICK WOLFSHEIMER
  BUSINESS APPLICATIONS MANAGEMENT GROUP
  DIVISION OF SYSTEMS OPERATIONS
  PRODUCTION SUPPORT TEAM

  NO FREEFORM REQUIREMENTS FOR THIS RECORD
  ----------------------------------------

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************



______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                        Page 9
____________________________________________________________________________


   3.   00025281   CABSKIP INCREASE MAX CONTRACTORS DROP OSA (CLAIMS,RESP,IUR)

  DATE ENTERED:    11/22/06

  TITLE:           CABSKIP INCREASE MAX CONTRACTORS DROP OSA (CLAIMS,RESP,IUR)

  PROJECT CODE:    CM01

  PRIORITY:        2

  RELEASE LEVEL: R2008100

  GROUP LEVEL:     2

  HOST SITE ID:    CWFM1000

  STATUS ON CR:    INIT

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   4
  EST. HOURS:      0750
  ACT. HOURS:      0320
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  DUE TO CONTRACTOR TRANSITIONS, THERE IS A NEED TO INCREASE THE MAXIMUM
  LIMITATION OF 4 CONTRACTORS TO AN UNLIMITED NUMBER OF CONTRACTORS.
  WHEN A CONTRACTOR TRANSITION OCCURS THERE IS A NED TO DROP OSA
  PROCESSING FOR A SPECIFIC NUMBER OF DAYS. THE EXISTING TECHNICAL
  CAPABILITY TO DROP OSA PROCESSING IS THE CABBHXMT JOB. THIS JOB TAKES
  HOST SEPECIFIED CONTRACTORS AND DOPS OSA ACTIVITY (CLAIMS, RESPONSES,
  AND IUR) FROM DATE OF IMPLEMENTATION THRU THE DATE SPECIFIED. THERE IS
  A MAXIMUM OF 4 CONTRACTORS THAT CAN BE SPECIFIED. CR 25097 AND CR 25188
  COMBINED FOR A TOTAL OF 9 CONTRACTORS WHICH REQUIRED THEIR OSA BE
  DROPPED. THE HOST WORKED AROUND THIS PROBLEM BY MANUALLY ALTERING
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 10
____________________________________________________________________________

  THEIR INPUT FILE CONCATENATION TO COMMENT OUT THOSE SPECIFIC CONTRACTOR
  INPUT FILES. THIS IS NOT THE DESIRED MEANS TO AFFECT DROPPING OF
  OSA. DUE TO ADDITIONALLY ANTICIPATED A/B MAC CONTRACTOR TRANSITIONS,
  THIS CR IS BEING CREATED. CURRENTLY, THE SOFTWARE PROCESSES THE PARM
  AND DOES NOT TABLE THE 1 TO 4 CONTRACTORS. THIS SOFTWWARE CHANGE
  WILL BE DESIGNED TO PROCESS MULTIPLE PARM CARDS TO EFFECTIVELY
  ALLOW AN UNLIMITED NUMBER OF CONTRACTORS TO BE SPECIFIED.

  AFTER FURTHER DISCUSSION WITH CMS AND THE HOSTS MAX 10 CONTRACTORS
  LIMIT FOR THE CABSKIP PARM IS DETERMINED.

  WHILE TESTING THIS CR PLEAS MAKE SURE PLOG 25025 IS ALSO BEING
  TESTED AS PER CMS DECISION.

  NO FREEFORM REQUIREMENTS FOR THIS RECORD
  ----------------------------------------

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 11
____________________________________________________________________________


   4.   00025343   5481-NATIONAL PROCESS TO AUTOMATE THE EXCEPTIONS TO THERAPY

  DATE ENTERED:    12/22/06

  TITLE:           5481-NATIONAL PROCESS TO AUTOMATE THE EXCEPTIONS TO THERAPY

  PROJECT CODE:    CM01

  PRIORITY:        1

  RELEASE LEVEL: R2008100

  GROUP LEVEL:     1

  HOST SITE ID:    CWFM2000

  STATUS ON CR:    WORK

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   3
  EST. HOURS:      0300
  ACT. HOURS:      0220
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  Financial limitations on Medicare covered therapy services
  (therapy caps) were implemented on January 1, 2006. In
  the Deficit Reduction Act, Congress provided that exceptions
  to this dollar limitation may be made when provision of
  additional therapy services is determined to be medically
  necessary. This exceptions process was initially effective
  only for services provided in calendar year 2006. Additional
  legislation, the Tax Relief and Health Care Act, has extended the
  application of this exceptions process for one year, calendar year
  2007.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 12
____________________________________________________________________________


  A nationally consistent systematic process to implement the exceptions
  is preferable to local processes. This instruction provides requirement
  for this national process, implementing the exceptions via the Common
  Working File.

  CWF REQS:

  CWF shall not reject services that would otherwise exceed the therapy
  financial limitations if modifier KX is appended to the HCPCS
  codes for the service.
  The following Utilization codes should no longer set if KX modifier
  is present on HUOP or HUBC:
  '8022' '8024', '5412', and '5413'.
  This applies to Dates of Service 01/01/2006 and after.
  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:          25343____________    WORK TYPE:   ___   Incidental
  SUBSYSTEM:   _________________                 ___   Minor
  FUNCTION:    _________________                 xxx   Major
  PROGRAM:     _________________                 ___   New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                 Vivian Rogers
      Telephone:           410-786-8142
      FAX, CMS:            773-252-1319
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     Janice Maxwell
      Telephone:           773-252-1327
      FAX,Richardson,TX:   773-252-1319
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       Heather Byram
       Telephone:          717-909-2228
       FAX,Baltimore,MD:   443-436-0819
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 13
____________________________________________________________________________

  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *               blank line is found.                              *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (X) Host
  ( ) Satellite Part A Inpatient
  (X) Satellite Part A Outpatient
  (X) Satellite Part B
  ( ) Hospice
  (X) Home Health
  ( ) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  HUBC and HUOP claims submitted with line items containing
  Modifier 'KX' that would otherwise exceed the financial PT/OT
  limitations will now bypass the following errors:

  EDITS:
  8022 - Physical therapy expense limit over applied. Physical
         therapy expense submitted is greater than the expense to
         be met.

  8024 -   Occupational therapy expense limit over-applied.
           Occupational therapy expense submitted is greater than
           expense to be met.

  5412 -   Physical therapy adjustment necessary for MSP claim. This
           edit will be bypassed for all CHOICES, and ESRD Managed
           Care Demonstration and ENCOUNTER claims.

  5413 - Occupational therapy adjustment necessary for MSP claim.
         This edit will be bypassed for all CHOICES, and ESRD
         Managed Care Demonstration and ENCOUNTER claims.

  MODIFIERS:
  GN - Services delivered under an outpatient speech-language
  pathology plan of care.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 14
____________________________________________________________________________

 GO - Services delivered under an outpatient OT plan of care

 GP - Services delivered under an outpatient PT plan of care

 KX - Exception to therapy cap.

 This applies to claims with Dates of Service 01/01/2006
 and after.
 ***.......This is the width of the Release Document.......***

 Analyze Current Situation:

 Alternative Solutions: N/A

 Evaluation of Alternative Solutions: N/A

 Recommendation: N/A


 *******************************************************************
 * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
 * the release document. Numerically list statements that reflect *
 * the NEW BUSINESS REQUIREMENTS.                                  *
 *******************************************************************

   NEW BUSINESS REQUIREMENTS:

 Requirement 1
 CWF must bypass error code '8022' (Physical therapy expense
 limit over applied. Physical therapy expense submitted is
 greater than the expense to be met) when an HUOP claim
 (TOB 22X, 23X, 34X, 74X and 75X) is submitted with Modifiers
 'GN'(Services delivered under an outpatient speech-language
 pathology plan of care) or 'GP' (Services delivered under an
 outpatient PT plan of care), Dates of Service on or after
 01/01/2006 and Modifier 'KX' (Exception to therapy cap) is
 present.

  Requirement 2
  CWF must bypass error code '8022' (Physical therapy expense
  limit over applied. Physical therapy expense submitted is
  greater than the expense to be met) when an HUBC claim is
  submitted with Modifiers 'GN' (Services delivered under an
  outpatient speech-language pathology plan of care) or
  'GP' (Services delivered under an outpatient PT plan of care),
  Dates of Service are on of after 01/01/2006, and Modifier 'KX'
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 15
____________________________________________________________________________

  (Exception to therapy cap) is present.

  Requirement 3
  CWF must bypass error code '8024' (Occupational therapy
  expense limit over-applied. Occupational therapy expense
  submitted is greater than the expense to be met) when an
  HUOP claim (22X, 23X, 34X, 74X, 75X) is submitted with
  Date of Service on or after 01/01/2006, Modifiers 'KX' (exception
  to therapy cap) and 'GO' (Services delivered under an outpatient
  OT plan of care) is present.

  Requirement 4
  CWF must bypass error code '8024' (Occupational therapy
  expense limit over-applied. Occupational therapy expense
  submitted is greater than the expense to be met) when an
  HUBC claim is submitted with Modifier 'GO' (Services delivered
  under an outpatient OT plan of care) Date of Service on or after
  01/01/2006, and contains Modifier 'KX' (Exception to therapy cap).

  Requirement 5
  CWF must bypass error code '5412' (Physical therapy adjustment
  necessary for MSP claim) when an HUOP claim (22x, 23X, 34X, 74X, 75X)
  is submitted that contains a Date of Service on or after
  01/01/2006, Modifier 'GP' (Services delivered under an outpatient PT
  plan of care) and 'KX' (Exception to therapy cap) are present.

  Requirement 6
  CWF must bypass error code '5412' (Physical therapy adjustment
  necessary for MSP claim) when an HUBC claim is submitted
  that contains a Date of Service on, or after 01/01/2006,
  Modifier 'GN' (Services delivered under an outpatient speech-language
  pathology plan of care) or 'GP' (Services delivered under an outpatient
  PT plan of care) and Modifier 'KX' (Exception to therapy cap).

  Requirement 7
  CWF must bypass error code '5413' (Occupational therapy
  adjustment necessary for MSP claim) when an HUOP (22X, 23X
  34X, 74X, 75X) is submitted that contains a Date of Service
  on, or after 01/01/2006, Modifier 'GO' (Services delivered under an
  outpatient plan of care) and 'KX'(Exception to therapy cap).

  Requirement 8
  CWF must bypass error code '5413' (Occupational therapy
  adjustment necessary for MSP claim) when an HUBC is submitted
  that contains a Date of Service on, or after 01/01/2006, Modifier
  'GO' (Services delivered under an outpatient OT plan of care) and
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 16
____________________________________________________________________________

  'KX' (Exception to therapy cap).
  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  ******************************************************************
  * If you want the EVENT-RESPONSEs printed in the release document*
  * remove the word "None" and delete the delimiter line. Number *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.        *
  * NBR 1, Event would be 1.1, NBR 2,Events would be 2.1, 2.2, etc.*
  ******************************************************************
    EVENT-RESPONSE LIST:
  ***.......This is the width of the Release Document.......***

  Event 1.1
  Submit an HUOP record (TOB 22X, 23X, 34X, 74X and 75X) that
  contains PT services (modifier GN/GP) and will cause the
  financial limit to be exceeded and set error code '8022'.
  One of the Modifier fields contains modifier 'KX'.

  Response
  The edit is bypassed.

  Event 1.2
  Submit an HUOP record (TOB 22X, 23X, 34X, 74X and 75X) that
  contains PT services (modifier GN/GP) that will cause the
  financial limit to be exceeded and set error code '8022'.
  Modifier 'KX' is not on the claim.

  Response
  Edit '8022' is set.

  Event 1.3
  Submit an HUOP record (TOB 22X, 23X, 34X, 74X and 75X) that
  contains PT services (modifier GN/GP) that will cause the
  financial limit to be exceeded and set error code '8022'.
  Modifier 'KX' is not on the claim; '8022' is present in the
  override field.

  Response
  Edit '8022' is not set.

  Event 2.1
  Submit an HUBC record that contains PT services (modifier GN/GP)
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 17
____________________________________________________________________________

  that will cause the financial limit to be exceeded and set error
  code '8022'. One of the Modifier fields contains Modifier
  'KX'.

  Response
  The edit is bypassed.

  Event 2.2
  Submit an HUBC record that contains PT services (modifier GN/GP)
  that will cause the financial limitation to be exceeded and set
  error code '8022'. Modifier 'KX' is not present.

  Response
  Edit '8022' is set.

  Event 2.3
  Submit an HUBC record that contains PT services (modifier GN/GP)
  that will cause the financial limitation to be exceeded and set
  error code '8022'. Modifier 'KX' is not present, '8022' is present
  in the override field.

  Response
  Edit '8022' is not set.

  Event 3.1
  Submit an HUOP record (TOB 22X, 23X, 34X, 74X and 75X) that
  contains OT services (modifier GO) that will cause the
  financial limitation to be exceeded and set error code '8024'.
  Modifier 'KX' is present.

  Response
  The edit is bypassed.

  Event 3.2
  Submit an HUOP record (TOB 22X, 23X, 34X, 74X and 75X) that
  contains OT services (modifier GO) that will cause the financial
  limitation to be exceeded and set error '8024'. Modifier 'KX'
  is not submitted.

  Response
  Edit '8024' is set.

  Event 3.3
  Submit an HUOP record (TOB 22X, 23X, 34X, 74X and 75X) that
  contains OT services (modifier GO) that will cause the financial
  limitation to be exceeded and set error '8024'. Modifier 'KX'
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 18
____________________________________________________________________________

  is not submitted; '8024' is present in the override field.

  Response
  Edit '8024' is not set.

  Event 4.1
  Submit an HUBC record that contains OT services (modifier GO) that
  will cause the financial limitation to be exceeded and set error
  code '8024'. One of the Modifier fields contains Modifier 'KX'.

  Response
  The edit is bypassed.

  Event 4.2
  Submit an HUBC record that contains OT services (modifier GO)
  that will cause the financial limitation to be exceeded and set error
  code '8024'. Modifier 'KX' is not submitted.

  Response
  Edit '8024' is set.

  Event 4.3
  Submit an HUBC record that contains OT services (modifier GO)
  that will cause the financial limitation to be exceeded and set error
  code '8024'. Modifier 'KX' is not submitted; '8024' is present in
  the override field.

  Response
  Edit '8024' is not set.

  Event 5.1
  Submit an HUOP claim (TOB 22X, 23X, 34X, 74X and 75X) that
  contains PT services (modifier GN/GP) that will cause the
  financial limitation to be exceeded and set error code '5412'.
  Modifier 'KX' is submitted on the claim.

  Response
  Edit '5412' is not set.

  Event 5.2
  Submit an HUOP claim (TOB 22X, 23X, 34X, 74X and 75X) that
  contains PT services (modifier GN/GP) that will cause the financial
  limitation to be exceeded and set error code '5412'. Modifier
  'KX' is not submitted.

  Response
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 19
____________________________________________________________________________

 Edit '5412' is set.

 Event 5.3
 Submit an HUOP claim (TOB 22X, 23X, 34X, 74X and 75X) that
 contains PT services (modifier GN/GP) that will cause the financial
 limitation to be exceeded and set error code '5412'. Modifier
 'KX' is not submitted; '5412' is present in the override field.

 Response
 Edit '5412' is not set.

 Event 6.1
 Submit an HUBC claim that contains PT services (modifier GN/GP) that
 will cause the financial limitation to be exceeded and set error
 code '5412'. Modifier 'KX' is submitted.

 Response
 Edit '5412' is not set.

 Event 6.2
 Submit an HUBC claim that contains PT services (modifier GN/GP)
 that will cause the financial limitation to be exceeded and set
 error code '5412'. Modifier 'KX' is not submitted.

 Response
 Edit '5412' is set.

 Event 6.3
 Submit an HUBC claim that contains PT services (modifier GN/GP)
 that will cause the financial limitation to be exceeded and set
 error code '5412'. Modifier 'KX' is not submitted; '5412' is
 present in the override field.

 Response
 Edit '5412' is not set.

 Event 7.1
 Submit an HUOP claim (TOB 22X, 23X, 34X, 74X and 75X)
 that contains OT services (modifier GO) that will cause the
 financial limitation to be exceeded and set '5413'. Modifier
 'KX' is submitted.

 Response
 Edit '5413' is not set.

  Event 7.2
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 20
____________________________________________________________________________

  Submit an HUOP claim (TOB 22X, 23X, 34X, 74X and 75X) that contains
  PT service (modifier OT) that will cause the financial limitation
  to be exceeded and set error code '5413'. Modifier 'KX' is
  not submitted.

  Response
  Edit '5413' is set.

  Event 7.3
  Submit an HUOP claim (TOB 22X, 23X, 34X, 74X and 75X) that contains
  PT service (modifier OT) that will cause the financial limitation
  to be exceeded and set error code '5413'. Modifier 'KX' is
  not submitted; '5413' is present in the override field.

  Response
  Edit '5413' is not set.

  Event 8.1
  Submit an HUBC claim that contains OT services (modifier OT) that will
  cause the financial limitation to be exceeded and set
  error code '5413'. Modifier 'KX' is submitted.

  Response
  Edit '5413' is not set.

  Event 8.2
  Submit an HUBC claim that contains OT services (modifier OT) that will
  cause the financial limitation to be exceeded and set
  error code '5413'. Modifier 'KX' is not submitted.

  Response
  Edit '5413' is set.

  Event 8.3
  Submit an HUBC claim that contains OT services (modifier OT) that will
  cause the financial limitation to be exceeded and set
  error code '5413'. Modifier 'KX' is not submitted; '5413' is present
  in the override field.

  Response
  Edit '5413' is not set.

  ***.......This is the width of the Release Document.......***

  The Entity List includes only NEW acronyms and terminology
  that is currently not in use in CWF.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 21
____________________________________________________________________________


  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1. Utilization Module

  Solution Criteria: N/A

    EDITS AFFECTED:
  ***.......This is the width of the Release Document......***
  ***UNDER DEVELOPMENT***
  a. Error Code: 8022 ( )New (X)Modified ( )Deleted
  Disposition: AA

  Type of Record: HUOP

  Error Message:
  Outpatient physical therapy expense limit over applied.
  Physical therapy expense submitted is greater than the
  expense to be met.

  Set Condition for edit '8022':
  When the physical therapy expenses submitted are greater than
  the amount remaining to be met for the year, set the '8022'
  error code.

  Dates of Service on or after 01/01/2007 through
  12/31/2007: Limit is $1780.00.

  Dates of Service on or after 01/01/2006 through
  12/31/2006: Limit is $1740.00.
  Dates of Service on or after 09/01/2003: Limit is $1590.00.
  Dates of Service 01/01/2000 through 08/31/2003: No Limit

  When Date of Service is prior 01/01/2006 or after 12/31/2007
  or Type of Bill is not equal to '22x', '23x', '34x', '74x' or
  '75x' or the No-Pay Code on claim header equals 'N' or no
  line item has Modifier 'GN' or 'GP' or PTOT override Code on
  the claim header equal '1', bypass this edit.

  Trailer Information:     08, 11, 34

  ***UNDER DEVELOPMENT***
  b. Error Code: 8022 ( )New (X)Modified ( )Deleted
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 22
____________________________________________________________________________

  Disposition:   AA

  Type of Record: HUBC

  Error Message:
  Part B physical therapy expense limit over applied. Physical
  therapy expense submitted is greater than the expense to be
  met.

  Set Condition for edit '8022':

  When the physical therapy expenses submitted are greater than
  the amount remaining to be met for the year, set the '8022'
  error code.

  Dates of Service on or after 01/01/2007 through
  12/31/2007: Limit is $1780.00

  Dates of Service on or after 01/01/2006 through
  12/31/2006: Limit is $1740.00

  Dates of Service is 09/01/2003: Limit is $1590.00

  Dates of Service 01/01/2000 through 08/31/2003: No Limit
  Dates of Service 1999: Limit is $1500.00.

  Dates of Service 1994-1998 (inclusive): Limit is $900.00.
  Dates of Service 1990-1993 (inclusive): Limit is $750.00.

  Dates of Service 1989 and earlier: Limit is $500.00.

  Dates of Service after 09/01/2003 and HIBC-ABCROSS-IND
  (labeled ED OVERRIDE in HITF) equals '3', bypass this edit.

  Trailer Information:   07, 08, 11

  ***UNDER DEVELOPMENT***
  c. Error Code: 8024 ( )New (X)Modified ( )Deleted
  Disposition: AA

  Type of Record: HUOP

  Error Message:
  Occupational therapy expense limit over-applied.
  Occupational therapy expense submitted is greater than the
  expense to be met.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 23
____________________________________________________________________________



  Set Condition for edit '8024':
  When the occupational therapy expenses submitted are greater
  than the amount remaining to be met for the year, set the
  '8024' error code.

  Dates of Service on or after 01/01/2007 through
  12/31/2007: Limit is $1780.00

  Dates of Service on or after 01/01/2006 through
  12/31/2006: Limit is $1740.00
  Date of Service on or after 09/01/2003: Limit is $1590.00
  Dates of Service 01/01/2000 through 08/31/2003: No Limit

  When Date of Service is prior 01/01/2006 or after 12/31/2007
  or Type of Bill is not equal to '22x', '23x', '34x', '74x' or

  Trailer Information: 08, 11, 34
  ***UNDER DEVELOPMENT***
  d. Error Code: 8024 ( )New (X)Modified ( )Deleted
  Disposition: AA

  Type of Record: HUBC

  Error Message:
  Occupational therapy expense limit over-applied.
  Occupational therapy expense submitted is greater than the
  expense to be met.

  Set Condition for edit '8024':

  When the occupational therapy expenses submitted are greater
  than the amount remaining to be met for the year, set the
  '8024' error code.

  Dates of Service on or after 01/01/2007 through
  12/31/2007: Limit is $1780.00

  Dates of Service on or after 01/01/2006 through
  12/31/2006: Limit is $1740.00

  Dates of Service after 09/01/2003: Limit is $1590.00.
  Dates of Service 01/01/2000 through 08/31/2003: No Limit.

  Dates of Service in 1999: Limit is $1500.00.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 24
____________________________________________________________________________


  Dates of Service 1994-1998 (inclusive): Limit is $900.00.
  Dates of Service 1990-1993 (inclusive): Limit is $750.00.
  Dates of Service 1989 and earlier: Limit is $500.00.

  When Date of Service are after 06/30/2003 and HIBC-ABCROSS-
  IND (labeled ED OVERRIDE in HITF) equals '3', bypass this
  edit.

  Trailer Information:   07, 08, 11

  ***UNDER DEVELOPMENT***
  e. Error Code: 5412 ( )New (X)Modified ( )Deleted
  Disposition: UR

  Type of Record: HUOP

  Error Message:
  Physical therapy adjustment necessary for MSP claim. This
  edit will be bypassed for all CHOICES, and ESRD Managed Care
  Demonstration and ENCOUNTER claims.

  Set Condition for edit '5412':
  When the physical therapy expenses submitted are greater than
  the amount remaining to be met for the year and the claim ha
  an MSP Value Code and amount, set the '5412' error code.

  Dates of Service on or after 01/01/2007 through
  12/31/2007: Limit is $1780.00
  Dates of Service on or after 01/01/2006 through
  12/31/2006: Limit is $1740.00

   Date of Service on or after 09/01/2003:   Limit $1590.00

  Dates of Service 01/01/2000 through 08/31/2003: No Limit.
  When Date of Service are prior to 01/01/2006 or after
  12/31/2007 or Type of Bill is not equal to '22x', '23x',
  '34x', '74x', or '75x' or NOPAY CODE on claim header equal '
  or no line item has Modifier 'GN' or 'GP or PTOT OVERRIDE CO
  on the claim header equals '1' or claim is CHOICES, ESRD
  Manager Care Demonstration or ENCOUNTER claim, bypass this
  edit.

  Trailer Information: 03, 08, 11

  ***UNDER DEVELOPMENT***
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 25
____________________________________________________________________________

  f. Error Code: 5412    ( )New (X)Modified ( )Deleted
  Disposition: UR

  Type of Record: HUBC

  Error Message:
  Physical therapy adjustment necessary for MSP claim. This
  edit will be bypassed for all CHOICES, and ESRD Managed
  Care Demonstration and ENCOUNTER claims.


  Set Condition for edit '5412':

  Trailer Information:

  ***UNDER DEVELOPMENT***
  g. Error Code: 5413 ( )New (X)Modified ( )Deleted
  Disposition: UR

  Type of Record: HUOP

  Error Message:

  Set Condition for edit '5413':
  For a claim with all Dates of Service on or after
              01/01/2006 and within 12/31/2006:

       If the physical therapy expenses submitted are
       greater than the amount remaining to be met for the
       year, set the '5412' error code.


  Dates of Service on or after 01/01/2007 through 12/31/2007:
  Limit is $1780.00

  Dates of Service on or after 09/01/2003: Limit is $1590.

  Dates of Service between 01/01/2000 and 08/31/2003: No
  Limit.

  When the Dates of Service are prior to 01/01/2006 or after
  12/31/2007 or Type of Bill is not equal to '22x', '23x',
  '34x', '74x' or '75x' or no line items has Modifier 'GN' or
  'GP' or claim is denied or HIBC-ABCROSS-IND (labeled ED
  OVERRIDE in HITF is equal to '3') or claim is a CHOICES,
  ESRD Managed Care Demonstration or ENCOUNTER claim, bypass
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 26
____________________________________________________________________________

  this edit.
  For a claim with at least one Date of Service prior to
  09/01/2003:
        When the claim Part B year is greater than '1993',
        and the sum of the claim Part B total physical
        therapy charges subject to deductible plus the HLD-
        PTHPY-EXP is less than, or equal to, '1500.00', and
        the sum of claim Part B total physical therapy
        charges subject to deductible plus HLD-RICR-PTHPY is
        greater than '1500.00', and WS-MSP-AMT-APPLIED is
        greater than '0', set the '5412' error code.
  When the claim Part B year is greater than '1993', and less
  than, or equal to 1998, and the sum of the claim Part B
  total physical therapy charges subject to deductible plus
  the HLD-PTHPY-EXP is less than, or equal to, '900.00', and
  the sum of claim Part B total physical therapy charges
  subject to deductible plus HLD-RICR-PTHPY is greater than
  '900.00', and WS-MSP-AMT-APPLIED is greater than '0', set
  the '5412' error code.
  When the claim Part B year is less than, or equal to
  '1993', and the claim Part B year is greater than '1989',
  and the sum of the claim Part B total physical therapy
  charges subject to deductible plus the HLD-PTHPY-EXP is
  less than, or equal to, '750.00', and the sum of claim Part
  B total physical therapy charges subject to deductible plus
  HLD-RICR-PTHPY is greater than '750.00', and WS-MSP-AMT-
  APPLIED is greater than, or equal to '0', set the '5412'
  error code.
  When the claim Part B year is less than, or equal to
  '1989', and the sum of the claim Part B total physical
  therapy charges subject to deductible plus the HLD-PTHPY-
  EXP is less than, or equal to '500.00', and the claim Part
  B total physical therapy charges subject to deductible plus
  HLD-RICR-PTHPY is greater than '500.00', and WS-MSP-AMT-
  Applied is greater than '0', set the '5412' error code.
  When the claim Part B year is greater than '1993', and less
  than, or equal to, '1998', and the claim Part B total
  physical therapy charges subject to deductible plus the
  HLD-PTHPY-EXP is greater than '900.00', and WORK-RICR-PT-
  REM IS greater than, or equal to, WORK-PT-REM, and WS-MSP-
  AMT-APPLIED is greater than, '0', set the '5412' error
  code.
  When the claim Part B physical therapy benefits exhausted
  Indicator is equal to, '1', and the claim Part B year is
  greater than '1989', or less than, or equal to, '1993', and
  the sum of the claim Part B total physical therapy charges
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 27
____________________________________________________________________________

  subject to deductible plus the HLD-PTHPY-EXP is greater
  than, or equal to, '750.00', and WORK-RICR-PT-REM is
  greater than, or equal to, WORK-PT-REM, and WS-MSP-AMT-
  APPLIED is greater than '0', and the Claim Payment Denial
  0Indicator is equal to '0', bypass this edit.
  When the claim Part B physical therapy benefits exhausted
  Indicator is equal to '1', and the claim Part B year is
  less than, or equal to, '1989', and the sum of the claim
  Part B total physical therapy charges subject to deductible
  plus the HLD-PTHPY-EXP is greater than, or equal to
  '500.00', and the Claim Payment Denial Indicator is equal
  to '0', bypass this edit.
  When the claim Part B year is greater than '1998' and the
  sum of the claim Part B total physical therapy charges
  subject to deductible is equal to '0', bypass this edit.
  When the claim Part B year is greater than '1999', bypass
  this edit.

  When the claim Part B year is greater than '1998', and the
  sum of the claim Part B total physical therapy charges
  subject to deductible plus the HLD-PTHPY-EXP is less than,
  or equal to '1500.00', and the sum of claim Part B total
  physical therapy charges subject to deductible plus HLD-
  RICR-PTHY is greater than '1500.00', and WS-MSP-AMT-APPLIED
  is greater than '0', set the '5412' error code.
  When the claim Part B physical therapy benefits exhausted
  Indicator is equal to '1', and the claim Part B year is
  greater than '1999', bypass this edit.
  When the claim Part B physical therapy benefits exhausted
  Indicator is equal to '1', and the claim Part B year is
  greater than '1998', and less than '2000', and the sum of
  the claim Part B total physical therapy charges subject to
  deductible plus the HLD-PTHPY-EXP is greater than, or equal
  to, '1500.00', and the Claim Payment Denial Indicator is
  equal to '0', bypass this edit.
  When the claim Part B physical therapy benefits exhausted
  Indicator is equal to '1', and the claim Part B year is
  greater than '1993', and less than, or equal to, '1998',
  and the sum of the claim Part B total physical therapy
  charges subject to deductible plus the HLD-PTHPY-EXP is
  greater than, or equal to, '900.00', and the Claim Payment
  Denial Indicator is equal to '0', bypass this edit.

  When the claim Part B physical therapy benefits exhausted
  Indicator is equal to '1', and the claim Part B year is
  greater than '1989', or is less than, or equal to, '1993',
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 28
____________________________________________________________________________

  and the sum of the claim Part B total physical therapy
  charges subject to deductible plus the HLD-PTHPY-EXP is
  greater than, or equal to, '750.00', and the Claim Payment
  Denial Indicator is equal to '0', bypass this edit.

  When the claim Part B physical therapy benefits exhausted
  Indicator is equal to '1', and the claim Part B year is
  less than, or equal to '1989', and the sum of the claim
  Part B total physical therapy charges subject to deductible
  plus the HLD-PTHPY-EXP is greater than, or equal to,
  '500.00', and the Claim Payment Denial Indicator is equal
  to '0', bypass this edit.
  When the claim Part B total physical therapy charges
  subject to deductible is equal to '0', bypass this edit.
  When the claim Part B year is greater than '1999', bypass
  this edit.

  Trailer Information: 03, 08, 11

  ***UNDER DEVELOPMENT***
  g. Error Code: 5413 ( )New (X)Modified ( )Deleted
  Disposition: UR

  Type of Record: HUBC

  Error Message:
  Occupational therapy adjustment necessary for MSP claim. This
  edit will be bypassed for all CHOICES, and ESRD Managed Care
  Demonstration and ENCOUNTER claims.

  Set Condition for edit '5413':
  When the occupational therapy expenses submitted are greater
  than the amount remaining to be met for the year and the claim
  has an MSP Value Code and Amount greater than zero, set the
  '5413' error code.
  Dates of Service on or after 01/01/2007 through 12/31/2007:
   Limit is $1780.00
  Dates of Service on or after 01/01/2006 through 12/31/2006:
  Limit is $1740.00

  When Dates of Service are 09/01/2003: Limit is $1590.00.

  Dates of Service between 01/01/2000 and 08/31/2003: No Limit

  When Date of Service prior to 01/01/2006 or after 12/31/2007
  or Type of Bill is not equal to '22x', '23x', '34x', '74x',
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 29
____________________________________________________________________________

  '75x', or NOPAY CODE on claim header is equal to 'N', or No
  Line Item has modifier 'GO', or PTOT OVERRODE CODE on the
  claim header equals '1', or claim is a CHOICES, ESRD Managed
  Care Demonstration or ENCOUNTER claim, bypass this edit.

  Trailer Information: 03, 08, 11, 34

  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  Contractor:
    Author: Gehne, Wilfried
   Date: 06/27/2007
   Subject: Re: CWF Comments

     The first 750 characters of the comment are the following:
  Yes, the override capability should be maintained.
  Thanks for this comment.
  ************************************************************************
  Sent to Vivian on 08/30 after learning CR was reassigned from Kathy W.
  I am currently creating the requirements for CMS CR5481
  for CWF CR 25343 and need to address the following:
  This CR is going to allow Part B or Outpatient Claims when
  modifier KX is present and no longer set edits 8022
  (overapplied PT/SP limitations) or 8024 (overapplied OT
  limitation CWF does not back out PT or OT amounts from the
  Beneficiary Master Record on a Part B claim if edit 8022/8024 is
  present in the header override field.
  However, for Outpatient claims CWF does back out the pt or ot
  amount if edits 8022 or 8024 is present in the detail override.
  This has been inconsistent in CWF since PLOG24933
  was implemented. CWF continues to back out PT or OT limitations
  if edits 5412 (MSP claim for overapplied pt/sp) or 5413 (MSP
  claim for overapplied ot) for both Part B and Outpatient.
  The question to be addressed is how to handle if the KX modifier
  is present, do we back out or not back out amounts on adjustments
  and cancels?.
  Part of the problem is that for Part B the override is in the
  header and for Outpatient the override is in the detail causing
  inconsistencies.
  CWF is not backing out if edit is present and in some situations
  the amount on the Part B claim is not an over applied amount on
  Part B.....
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 30
____________________________________________________________________________

  CMS must make the decision if KX is present should the amount be
  backed out if an adjustment is received to deny or cancel a
  previously processed claim.
  Also CMS needs to determine if both Part B and Outpatient should
  be processed the same or differently as done today with the
  override edits.
  Please let us know so we know how to address in the January CR.

  Thanks,
  Janice Maxwell
  ***********************************************************
  Hi Janice,

  Since the claims are processed as exceptions to the therapy cap, the
  dollars associated with the exceptions are not applied to the cap
  amount.   So when these claims are subsequently adjusted or cancelled,
  the amount should not be backed out of the cap balance.   We shouldn't
  back out what was never applied to start with.
  I hope this answer's your question. If you need additional assistance
  please let me know.

  Thanks,

  Vivian Rogers
  Business Applications Management Group
  Division of Business Application Analysis
  Common Working File
  Vivian.Rogers@cms.hhs.gov
  phone:410-786-8142

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************


______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 31
____________________________________________________________________________


   5.   00025391   HHMO WHERE BENE HAS BOTH HMO AND HOSPICE GENERATING IUR

  DATE ENTERED:    02/02/07

  TITLE:           HHMO WHERE BENE HAS BOTH HMO AND HOSPICE GENERATING IUR

  PROJECT CODE:    CM01

  PRIORITY:        2

  RELEASE LEVEL: R2008100

  GROUP LEVEL:     2

  HOST SITE ID:    CWFM2000

  STATUS ON CR:    WORK

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   3
  EST. HOURS:      0300
  ACT. HOURS:      0182
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  Part A claims (HUIP and HUOP) are generating Informational
  Unsolicited Response due to HHMO when BENE has both
  Hospice and HMO. CWF should not return IUR when BENE
  has both HMO and Hospice during the Dates of Service.
  The HMO is not liable for the services.

  CWF is also not generating IUR due to HHMO overlay
  on HUIP and HUOP when CC 07 is present and the BENE only
  has HMO benefits and not Hospice.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 32
____________________________________________________________________________

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:          __25391__________    WORK TYPE:   ___   Incidental
  SUBSYSTEM:   _________________                 ___   Minor
  FUNCTION:    _________________                 _X_   Major
  PROGRAM:     _________________                 ___   New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                 Cathy Pflaum
      Telephone:           410-786-3016
      FAX, CMS:            410-786-0271
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     Vicki Sommers
      Telephone:           469-372-7642
      FAX,Richardson,TX:   469-372-0284
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       Shailan Mandayam
       Telephone:          443-436-6720
       FAX,Baltimore,MD:   443-436-3803
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *              blank line is found.                               *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *              after a colon. Try to format as it should appear *
  *              in the Release Document.                           *
  *******************************************************************
    IMPACT:
  (X) Host
  (X) Satellite Part A Inpatient
  (X) Satellite Part A Outpatient
  ( ) Satellite Part B
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 33
____________________________________________________________________________

  ( ) Hospice
  ( ) Home Health
  ( ) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  CWF is incorrectly generating an Informational Unsolicited
  Response due to HHMO overlay when a Part A Inpatient or
  Outpatient record in history has Dates of Service during
  both risk MA Plan and a open Hospice enrollment.
  According to CMS if a Beneficiary has both then the
  Hospice is liable and not the risk MA Plan. CWF should
  not be generating an IUR due to HHMO overlay for this
  condition.
  Note: Risk MA Plan is when the Risk Option Code is
  'A', 'B', or 'C'.
  CWF is also not generating an Informational Unsolicited
  Response due to HHMO overlay when a Part A Inpatient or
  Outpatient record in history has Condition Code 07
  present and the Beneficiary does not have Hospice. The
  condition to not generate the IUR due to a HHMO overlay is
  when the Beneficiary has both risk MA Plan and Hospice.

  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
  CWF is incorrectly generating an Informational Unsolicited
  Response due to HHMO overlay when a Part A Inpatient or
  Outpatient record in history has Dates of Service during
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 34
____________________________________________________________________________

  both risk MA Plan and a open Hospice enrollment.
  CWF should not generate the IUR for 5233 for this
  condition. If the Dates of Service are only during
  the risk MA Plan the IUR for 5233 should generate.
  Note: Risk MA Plan is when the Risk Option Code is
  'A', 'B', or 'C'.

  Requirement 2
  CWF needs to generate an Informational Unsolicited
  Response due to HHMO overlay when a Part A Inpatient or
  Outpatient record in history has Condition Code 07
  present and the Beneficiary does not have Hospice.
  The Condition Code 07 applies to Hospice edits only.

  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  *******************************************************************
  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
  * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
  *******************************************************************
    EVENT-RESPONSE LIST:
  ***.......This is the width of the Release Document.......***

  Event 1.1
  Submit an HHMO overlay and the Beneficiary also has an open
  Hospice period. The Beneficiary has both an Inpatient and
  Outpatient claims in history where the Dates of Service are
  during both the risk MA Plan and Hospice.

  Response
  An Informational Unsolicited Response (IUR) for 5233 is not
  generated on the Inpatient or Outpatient records.

  Event 2.1
  Submit an HHMO overlay and the Beneficiary has both an
  Inpatient and Outpatient claims in history with Condition
  Code 07 present where the Dates of Service are during
  the risk MA Plan and no Hospice Period present.

  Response
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 35
____________________________________________________________________________

  An Informational Unsolicited Response (IUR) for 5233 is
  generated on the Inpatient and Outpatient records.

  ***.......This is the width of the Release Document.......***

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

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1. HABBHHMO Module

  Solution Criteria: N/A

    EDITS AFFECTED: None
  ***.......This is the width of the Release Document......***

  a. Error Code:    XXXX   ( )New ( )Modified ( )Deleted
  Disposition:

  Type of Record:

  Error Message:

  Set Condition for edit '####':

  Trailer Information:


  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 36
____________________________________________________________________________

  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 37
____________________________________________________________________________


   6.   00025405   UR 5233 SETTING IN ERROR ON NO PAY SNF OVERLAPS HMO PERIOD

  DATE ENTERED:    02/13/07

  TITLE:           UR 5233 SETTING IN ERROR ON NO PAY SNF OVERLAPS HMO PERIOD

  PROJECT CODE:    CM01

  PRIORITY:        2

  RELEASE LEVEL: R2008100

  GROUP LEVEL:     2

  HOST SITE ID:    CWFM2000

  STATUS ON CR:    REQS

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   2
  EST. HOURS:      0125
  ACT. HOURS:      0125
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------

  The problem below is setting 5233 on N or B No Pay when the
  claim's Dates of Service overlap the HMO period.
  If the DOS does not overlap the HMO Period the edit does not
  set 5233 in error.

  One of our Satellites is reporting that SNF No pay claims are
  setting error code 5233 in error.
  I have looked in infoman and the documentation for error
  code 5233 and it looks like the 5233 should bypass for a no pay
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 38
____________________________________________________________________________

  code of 'B'. The satellite    reports 5233 correctly does not set
  on no pay code ='N'.

  I have sent the following file:
  Can you take a look at inpl record 6 for dos 5/14/06 to 7/27/06?

  CWM.TEST.NDM.KD.E5233.UTILMOVE


  Modifications are required to Utilization edit 5233 for above.

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:          __25405__________    WORK TYPE:   ___   Incidental
  SUBSYSTEM:   _________________                 ___   Minor
  FUNCTION:    _________________                 _x_   Major
  PROGRAM:     _________________                 ___   New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                 Cathy Pflaum
      Telephone:           410-786-3016
      FAX, CMS:            410-786-0271
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     Vicki Sommers
      Telephone:           469-372-7642
      FAX,Richardson,TX:   469-372-0284
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       Jackie Dolphus
       Telephone:          443-436-6721
       FAX,Baltimore,MD:   443-436-3803
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *              blank line is found.                               *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 39
____________________________________________________________________________

  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (X) Host
  (X) Satellite Part A Inpatient
  (X) Satellite Part A Outpatient
  ( ) Satellite Part B
  ( ) Hospice
  (X) Home Health
  ( ) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  Certain types of Part A claims are returning Utilization Edit
  '5233' (Dates of Service during HMO) and the Dates of Service
  overlap the risk HMO period and the record has a No Pay
  Code present. The edit does not set in error if the Dates of
  Service are within the risk HMO period. CWF should not set the
  the '5233' edit if the No Pay Code is present.



  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 40
____________________________________________________________________________

  CWF should not return utilization edit '5233' (Dates of
  Service during risk HMO Period) when the No Pay Code
  is present. This is occurring when the Dates of Service
  overlap the risk HMO period during certain situations
  on Part A records.

  1) When the SNF claim has Dates of Service that overlap
     the previous risk HMO period and a No Pay Code present.

  2) When the Outpatient claim has Dates of Service that overlap
     the risk HMO period and a No Pay Code present.

    Note: This applies to current or previous HMO period.

  3) When the Home Health claim has Dates of Service that overlap
     the risk HMO period with a No Pay Code present.

    Note: This applies to current or previous HMO period.

  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  *******************************************************************
  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
  * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
  *******************************************************************
    EVENT-RESPONSE LIST:
  ***.......This is the width of the Release Document.......***

  Event 1.1
  Submit an HUIP (TOB 21x) record and the Dates of Service
  overlaps the prior HMO period. The record has a No Pay Code
  present. The Beneficiary has a risk HMO period and the
  Option Code is 'A', 'B', or 'C'.

  Response
  The record does not set UR '5233' edit.

  Event 1.2
  Submit an HUOP (any TOB for HUOP) record and the Dates of
  Service overlaps a HMO period. The record has a No Pay Code
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 41
____________________________________________________________________________

  present. The Beneficiary has a risk HMO period and the
  Option Code is 'A', 'B', or 'C'.

  Response
  The record does not set UR '5233' edit.

  Event 1.3
  Submit an HUHH Final or LUPA record and the Dates of
  Service overlaps a HMO period. The record has a No Pay Code
  present. The Beneficiary has a risk HMO period and the
  Option Code is 'A', 'B', or 'C'.

  Response
  The record does not set UR '5233' edit.

  ***.......This is the width of the Release Document.......***

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

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1. Utilization Module for Part A

  Solution Criteria: N/A

    EDITS AFFECTED:
  ***.......This is the width of the Release Document......***

  a. Error Code:   5233    ( )New ( )Modified ( )Deleted
  Disposition:

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

  Error Message:
  For PPS claims, and claims with Provider Numbers beginning
  with '210', the Admission Date falls within a risk GHO Paid
  period, but no GHO Paid Code or Condition Code '69', is
  indicated on the claim.

  OR

  For Non-PPS claims, and SNF claims, the Statement Dates fall
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 42
____________________________________________________________________________

  within, or overlap a risk GHO period, but no GHO Paid Code or
  Condition code '69' is indicated on the claim.

  Set Condition for edit '5233':

  ** Programming only changes, no documentation updates required. **

  For Inpatient claims that have the following criteria:

        The claim falls within a risk GHO period,

        The GHO Pay Code equals zero with no Condition Code '69'
        present,

        The Admission Date and Service Dates are all equal.

        The utilized days equals zero.

        A No-Pay Code is absent.

  Services fall within, or overlap, a risk GHO period, but no
  GHO Paid Code is indicated on the claim.

  A RNHCO Notice of Election (41A), and the Admission Date falls
  within, or overlaps, a risk GHO period.

  A MCCD Notice of Election (89A), and the From Date falls
  within, or overlaps, a risk GHO period.

  Hospital, SNF, OUTP
  For PPS Claims, Non-PPS Inpatient claims, SNF claims, and
  claims with Provider Numbers beginning with '210', the
  Admission Dates fall within, or overlap, a risk GHO period,
  but no GHO Paid Code, or Condition Code '69', is indicated on
  the claim, set the '5233' error code.

  If a claim's Dates of Service are within a GHO period, and the
  Beneficiary Hospice Indicator equals zero, and the claim GHO
  Paid Code equals '0', and the Bene is not a SNF CHOICES Bene,
  set the '5233' error code.

  When Outpatient claim Dates of Service fall within a GHO
  Period with option code 'C', set the '5233' error code.
  When the claim's Dates of Service fall within or overlap a GHO
  period, and the claim Thru Date is less than the Hospice Start
  Date, the claim GHO Paid Code equals zero, the Bene is not a
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 43
____________________________________________________________________________

 SNF CHOICES Bene, and the Claim is not an IME/GME (Condition
 Code '69' present), set the '5233' error code.

 When the claim's Dates of Service fall within or overlap a GHO
 period, and the claim Thru Date equals the Hospice Start Date,
 the Patient status is not equal to '30', the claim GHO Paid
 Code equals zero, and the Bene is not a SNF CHOICES Bene, and
 the claim is not an IME/GME (Condition Code '69' present), set
 the '5233' error code

 When the claim's Dates of Service fall within or overlap a GHO
 period, and the claim is not an IME/GME (Condition Code '69'
 present), and the claim From Date is equal to the current
 Hospice Term Date, and the Hospice Revocation Indicator is
 other than zero, and if the claim From Date is greater than,
 or equal to, the Hospice term month plus one, the claim GHO
 Paid Code equals zero, and the Bene is not a SNF CHOICES Bene,
 set the '5233' error code.

 When the claim's Dates of Service fall within or overlap a GHO
 period, and the claim is not an IME/GME (Condition Code '69'
 present), and the claim From Date is greater than the current
 Hospice Term Date, the next Hospice Start Date is greater than
 zero, and the claim Thru Date is less than the next Hospice
 Start Date, and if the claim Thru Date is greater than, or
 equal to, the Hospice term month plus one, the claim GHO Paid
 Code equals zero, and the Bene is not a SNF CHOICES Bene, set
 the '5233' error code.

 When the claim's Dates of Service fall within or overlap a GHO
 period, and the claim is not an IME/GME (Condition Code '69'
 present), the claim From Date is greater than the current
 Hospice Term Date, and the Hospice Revocation Indicator is
 other than zero, and if the claim From Date is greater than,
 or equal to, the Hospice term month plus one, the claim GHO
 Paid Code equals zero, and the Bene is not a SNF CHOICES Bene
 is not true, set the '5233' error code.

 When the Demonstration Project Number is equal to '30', bypass
 this edit.

 When the GHO option equals '1' or '2', bypass this edit.

  When the Detail Override Edit Table is '5233', bypass this
  edit.
  When the GHO option is not equal to 'C', and bytes two through
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 44
____________________________________________________________________________

 five of the GHO ID equal '2603' or '5001', or the claim From
 Date is less than '88092', bypass this edit.

 When claim Util. days are equal to zero, and any of the
 following are true, bypass this edit:

         Claim Admit Date is not equal to the claim From Date,

         Claim Admit Date is not equal to the claim Thru Date,

 When the claim DRG equals '103' or '495', and the claim Admit
 Date is less than, or equal to, '95365', bypass this edit.

 When the Type of Bill '11x', if the DRG equals '380', or if
 Procedure Codes '6901', '6951', or '7491' are present for DRG
 '381'. When Condition Code 'A7' or 'A8' is present, for a PPS
 Provider with Admit Date 10/01/1998, or later, and a Non-PPS
 Provider with Date of Service 10/01/1998, or later, bypass
 this edit.

 When the Beneficiary Hospice Indicator equals '0' or '2', and
 claim GHO Paid Code does not equal zero, bypass this edit.

 When the Clinical Trial claim has a Condition Code '30' with
 Dates of Service 09/19/2000 and after for Outpatient and Date
 of Discharge 09/19/2000 and after for Inpatient, bypass this
 edit.

 When the claim has a Pat Stat '30', a Condition Code '78',
 Condition Code '65' is not present, and the claim STA-THU-DATE
 is greater or equal to 10012003, bypass this edit.

 NOTE:    For a Clinical Trial Inpatient claim with Pat Stat '30'
          STA-FRM-DATE needs to be used for the Discharge Date.

 When the claim has a Condition Code '78' with Dates of Service
 are between 10/01/2003 and 12/31/2004 for Outpatient and Date
 of Discharge are between 10/01/2003 and 12/31/2004 for
 Inpatient, bypass this edit.

  Hospital, SNF, OUTP
  For PPS Claims, Non-PPS Inpatient claims, SNF claims, and
  claims with Provider Numbers beginning with '210', the
  Admission Dates fall within, or overlap, a risk GHO period,
  but no GHO Paid Code, or Condition Code '69', is indicated on
  the claim, set the '5233' error code.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 45
____________________________________________________________________________


 If a claim's Dates of Service are within a GHO period, and the
 Beneficiary Hospice Indicator equals zero, and the claim GHO
 Paid Code equals '0', and the Bene is not a SNF CHOICES Bene,
 set the '5233' error code.

 When Outpatient claim Dates of Service fall within a GHO
 Period with option code 'C', set '5233' error code.

 When the claim's Dates of Service fall within or overlap a GHO
 period, and the claim is not an IME/GME (Condition Code '69'
 present), and the claim From Date is equal to the current
 Hospice Term Date, and the Hospice Revocation Indicator is
 other than zero, and if the claim From Date is greater than,
 or equal to, the Hospice term month plus one, the claim GHO
 Paid Code equals zero, and the Bene is not a SNF CHOICES Bene,
 set the '5233' error code.

 When the claim's Dates of Service fall within or overlap a GHO
 period, and the claim is not an IME/GME (Condition Code '69'
 present), the claim From Date is greater than the current
 Hospice Term Date, and the Hospice Revocation Indicator is
 other than zero, and if the claim From Date is greater than,
 or equal to, the Hospice term month plus one, the claim GHO
 Paid Code equals zero, and the Bene is not a SNF CHOICES Bene
 is not true, set the '5233' error code.

 When the Demonstration Project Number is equal to '30', bypass
 this edit.

 When the GHO option equals '1' or '2', bypass this edit.

 When the HMO Overrode Code is '1', bypass this edit.

 When the GHO option is not equal to 'C', and bytes two through
 five of the GHO ID equal '2603' or '5001', or the claim From
 Date is less than '88092', bypass this edit.

 When claim Util. days are equal to zero, and any of the
 following are true, bypass this edit:

       Claim Admit Date is not equal to the claim From Date,

       Claim Admit Date is not equal to the claim Thru Date,

        Claim No-Pay Code is not equal to spaces.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 46
____________________________________________________________________________


  When the claim DRG equals '103' or '495', and the claim Admit
  Date is less than, or equal to, '95365', bypass this edit.

  When the Type of Bill '11x', if the DRG equals '380', or if
  Procedure Codes '6901', '6951', or '7491' are present for DRG
  '381'. When Condition Code 'A7' or 'A8' is present, for a PPS
  Provider with Admit Date 10/01/1998, or later, and a Non-PPS
  Provider with Date of Service 10/01/1998, or later, bypass
  this edit.

  When the Beneficiary Hospice Indicator equals '0' or '2', and
  claim GHO Paid Code does not equal zero, bypass this edit.

  When the Clinical Trial claim has a Condition Code '30' with
  Dates of Service 09/19/2000 and after for Outpatient and Date
  of Discharge 09/19/2000 and after for Inpatient, bypass this
  edit.

  NOTE: For a Clinical Trial Inpatient claim with Pat Stat '30'
        STA-FRM-DATE needs to be used for the Discharge Date.

  When the claim has a Condition Code '78' with Dates of Service
  on or after 10/01/2003 for Outpatient and Date of Discharge on
  or after 10/01/2003 for Inpatient, bypass this edit.

  When the HMO Option Code is '4', bypass this edit.

  When an Inpatient claim for a Beneficiary that is in a Risk
  Management Plan has a Condition Code of '78' and
  the Dates of Service are on or after 01/01/2006 and the
  ICD-9 code is '37.94', set the '5233' error code.

  When an Inpatient claim has a Condition Code of '78' and
  the Dates of Service are on or after 01/01/2005 and the
  ICD-9 codes are '37.66' or '32.22', set the '5233' error code.

  When an Inpatient claim has a Condition Code '78' and the
  Dates of Service are between 10/01/2003 and 12/31/2004,
  bypass this edit.

  When an Inpatient claim has a Condition Code '78' and
  either of the ICD-9 codes of '37.66' or '32.22' are not
  present, bypass this edit.

  HHA, OUTP
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 47
____________________________________________________________________________

  Services fall within, or overlap, a risk GHO period, but no
  GHO Paid Code is indicated on the claim, set the '5233' error
  code.

  When the Beneficiary Hospice Indicator is equal to '0' or '2',
  and the GHO Paid Indicator is equal to zero, set the '5233'
  error code.

  When the GHO Paid Indicator is equal to zero, the GHO Option
  Code of the first GHO period is equal to 'C', the claim
  service Thru Date is greater than, or equal to, the Start Date
  of the first GHO period, and the claim service Thru Date is
  less than, or equal to, the Termination Date of the first GHO
  period, set the '5233' error code.

  When the GHO Paid Indicator is equal to zero, the GHO Option
  Code of the first GHO period is equal to 'C', the Termination
  Date of the first GHO period is equal to zero, and the claim
  Service Thru Date is greater than, or equal to, the Start Date
  of the first GHO period, set the '5233' error code.

  When the GHO Paid Indicator is equal to zero, the GHO Option
  Code of the second GHO period is equal to 'C', the claim
  service Thru Date is greater than, or equal to, the Start Date
  of the second GHO period, and the claim service Thru Date is
  less than, or equal to, the Termination Date of the second GHO
  period, set the '5233' error code.

  When the GHO Paid Indicator is equal to zero, the GHO Option
  Code of the second GHO period is equal to 'C', the claim
  service From Date is less than, or equal to, the Termination
  Date of the second GHO period, and the claim service Thru Date
  is greater than, or equal to, the Termination Date of the
  second GHO period, set the '5233' error code.

  When incoming Home Health PPS is a RAP '3x2', bypass this
  edit.

  When Lung Volume Reduction Demonstration number (Demonstration
  Number '30') is present, bypass this edit.

  When Outpatient Encounter Claims (Demonstration Number '38')
  is present, bypass this edit.

  When Type of Bill '13x', '83x', or '85x', or if one of the
  following CPT codes are present with a 'G7' Modifier: '59840',
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 48
____________________________________________________________________________

  '59841', '59850', '59851', '59852', '59855', '59856', '59857',
  or '59866', with Date of Service 10/01/1998, or later, bypass
  this edit.

  When Non-Payment Code 'B' or 'N' is present on an incoming
  Part A claim, bypass this edit.

  When the claim is a Hospice claim, bypass this edit.

  When the Outpatient claim is not within a GHO period, bypass
  this edit.

  When the header Override Code Table has '5233' present,
  bypass this edit.

  When the Non-Payment Code 'N', bypass this edit.

  When the GHO Paid Code is equal to '1', and the service From
  Date is greater than '86000', and the Group Health
  Organization (GHO) Option Code from the first period is not
  equal to 'A', 'B', or 'C', bypass this edit.

  When the GHO Paid Code is equal to '1' and the service From
  Date is not greater than '86000', and the GHO Option Code from
  the first period is not equal to 'C', bypass this edit.
  When the GHO Paid Code is equal to '1' and the GHO Option Code
  from the first period is not equal to 'A', 'B', or 'C', bypass
  this edit.


  When the GHO Paid Code is equal to '1', the GHO Option Code
  from the first period is not equal to 'C', and positions two
  through five of the GHO plan number are equal to '2603' or
  '5001', bypass this edit.

  When the GHO Paid Code is equal to '1', the GHO Code from the
  first period is not equal to 'C', positions two through five
  of the GHO plan number are not equal to '2603' or '5001', and
  the service From Date is less than '88092', bypass this edit.

  When the GHO Paid Code is equal to '1', and the service From
  Date is greater than '86000', and the GHO Option Code from the
  second period is not equal to 'A', 'B', or 'C', bypass this
  edit.

  When the GHO Paid Code is equal to '2' and the GHO Option Code
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 49
____________________________________________________________________________

  from the second period is not equal to 'A', 'B', or 'C',
  bypass this edit.

  When the GHO Paid Code is equal to '2' and the service From
  Date is not greater than '86000', and the GHO Option Code from
  the second period is not equal to 'C', bypass this edit.

  When the GHO Paid Code is equal to '2', the GHO Option Code
  from the second period is not equal to 'C', and position two
  through five of the GHO plan number are equal to '2603' or
  '5001', bypass this edit.

  When the GHO Paid Code is equal to '2', the GHO Option Code
  from the second period is not equal to 'C', position two
  through five of the GHO plan number are not equal to '2603' or
  '5001', bypass this edit.

  When the GHO Paid Code is equal to '2', the GHO Option Code
  from the second period is not equal to 'C', position two
  through five of the GHO plan number are not equal to '2603' or
  '5001', and the service From Date is less than '88092', bypass
  this edit.

  When the GHO is CHOICES and the Beneficiary Hospice Indicator
  is equal to '0' or '2', bypass this edit.

  OUTP
  When the Outpatient stay Thru Date is less than, or equal to,
  Indicator is equal to zero, set the '5233' error code.

  When the Outpatient stay From Date is equal to the Termination
  Date for the first, second, third, or fourth Hospice period,
  the Hospice Revocation Indicator for the Hospice period is
  other than zero, the service From Date is greater than, or
  equal to, the date of the first day of the month following the
  Termination Date for the Hospice period, and the GHO Paid
  Indicator is equal to zero, set the '5233' error code.

  When the Outpatient service From Date is greater than the
  Termination Date for the first, second, or third Hospice
  period, the Start Date for the first, second or third Hospice
  period is greater than zeros, the Outpatient service Thru Date
  is less than the Start Date for the first, second or third
  Hospice period, the Outpatient service Thru Date is not less
  than the date of the first day of the month after the
  Termination Date for the first, second or third Hospice
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 50
____________________________________________________________________________

  period, and the GHO Paid Indicator equals zero, set the '5233'
  error code.

  When the Outpatient service From Date is greater than the
  Termination Date for the first, second or third Hospice
  period, the Start Date for the second or third or fourth
  Hospice period is greater than zeros, the Outpatient service
  Thru Date is less than the Start Date for the second, third or
  fourth Hospice period, the Outpatient service Thru Date is not
  less than the date of the first day of the month following the
  Termination Date for the first, second or third Hospice
  period, and the GHO Paid Indicator is equal to zero, set the
  '5233' error code.

  When the Outpatient service From Date is greater than the
  Termination Date for the first, second or third Hospice
  period, the Hospice Revocation Indicator for the first, second
  or third Hospice period is other than zero the service From
  Date is greater than, or equal to, the first day of the month
  following the Termination Date for the first, second or third
  Hospice period, and the GHO Paid Indicator is equal to zero,
  set the '5233' error code.

  FOURTH HOSPICE PERIOD ONLY:
  When the Outpatient service Thru Date is greater than the
  Start Date for the fourth Hospice period, the Outpatient
  service From Date is greater than, or equal to, the
  Termination Date for the fourth Hospice period, the Hospice
  Revocation Indicator for the fourth Hospice period is other
  than zero, the stay From Date is greater than, or equal to,
  the first day of the month following the Termination Date for
  the fourth Hospice period, and the GHO Paid Indicator is equal
  to zero, set the '5233' error code.

  When an Outpatient claim for a Beneficiary that is in a Risk
  Management Plan has a Condition Code '78' and the Dates
  of Service are on or after 01/01/2006 and the HCPCS codes are
  'G0297', 'G0298', 'G0299', or 'G0300', set the '5233' error
  code.

  When Outpatient claim has a Condition Code '78' and the Dates
  of Service are on or after 01/01/2005 and the HCPCS codes are
  'G0302', 'G0303', 'G0304', or 'G0305', set the '5233' error
  code.

  When an Outpatient claim has a Condition Code '78' and one
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 51
____________________________________________________________________________

  of the HCPCS codes are not 'G0302', 'G0303', 'G0304', or
  'G0305', bypass this edit.

  When an Outpatient claim has TOB '73' and the Revenue Code is
  '0519' and Dates of Service on or after 01/01/2006 but will
  apply to a claim that processes on or after 04/03/2006, bypass
  this edit.

  Trailer Information: 05, 08

  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 52
____________________________________________________________________________


   7.   00025409   RECEIVING ASRA WITH DISPOSITION 01 ON HUHH-REFER TO PL25323

  DATE ENTERED:    02/16/07

  TITLE:           RECEIVING ASRA WITH DISPOSITION 01 ON HUHH-REFER TO PL25323

  PROJECT CODE:    CM01

  PRIORITY:        3

  RELEASE LEVEL: R2008100

  GROUP LEVEL:     2

  HOST SITE ID:    CWFM1000

  STATUS ON CR:    INIT

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   3
  EST. HOURS:      0300
  ACT. HOURS:      0300
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  REFER TO PL25323-

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:         _25409___________   WORK TYPE: ___ Incidental
  SUBSYSTEM: _________________                _X_ Minor
  FUNCTION:   _________________               ___ Major
  PROGRAM:    _________________               ___ New Subsystem
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 53
____________________________________________________________________________


  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                 Cathy Pflaum
      Telephone:           410-786-3016
      FAX, CMS:            410-786-0271
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     Karen Chaffin
      Telephone:           469-372-0645
      FAX,Richardson,TX:   469-372-0284
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       Heather Byram
       Telephone:          717-909-2228
       FAX,Camp Hill PA:   717-691-3090
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *               blank line is found.                              *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (X) Host
  ( ) Satellite Part A Inpatient
  ( ) Satellite Part A Outpatient
  ( ) Satellite Part B
  ( ) Hospice
  (X) Home Health
  ( ) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  When a Home Health RAP (TOB 3x2) is submitted for Dates of Service
  greater than the 36 Home Health Episodes posted, CWF is
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 54
____________________________________________________________________________

  returning Disposition Code '01' with an ASRA. CWF only maintains
  36 Home Health Episodes and drops the previous episode from the
  the Auxiliary file.

  Utilization Error Code 5386 (The detail line item date on the
  final claim does not fall within the Home Health PPS episode
  period on file) must be modified to not set if the detail date
  on an incoming claim is earlier than the date ranges on the
  Home Health PPS episode period if more than 36 Home Health
  episodes.

  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
  Modify CWF to no longer return ASRA on a Home Health RAP
  (Type of Bill '3x2') when the date is prior to the 36
  posted Home Health Episodes. CWF will not create an episode
  in this situation.

  Requirement 2
  Modify Error Code '5386' to not set if the detail line item
  date on an incoming claim is earlier than the date ranges
  on the Home Health PPS episode periods on file when 36
  episodes are present.

  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 55
____________________________________________________________________________

  that the system should function AFTER the change.

  *******************************************************************
  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
  * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
  *******************************************************************
    EVENT-RESPONSE LIST:
  ***.......This is the width of the Release Document.......***

  Event 1.1
  Submit a Home Health Rap using Type of Bill '3x2" and the
  date is earlier than the 36 Home Health episodes posted for
  the beneficiary.

  Response
  The RAP does not return an ASRA if it receives a disposition
  code 01.

  Event 2.1
  Submit a Home Health record with Dates of Service prior
  to the earliest date on the Home Health PPS episode
  period file and there are 36 episodes present.

  Response
  The record does not set Error Code '5386'.
  ***.......This is the width of the Release Document.......***

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

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1. Utilization Module

  Solution Criteria: N/A

    EDITS AFFECTED:
  ***.......This is the width of the Release Document......***

  a. Error Code: 5386 ( )New (X)Modified ( )Deleted
  Disposition: UR
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 56
____________________________________________________________________________


  Type of Record: HHA

  Error Message:
  The detail line item date on the final claim does not fall
  within the Home Health PPS episode period on file.

  Set Condition for edit '5386': Under Development
  In a final claim, if the detail line item date does not fall
  within the Home Health PPS episode period, set the '5386'
  error code.

  If the Home Health PPS episode has a Cancellation Indicator of
  '1' posted, set the '5386' error code.

  For LUPA Final claims, bypass this edit.

  When a Non-Payment code is present and the detail line item
  date is within the Home Health PPS episode period on file,
  bypass this edit.

  When Non-Payment code with Condition Code '21' present and the
  detail line item date does not fall within the Home Health PPS
  episode on file, bypass this edit.

  Trailer Information: 08
  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 57
____________________________________________________________________________


   8.   00025433   REMOVE HIQM FROM FUTURE PROVIDER INQUIRY CHANGES

  DATE ENTERED:    03/07/07

  TITLE:           REMOVE HIQM FROM FUTURE PROVIDER INQUIRY CHANGES

  PROJECT CODE:    CM01

  PRIORITY:        3

  RELEASE LEVEL: R2008100

  GROUP LEVEL:     2

  HOST SITE ID:    CWFM1000

  STATUS ON CR:    REQS

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   3
  EST. HOURS:      0300
  ACT. HOURS:      0180
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  Since HIQM is no longer used as an inquiry screen for providers,
  CMS has requested we remove this transaction from any future
  changes to be made to any Provider inquiry screens.

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:         25433____________   WORK TYPE: ___ Incidental
  SUBSYSTEM: _________________                ___ Minor
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 58
____________________________________________________________________________

  FUNCTION:    _________________                ___ Major
  PROGRAM:     _________________                ___ New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                 Cathy Pflaum
      Telephone:           410-786-3016
      FAX, CMS:            410-786-0271
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     Rita Crane
      Telephone:           469-372-2199
      FAX,Richardson,TX:   469-372-0284
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       Shailan Mandayam
       Telephone:          443-436-6720
       FAX,Baltimore,MD:   443-436-3803
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *               blank line is found.                              *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (X) Host
  ( ) Satellite Part A Inpatient
  ( ) Satellite Part A Outpatient
  ( ) Satellite Part B
  ( ) Hospice
  ( ) Home Health
  ( ) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 59
____________________________________________________________________________


  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

    NEW BUSINESS REQUIREMENTS:

  Requirement 1
  xxxx

  Requirement 2
  xxx

  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  *******************************************************************
  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
  * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
  *******************************************************************
    EVENT-RESPONSE LIST: None
  ***.......This is the width of the Release Document.......***

  Event 1.1

  Response
  ***.......This is the width of the Release Document.......***

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 60
____________________________________________________________________________

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

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1.

  Solution Criteria: N/A

    EDITS AFFECTED: None
  ***.......This is the width of the Release Document......***

  a. Error Code:    XXXX   ( )New ( )Modified ( )Deleted
  Disposition:

  Type of Record:

  Error Message:

  Set Condition for edit '####':

  Trailer Information:

  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 61
____________________________________________________________________________


   9.   00025466   5560-EXCL SANCTIONED PROVIDERS (PT A/DMERC) FROM COBC PROC.

  DATE ENTERED:    03/22/07

  TITLE:           5560-EXCL SANCTIONED PROVIDERS (PT A/DMERC) FROM COBC PROC.

  PROJECT CODE:    CM01

  PRIORITY:        1

  RELEASE LEVEL: R2008100

  GROUP LEVEL:     1

  HOST SITE ID:    CWFM1000

  STATUS ON CR:    WORK

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   4
  EST. HOURS:      0750
  ACT. HOURS:      0720
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------

  3/22/2007

  Currently, in accordance with existing requirements from CMS
  all Medicare contractors including Program Safeguard Contractors,
  maintain a list of those physician, suppliers and providers
  whose Medicare billing privileges have been suspended, per
  direction from the Office of the Inspector General (OIG).

  Part A, MACS and DMERCs already have shared system edits in place
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 62
____________________________________________________________________________

  to identify these physician, suppliers and providers. However,
  that capability does not prevent Part A and DMERC/DME MAC from
  receiving a BOI Trailer '29' from CWF. Thus, these claims are
  crossed over to the Trading Partners.

  Effective with this instruction CWF is creating a new one-byte
  field in the header of the HUDC, HUIP, HUOP, HUHH and HUHC
  records that will contain a new indicator 'S' for Sanctioned
  Providers'.

  Fully denied claims submitted to CWF with this new indicator
  will not cross over, and will not receive a Trailer '29'.

  CWF must:
  Create a new one byte field in the header of the HUDC, HUIP,
  HUOP, HUHH and HUHC record.

  CWF will create a new edit that will set when the value in the
  incoming HUDC, HUIP, HUOP, HUHH and HUHC record is other
  than 'S' or Space.

  CWF will create a new one-byte field that will display in
  the header of the record in HIMR.

  CWF will create a new one-byte field that will display in
  the header of the record on the NCH file.

  CWF will create a new one-byte field that will display in
  the header of the record in ITF.


  Yvonne Anderson

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:          ____25466________   WORK TYPE:   ___   Incidental
  SUBSYSTEM:   _________________                ___   Minor
  FUNCTION:    _________________                _x_   Major
  PROGRAM:     _________________                ___   New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:               Kathy Woytan
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 63
____________________________________________________________________________

       Telephone:          410-786-4982
       FAX, CMS:           410-786-0271
       Responsibilities:   REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     Yvonne Anderson
      Telephone:           469-372-5420
      FAX,Richardson,TX:   469-372-0284
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       Alligood/Frye
       Telephone:          717-909-2226
       FAX,Baltimore,MD:   443-436-3803
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *               blank line is found.                              *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (X) Host
  (X) Satellite Part A Inpatient
  (X) Satellite Part A Outpatient
  (X) Satellite Part B
  (X) Hospice
  (X) Home Health
  (X) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  Part A contractors, including Medicare Administrative Contractors
  (MACs) and durable Medical Equipment Medicare Administrative
  Contractors (DMACs) already have shared system edits in place to
  identify physicians, suppliers and providers that are sanctioned.

  However, the capability to identify the provider as sanctioned
  does not prevent a Part A contractor from receiving a CWF, BOI
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 64
____________________________________________________________________________

 Trailer '29' for claims that are ordered or arranged by the
 sanctioned provider.

 In addition, identifying the supplier as sanctioned does not
 prevent the DMAC claims from receiving a CWF, BOI Trailer '29'
 for equipment or medical supplies that have been ordered or
 provided by the sanctioned supplier.

 Creating this new field will allow CWF to differentiate
 between fully denied claims for providers who are not sanctioned
 that COBA trading partners may elect to receive, and fully denied
 sanctioned provider claims that CMS wishes to auto-exclude
 from the crossover process.

 Effective with this instruction, the CWF systems maintainer
 shall create a new one-byte field in the header of its DMAC
 (HUDC) and Part A (HUIP, HUOP, HUHH and HUHC) claim records
 that the contractor will use to identify sanctioned
 providers/suppliers.

 Note: Part B (HUBC) is not being addressed at this time
       because CR5353, CWF CR 00025157 which was implemented
       in April 2007 created a new one-byte sanctioned
       provider field for HUBC records.

 The valid value for the new 'Sanctioned Provider' field will
 be an 'S' or Space'. A new consistency edit will be created
 that will set when a value other than 'S' or Space is submitted
 in the new one-byte field. (Zero is not a valid value).

 When the incoming claim contains an 'S' in the new one-byte
 'Sanctioned Provider' field, CWF will exclude the claim only
 if it is 'fully denied' from the COBC process. When the claim
 is fully denied, the claim will not crossover, and a CWF BOI
 Trailer '29' will not be generated.




 ***.......This is the width of the Release Document.......***

 Analyze Current Situation:

 Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 65
____________________________________________________________________________


  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

     NEW BUSINESS REQUIREMENTS:

  Requirement 1
  CWF must allow and display a new one-byte field 'Sanctioned
  Provider' Indicator in the header of the incoming HUDC
  record. (The field was created previously for HUBC records
  with CR 00025157. Since this layout is common to both HUBC and
  HUDC records, the existing field will now be used for HUBC
  and HUDC records).

   CABEHUBC Copybook
     Field Name      = HUBC-SANCTIONED-IND
     Field Number    = 51b
     Field Position = 311

  Requirement 2
  CWF must create and display a new one-byte field 'Sanctioned
  Provider' Indicator in the header of the incoming HUIP record.

  CABEHUIN   Copybook
     Field   Name     = HUIN-SANCTIONED-IND
     Field   Number   = 59
     Field   Position = 708

  (The layout for the CABEHUIN copybook with the new field will be
   included with the external copybook CR 00025595).

  Requirement 3
  CWF must create and display a new one-byte field 'Sanctioned
  Provider' Indicator in the header of the incoming HUOP, HUHH
  and HUHC record.

  CABEHUON Copybook
     Field Name     = HUON-SANCTIONED-IND
     Field Number   = 61
     Field Position = 708
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 66
____________________________________________________________________________


 (The layout for the CABEHUON copybook with the new field will be
  included with the external copybook CR 00025595).

 Requirement 4
 The valid value for the new 'Sanctioned Provider' Indicator field
 will be an 'S' or Space.

 Note: Although the field for 'Sanctioned Provider' was
       created for Part B previously, an error code to
       reject invalid values was not created at that time.
       Therefore, the consistency error code being created
       will also set on HUBC records.

 CWF will create a new consistency error code '2510' that will
 reject when an HUBC or HUDC record is submitted and the new
 'Sanctioned Provider' Indicator field contains a value not
 equal to 'S' or 'Space'.

  The edit will be bypassed when:

   -The Entry Code is equal to '3' (Cancel Only)

   -The Entry Code is equal to '9' (History Bill).

 Requirement 5
 The valid value for the new 'Sanctioned Provider' Indicator field
  will be an 'S' or Space.

 CWF will create a new consistency error code '0048' that will
 reject when an HUIP, HUOP, HUHH, or HUHC record is submitted
 and the new 'Sanctioned Provider' Indicator field contains a
 value not equal to 'S' or 'Space'.'

 The edit will be bypassed when:

   -The Action Code is equal to '4' (Cancel Only)

   -The Action Code is equal to '7' (History Bill).

 Requirement 6
 CWF must begin to display the 'S' stored in the one-byte
 'Sanctioned Provider' Indicator field in the header
 of DMAC (HUDC) records on the Claim History file.

  **Note: This copybook and requirement is internal to CWF.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 67
____________________________________________________________________________


 Requirement 7
 CWF must create and display a new one-byte field 'Sanctioned
 Provider' Indicator in the header of the Part A (HUIP, HUOP,
 HUHH and HUHC), records on the Claim History file that will
 store the 'S' Indicator.

 **Note:    This copybook and requirement is internal to CWF.

 Requirement 8
 CWF must create a new one-byte field 'Sanctioned Provider'
 Indicator field in the header of the HUIP record layout for
 the NCH file.

  CABEHUIP Copybook
    Field Name      = HUIP-SANCTIONED-IND
    Field Number    = 66
    Field Position = 761

 The layout for the CABEHUIP copybook with the new field will be
 included with the external copybook CR 00025595.

 Requirement 9
 CWF must create a new one-byte field 'Sanctioned Provider'
 Indicator field in the header of the HUOP, HUHH, and HUHC
 record layout for the NCH file.

 CABEHUOP   Copybook
    Field   Name     = HUOP-SANCTIONED-IND
    Field   Number   = 55
    Field   Position = 761

 The layout for the CABEHUOP copybook with the new field will be
 included with the external copybook CR 00025595.

 Requirement 10
 CWF must create and display a new one-byte field 'Sanctioned
 Provider' Indicator field in the header of the HIDC record
 in the Internal Testing Facility (ITF).

            DMEPOS CLAIM                     TRANSID    HIDC    PAGE 01



   HI-CLAIM-NUM             SURNAME         FIRST-INIT    SEX
   DMERC                DOB           REQ-ID       RESPONSE-CODE    PRINTE
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 68
____________________________________________________________________________

   NUM-LINES      ENTRY-CODE      INVESTIGATION-IND     SPLT-CLM-IND     PAY-DEN
   HCPCS-YR       ADJ: MASS     CLM                      DOC-CTL-NO
   CLM-RCPT-DT           PAY-DEN-DT
   REP-PAYEE-IND      SUBMITTER-ID               ACCIDENT-SW     PAT-REL-IND
   WORK-REL-IND     SIGNATURE-IND      BENE-DIED-IND      COMP-IND
   COMP-CARRIER            COMP-ID-NUM                          ASSIGN-IND
   AMT-PAID-BY-BENE           PRIVACY-FLAG      DT-BILLED          EXAMINER-NUM
   REMARKS                 MICRO-IND     UPIN         NPI-HEADER
   DIAG2        DIAG3        DIAG4        DIAG5        DEMO-NUMBER
   CROSSOVER ID:                                   LIAB IND        IHS-IND
   IDE-NUMBER                                      NCPDP IND    >>>SANC-IND
   OVERRIDE EDIT1:         EDIT2:       EDIT3:       EDIT4:       EDIT5:


  2-ISA+SAVE   4-NO DATA    12-ENTER TXN    7-UP   8-DN   10-ISA 13-SAVE    14-REWR

  Requirement 11
  CWF must create and display a new one-byte field 'Sanctioned
  Provider' Indicator field in the header of the HIIP, HIOP, HIHH
  and HIHC records in the CWF Internal Testing Facility (ITF).


    HIIP / HIIPCIP             CWF INPATIENT BILL - PAGE 1 CICS:
    RS C   CN                            NAME                            FN
                                         DOB              SEX     ADJ: MASS       C
    PRTR      IN              PN                 NPI              REQID 1       ADMDT
    MED-RECNO                          PAT-NO                                       A
    TYPE         TREAT-CD 1)                          ZIP                 PAT-STAT 0
    RUGS-IND               2)                         TOT-LIFEDYS 000       YR2-LIFE
    DEMO-NUMBER            3)
    COV-FROM            COV-THRU            UTIL-DAYS      COST-DYS       PRICER-CD
    NON-UTIL-DAYS           YR1-CODAYS          YR2-CODAYS          UB-CD       KRON-
    PAT-FIL-CD     PASS-PER-DIEM            RCPT-DT           APPR-DT       LIAB IND
    FORW-DT               DRG         REIMB-AMT                 EXTCAUSEINJ
    PR-DIAG           CD1            CD2         CD3         CD4        >>>SANC-IND
         CD5          CD6            CD7         CD8          EXCP-
    PRPR-CD-DT                         PRC1                       PRC2
    PRC3-CD-DT                         PRC4                       PRC5
    IDE 1           2            3          4         5           6           7
    OVERRIDE EDIT1:           EDIT2:        EDIT3:      EDIT4:         EDIT5:



    2-ISA+SAVE 4-NO DATA 12-ENTER TXN 7-UP 8-DN 10-ISA 13-SAVE 14-REWRITE

    **********************************************************************
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 69
____________________________________________________________________________



   HIOP                         CWF OUTPATIENT BILL      PAGE 1 CICS:
   RS C   CN                           NAME                            FN
                                       DOB              SEX     RAP-IND
   PRTR       IN             PN                 NPI                   REQID 1      A
   MED-RECNO                         PAT-PAID 0000000     PCN
                                                 ADJ: MASS        CLM     ADMDT
   TYPE        TREAT-CD 1)                          ZIP                PAT-STAT
                         2)                         FST-SVC             LST-SVC
   DEMO-NUMBER           3)
   UB-CD 9 ESRD-REIMB-METH 0 ORIG-START-REVOC         PRICER-CD       LIAB-IND
   REC-DT            APP-DT            SCHED-PMT-DT             REIM-AMT
   EXT-CAUSE-INJURY           REASON-PAT-VISIT                EXCP-IND        LUPA
   PR-DIAG          CD1         CD2         CD3          CD4       >>>SANC-IND
                    CD5         CD6         CD7          CD8
   PRPROC-CD                        PRC1                       PRC2
         PRC3                       PRC4                       PRC5
   IDE 1          2           3          4          5           6           7
   OVERRIDE EDIT1:          EDIT2:       EDIT3:        EDIT4:        EDIT5:




    2-ISA+SAVE 4-NO DATA 12-ENTER TXN 7-UP 8-DN 10-ISA 13-SAVE 14-REWRITE

    **********************************************************************


   HIHH                        CWF HOME HEALTH BILL      PAGE 1 CICS: CMYA
   RS C   CN                           NAME                            FN
                                       DOB              SEX     RAP-IND
   PRTR       IN            PN                  NPI                   REQID 1     A
   MED-RECNO                         PAT-PAID 0000000     PCN
                                                 ADJ: MASS        CLM     ADMDT
   TYPE        TREAT-CD 1)                          ZIP                PAT-STAT
                         2)                         FST-SVC             LST-SVC
   DEMO-NUMBER           3)
   UB-CD 9 ESRD-REIMB-METH 0 ORIG-START-REVOC         PRICER-CD       LIAB-IND
   REC-DT            APP-DT            SCHED-PMT-DT             REIM-AMT
   EXT-CAUSE-INJURY          REASON-PAT-VISIT                 EXCP-IND       LUPA
   PR-DIAG          CD1         CD2         CD3          CD4       >>>SANC-IND
                    CD5         CD6         CD7          CD8
   PRPROC-CD                        PRC1                       PRC2
         PRC3                       PRC4                       PRC5
   IDE 1          2          3           4          5           6          7
______________________________________________________________________________
Computer Sciences Corporation                                     Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 70
____________________________________________________________________________

   OVERRIDE     EDIT1:       EDIT2:       EDIT3:      EDIT4:            EDIT5:




    2-ISA+SAVE 4-NO DATA 12-ENTER TXN 7-UP 8-DN 10-ISA 13-SAVE 14-REWRITE

    **********************************************************************


   HIHC                          CWF HOSPICE BILL       PAGE 1     CICS: CMYA
   RS C    CN                           NAME APPLE                     FN
                                        DOB            SEX       RAP-IND
   PRTR         IN            PN                NPI                   REQID 1       A

   MED-RECNO                          PAT-PAID 0000000   PCN
                                                 ADJ: MASS      CLM     ADMDT
   TYPE        TREAT-CD 1)                          ZIP              PAT-STAT
                         2)                         FST-SVC           LST-SVC
   DEMO-NUMBER           3)
   UB-CD    ESRD-REIMB-METH     ORIG-START-REVOC       PRICER-CD      LIAB-IND
   REC-DT            APP-DT            SCHED-PMT-DT           REIM-AMT
   EXT-CAUSE-INJURY           REASON-PAT-VISIT              EXCP-IND       LUPA
   PR-DIAG 4660     CD1         CD2         CD3        CD4      >>>SANC-IND
                    CD5         CD6         CD7        CD8
   PRPROC-CD                        PRC1                     PRC2
         PRC3                       PRC4                     PRC5
   IDE 1          2           3          4         5          6           7
   OVERRIDE EDIT1:          EDIT2:       EDIT3:      EDIT4:        EDIT5:




   2-ISA+SAVE 4-NO DATA 12-ENTER TXN 7-UP 8-DN 10-ISA 13-SAVE 14-REWRITE

  Requirement 12
  CWF must create and display a new one-byte field 'Sanctioned
  Provider' Indicator field in the header of the DMEPOS Claim
  History on the DMEH screen in HIMR.

   DMEH                    DMEPOS CLAIM HISTORY                  PAGE       1 OF    3
   HIC                           LOCAL HOST              DOB                    SEX
   CORR                  NAME                            DOD                 SOURCE 0
   BOI    CMN 1
               INP 0000 OUT 0000 HOS 0000 PTB 0000 DME 0001 HHA 0000 BLK N
   NPI HEADER
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
    Common Working File                                                  R2008100
    Full Requirements Document                                    October 3, 2007
    Change Requests                                                       Page 71
    ____________________________________________________________________________

       ICN              NUM-LINES       ENTRY CD CLM FROM            CLM THRU
       DMERC                SURNAME          FI DOB            SEX      ASSIGNMENT
       IDE NUMBER:                                    ADJ: MASS    CLM
       CLAIM REIM                                                  MSP FLAG
       AMT PAID BY BENE             PAY DENIAL IND                 MSP AMT
       DED MED                      PAY DENIAL DTE                 ACCIDENT
0       CASH DED                     CLAIM RECEIPT DTE              PAT REL
       CO INS                       CPT INTEREST                >>SANC-IND
       UNSOL IND    IHS IND         COMP CARRIER                   WORK RELATED
                                    COMP ID NUM                    SIGNATURE
       LIAB IND     NCPDP IND       COMP IND             DOA              CANC
                          REFER UPIN          DIAG CD: PRI         SEC1        SEC
       CLEAN CLM   SPLIT                            BENE DIED      PRIVACY     MIC
       REP PAYEE   SRCE     AUTO ADJ     IND3            IND4      IND5        HCP
       REMARKS:               SUBMITTER                   DEMO NUM             EXA
       OVERRIDE EDIT1:      EDIT2:       EDIT3:        EDIT4:       EDIT5:



                F2=MENU F3=RETURN F4=BENA F5=BENB F7=BWD F8=FWD F12=EXIT

      Requirement 13
      CWF must create and display a new one-byte field 'Sanctioned
      Provider' Indicator field in the header of the INPH, OUTH, HHAH,
      and HOSH records in HIMR.


       INPH                    INP HOSPITAL/SNF CLAIM HISTORY          PAGE    1 OF
       HIC                                    LOCAL HOST         DOB                SEX
       CORR                  NAME                                DOD            SOURCE
       CMN 1 HHB 1 HHE 1 MSP 3 REP 2
                     INP 0001 OUT 0003 HOS 0000 PTB 0006 DME 0002 HHA 0003 BLK
       ICN                    NPI                 ADJ: MASS_ CLM         FROM
       EXCP/NONEXCP IND 0 PROV             INTER             ACT CD 1 THRU
       ADM DTE           DISCHGDTE             BILL      PATSTAT       FORM   LIAB IND
       DAYS:UTL      NON UTL       CST       CO:YR1      YR2       TOT LFE      LFE
       CANCEL ADJ CODE         ASSOC ADJ CODE          MSP      DESCRIPTION
       KRON                              PASS PER DIEM                   DRG
       RECEIVED DTE             PPROVED DTE                      SCHED PMT DTE
       NOPAY     INP DED                 REIM AMT                  DOA           CANC
       PR-DIAG:           DIAG: 2:             3:          4:             5:
       UNSOL IND:                 6:           7:          8:             9:
       PRI-PROC CD/DTE:                        EXT-INJ-DIAG:              PRICER CD 14
       PROC     2:                     3:                     4:
       CD/DTE: 5:                      6:                TRANS 3 SRC 3 >>SANC-IND
       IDE NUM 1          2            3          4           5           6          7
    ______________________________________________________________________________
    Computer Sciences Corporation                                      Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 72
____________________________________________________________________________

   TREAT AUTH 1)                       2)                       3)
   PRO CONTROL NUM               PAT CTL NUM EVENT 2-1                      DEMO NUMBE
   MEDCAID NUM                      MED REC NUM                            MED STAT CD


      F2=MENU F3=RETURN F4=BENA F5=BENB F7=BWD F8=FWD F12=EXIT                05/17/0

  ***********************************************************************

   OUTH
                              OUTP CLAIM HISTORY           PAGE     1 OF     5
   HIC                                   LOCAL HOST        DOB                 SEX
   CORR                 NAME                               DOD             SOURCE
   CMN 1 HHB 1 HHE 1 MSP 3 REP 2
                 INP 0001 OUT 0003 HOS 0000 PTB 0006 DME 0002 HHA 0003 BLK
   ICN                     PROV                   INTER              FROM
   CANCEL ADJ CODE         NPI              ADJ: MASS_ CLM           THRU
   ADMDT         ASSOC ADJ CODE     BILL      PAT STAT      RIC        LIAB IND
   NO PAY CD:                   ACT CD:       DOA            FORM         CANC
   EXCP/NONEXCP IND             ESRD REIMB METH              LUPA       PRICER CD
   PMT DIST PROV                   TOT CHRG                    DED PT:
   RECEIVED DTE               PMT DIST PAT                     DED OT:
   REIMB AMT              APPROVED DTE                     SCHED PMT DTE 00/00/0
   UNSOL IND                        EXP SUB DED                DEMO NUMBER
   PRINC DIAG CD:                   >>SANC IND                 IDE NUMBER 1)
   OTHER DIAG CD 2:          3:          4:          5:                     2)
                  6:         7:          8:          9:                     3)
   EXT-INJ-DIAG:         REASON-PAT-VISIT:                                  4)
   PRINC PROC CD/DTE:                                                       5)
   OTHER PROC CD/DTE: 2:                          3:                        6)
                       4:                         5:                        7)
                       6:                             >>SANC-IND


     F2=MENU F3=RETURN F4=BENA F5=BENB F7=BWD F8=FWD F12=EXIT                05/17/05

  ***********************************************************************

   HHAH                             HHA CLAIM HISTORY                       PAGE    1
   HIC                                  LOCAL HOST                   DOB
   CORR                  NAME                                        DOD
   HHB 1 HHE 1 MSP 3
                        INP 0000 OUT 0000 HOS 0000 PTB 0000 DME 0000 HHA 00
   ICN                          PROV               INTER 00400      FROM
   CANCEL ADJ CODE              NPI              ADJ: MASS   CLM    THRU
   ADMDT           ASSOC ADJ CODE A6 BILL      PAT STAT    RIC     LIAB IND
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 73
____________________________________________________________________________

   NO PAY CD:                  ACT CD:       DOA           FORM       CANC
   EXCP/NONEXCP IND            ESRD REIMB METH             LUPA     PRICER CD
   PMT DIST PROV                       TOT CHRG                 DED PT:
   RECEIVED DTE                   PMT DIST PAT                  DED OT:
   REIMB AMT                      APPROVED DTE                  SCHED PMT DTE
   UNSOL IND                       EXP SUB DED              DEMO NUMBER
   PRINC DIAG CD:                   >>SANC-IND              IDE NUMBER 1)
   OTHER DIAG CD 2:         3:          4:          5:                  2)
                  6:        7:          8:          9:                  3)
   EXT-INJ-DIAG:         REASON-PAT-VISIT:                              4)
   PRINC PROC CD/DTE:                                                   5)
   OTHER PROC CD/DTE: 2:                         3:                     6)
                      4:                         5:                     7)
                      6:



   F2=MENU F3=RETURN F4=BENA F5=BENB F7=BWD F8=FWD F12=EXIT             07/26/07


  ***********************************************************************

   HOSH                           HOSPICE CLAIM HISTORY                  PAGE      1
   HIC                                  LOCAL HOST                DOB
   CORR                  NAME                                     DOD

   CORR                  NAME                                     DOD
   BOI 1 HOS 1 MSP 3
                         INP 0000 OUT 0000 HOS 0004 PTB 0000 DME 0000 HHA 00
   ICN                           PROV                 INTER              FROM
   CANCEL ADJ CODE       BILL     PAT STAT       RIC     ACT CD          THRU
   PMT DIST PROV                  REIMB AMT             .00     TOT CHRG
   RECEIVED DTE                   APPROVED DTE                    SCHED PMT DTE
   NOPAY CD:           DOA            FORM: UB92     CANC       EXCP/NONEXC IND
   PRI-DIAG:           DIAG: 2:          3:          4:            5:
   DEMO NUMBER                6:         7:          8:            9:
   EXT-INJ-DIAG:                      UNSOL IND    PRICER CD      NPI
   PRI-PRIC CD/DTE                                 ADJ: MASS     CLM    LIAB IND
   PROC CD/DTE: 1:                       2:                           >>SANC-IND
                 3:                      4:
                 5:

  Requirement 14
  When the new Sanctioned Indicator field contains a value of 'S':

  CWF will bypass the COBC process for fully denied HUDC records.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 74
____________________________________________________________________________

  When bypassing the COBC process, fully denied DMAC records will
  not cross over, and will not return a Trailer '29'.

  A HUDC is fully denied when:

   1. The header Pay Denial Indicator on the incoming HUDC record
      contains a value equal to:
        '12', '13', '14', '15', '16', '17', '18', '25', 26'
        'E', 'F', 'G', 'H', 'J', 'K', '0', 'Q', 'T', 'U', 'V', 'X',
        'Y', or 'Z'.

   2. The detail Pay Process Indicator on the incoming HUDC record
      contains a value equal to:
        '12', '13', '14', '15', '16', '17', '18', '25', 26'
        'E', 'F', 'G', 'H', 'J', 'K', 'Q', 'T', 'U', 'V', 'X',
        'Y', 'Z', 'B', 'C' or 'N'.

   3. None of the details on the incoming HUDC record have a Payment
      Process Indicator equal to 'A', 'R' or 'S'.

  CWF will bypass original claims (Entry Code 1) and adjustment
  claims (Entry Code 5) for HUDC records.

  Note: If the Beneficiary has a COIF File that contains other
        inclusions/exclusion and an incoming HUBC or HUDC record
        is fully denied, and contains an 'S' in the Sanctioned
        Provider Indicator field, the claim will be excluded from
        COBC processing. The inclusions/exclusions will be bypassed.

  Requirement 15
  When the new Sanctioned Indicator field contains a value of 'S':

  CWF will bypass the COBC process for fully denied HUIP, HUOP, HUHH
  or HUHC records. When bypassing the COBC process for fully denied
  Part A records will not cross over, and will not return a
  Trailer '29'.

  A HUIP, HUOP, HUHH or HUHC record is fully denied when:

   1. The No-Pay Code field is equal to 'B' or 'N', or the No-Pay
      field is equal to a cost avoid '12', '13', '14', '15', '16',
      '17', '18', '25', '26', 'E', 'F', 'G', 'H', 'J', 'K', 'Q',
      'T', 'U', 'V', 'Y', 'X', or 'Z'.

   2) Or a No-Pay/Cost Avoid Code is not present, but the Total
      Non-Covered Amount is equal to the Total Charge Amount for
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 75
____________________________________________________________________________

     the claim.

  CWF will bypass original claims (Action Code 1) and adjustment
  claims (Action Code 3) for HUIP, HUOP, HUHH and HUHC records.

  Note: If the Beneficiary has a COIF File that contains other
        inclusions/exclusion and an incoming HUIP, HUOP, HUHH, or
        HUHC is fully denied, and contains an 'S' in the Sanctioned
        Provider Indicator field, the claim will be excluded from
        COBC processing. The inclusions/exclusions will be bypassed.


   ***.......This is the width of the Release Document.......***


   The Event-Response List provides a description of the way
   that the system should function AFTER the change.

   ******************************************************************

   * If you want the EVENT-RESPONSEs printed in the release document*
   * remove the word "None" and delete the delimiter line. Number *
   * Events to correspond with the NEW BUSINESS REQUIRMENTS.        *
   * NBR 1, Event would be 1.1, NBR 2,Events would be 2.1, 2.2, etc.*
   ******************************************************************
     EVENT-RESPONSE LIST:
   ***.......This is the width of the Release Document.......***

  Event 1.1
  An HUDC record is submitted for a Provider that has been
  sanctioned. The header of the HUDC record contains the
  new one-byte field for the 'Sanctioned Provider' Indicator.

  Response
  The incoming record is processed through CWF with the new
  one-byte field.

  Event 2.1
  An HUIP record is submitted for a Provider that has been
  sanctioned. The header of the HUIP record contains the
  new one-byte field for the 'Sanctioned Provider' Indicator.

  Response
  The incoming record is processed through CWF with the new
  one-byte field.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 76
____________________________________________________________________________

  Event 3.1
  An HUOP, HUHH or HUHC record is submitted for a Provider
  that has been sanctioned. The header of the record contains
  the new one-byte field for the 'Sanctioned Provider' Indicator.

  Response
  The incoming record is processed through CWF with the new
  one-byte field.

  Event 4.1
  An HUBC record is submitted for a Provider that has been
  sanctioned. The value in the new 'Sanctioned Provider'
  Indicator field is not equal to 'S' or Space. The Entry
  Code on the incoming record is equal to '1'.

  Response
  The incoming record is rejected, error code '2510' is set.

  Event 4.2
  An HUBC record is submitted for a Provider that has been
  sanctioned. The value in the new 'Sanctioned Provider'
  Indicator field is not equal to 'S' or Space. The Entry
  Code on the incoming record is equal to '3'.

  Response
  The incoming record is accepted, error code '2510' is
  not set.

  Event 4.3
  An HUBC record is submitted for a Provider that has been
  sanctioned. The value in the new 'Sanctioned Provider'
  Indicator field is equal to 'S' or Space. The Entry
  Code on the incoming record is equal to '3'.

  Response
  The incoming record is accepted, error code '2510' is
  not set.

  Event 4.4
  An HUBC record is submitted for a Provider that has been
  sanctioned. The value in the new 'Sanctioned Provider'
  Indicator field is not equal to 'S' or Space. The Entry
  Code on the incoming record is equal to '9'.

  Response
  The incoming record is accepted, error code '2510' is
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 77
____________________________________________________________________________

  not set.

  Event 4.5
  An HUBC record is submitted for a Provider that has been
  sanctioned. The value in the new 'Sanctioned Provider'
  Indicator field is equal to 'S' or Space. The Entry
  Code on the incoming record is equal to '9'.

  Response
  The incoming record is accepted, error code '2510' is
  not set.

  Event 4.6
  An HUDC record is submitted for a Provider that has been
  sanctioned. The value in the new 'Sanctioned Provider'
  Indicator field is not equal to 'S' or Space. The Entry
  Code on the incoming record is equal to '1'.

  Response
  The incoming record is rejected, error code '2510 is set.

  Event 4.7
  An HUDC record is submitted for a Provider that has been
  sanctioned. The value in the new 'Sanctioned Provider'
  Indicator field is not equal to 'S' or Space. The Entry
  Code on the incoming record is equal to '3'.

  Response
  The incoming record is accepted, error code '2510' is
  not set.

  Event 4.8
  An HUDC record is submitted for a Provider that has been
  sanctioned. The value in the new 'Sanctioned Provider'
  Indicator field is equal to 'S' or Space. The Entry
  Code on the incoming record is equal to '3'.

  Response
  The incoming record is accepted, error code '2510' is
  not set.

  Event 4.9
  An HUDC record is submitted for a Provider that has been
  sanctioned. The value in the new 'Sanctioned Provider'
  Indicator field is not equal to 'S' or Space. The Entry
  Code on the incoming record is equal to '9'.
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 78
____________________________________________________________________________


  Response
  The incoming record is accepted, error code '2510' is
  not set.

  Event 4.10
  An HUDC record is submitted for a Provider that has been
  sanctioned. The value in the new 'Sanctioned Provider'
  Indicator field is equal to 'S' or Space. The Entry
  Code on the incoming record is equal to '9'.

  Response
  The incoming record is accepted, error code '2510' is
  not set.

  Event 5.1
  An HUIP, HUOP, HUHH or HUHC record is submitted for a
  Provider that has been sanctioned. The value in the new
  'Sanctioned Provider' Indicator field is not equal to
  'S' or Space. The Action Code on the incoming record
  is equal to '1'.

  Response
  The incoming record is rejected, error code '0048 is set.

  Event 5.2
  An HUIP, HUOP, HUHH or HUHC record is submitted for a
  Provider that has been sanctioned. The value in the new
  'Sanctioned Provider' Indicator field is not equal to
  'S' or Space. The Action Code on the incoming record
  is equal to '4'.

  Response
  The incoming record is accepted, error code '0048' is
  not set.

  Event 5.3
  An HUIP, HUOP, HUHH or HUHC record is submitted for a
  Provider that has been sanctioned. The value in the new
  'Sanctioned Provider' Indicator field is equal to 'S'
  or Space. The Action Code on the incoming record is equal
  to '4'.

  Response
  The incoming record is accepted, error code '0048' is
  not set.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 79
____________________________________________________________________________


 Event 5.4
 An HUIP, HUOP, HUHH or HUHC record is submitted for a
 Provider that has been sanctioned. The value in the new
 'Sanctioned Provider' Indicator field is not equal to
 'S' or Space. The Action Code on the incoming record
 is equal to '7'.

 Response
 The incoming record is accepted, error code '0048' is
 not set.

 Event 5.5
 An HUIP, HUOP, HUHH or HUHC record is submitted for a
 Provider that has been sanctioned. The value in the new
 'Sanctioned Provider' Indicator field is equal to
 'S' or Space. The Action Code on the incoming record
 is equal to '7'.

 Response
 The incoming record is accepted, error code '0048' is
 not set.

 Event 6.1
 An HUDC record that contains the new header 'Sanctioned
 Provider' Indicator field is submitted.

 Response
 The record is processed in the CLAIM HISTORY file.

 Event 7.1
 An HUIP, HUOP, HUHH and HUHC record that contains the new
 header 'Sanctioned Provider' Indicator field is submitted.

 Response
 The record is processed in the CLAIM HISTORY file.

 Event 8.1
 An HUIP record that contains the new header 'Sanctioned
 Provider' Indicator field is submitted.

 Response
 The record is processed in the NCH file.

  Event 9.1
  An HUOP, HUHH and HUHC record that contains the new header
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 80
____________________________________________________________________________

  'Sanctioned Provider' Indicator field is submitted.

  Response
  The record is processed in the NCH file.

  Event 10.1
  Access the Internal Testing Facility (ITF) and select an
  HUDC record.

  Response
  The header portion of the HUDC record in ITF contains a
  new one-byte field for 'Sanctioned Provider' Indicator.

  Event 10.2
  Submit an HUDC record in ITF for a Provider that has been
  sanctioned. The record contains an 'S' in the new one-byte
  'Sanctioned Provider' Indicator field.

  Response
  Access the HUDC record that was submitted in ITF. An 'S'
  'S' is displayed in the new header 'Sanctioned Provider
  Indicator field.

  Event 11.1
  Access the Internal Testing Facility (ITF) and select an
  HUIP, HUOP, HUHH and HUHC record.

  Response
  The header portion of each of the records in ITF contains a
  new one-byte field for 'Sanctioned Provider' Indicator.

  Event 11.2
  Submit an HUIP record in ITF for a Provider that has been
  sanctioned. The record contains an 'S' in the new one-byte
  'Sanctioned Provider' Indicator field.

  Response
  Access the HUIP record that was submitted in ITF. An 'S'
  'S' is displayed in the new header 'Sanctioned Provider
  Indicator field.

  Event 11.3
  Submit an HUOP record in ITF for a Provider that has been
  sanctioned. The record contains an 'S' in the new one-byte
  'Sanctioned Provider' Indicator field.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 81
____________________________________________________________________________

 Response
 Access the HUOP record that was submitted in ITF. An 'S'
 'S' is displayed in the new header 'Sanctioned Provider
 Indicator field.

 Event 11.4
 Submit an HUHH record in ITF for a Provider that has been
 sanctioned. The record contains an 'S' in the new one-byte
 'Sanctioned Provider' Indicator field.

 Response
 Access the HUHH record that was submitted in ITF. An 'S'
 'S' is displayed in the new header 'Sanctioned Provider
 Indicator field.

 Event 11.5
 Submit an HUHC record in ITF for a Provider that has been
 sanctioned. The record contains an 'S' in the new one-byte
 'Sanctioned Provider' Indicator field.

 Response
 Access the HUHC record that was submitted in ITF. An 'S'
 'S' is displayed in the new header 'Sanctioned Provider
 Indicator field.

 Event 12.1
 Access the DMEH screen in HIMR for a Beneficiary that has
 an 'S' in the 'Sanctioned Provider' Indicator field on a HUDC
 record.

 Response
 A new one-byte field is displayed in the header of the
 HUDC record in HIMR.

  DMEH                DMEPOS CLAIM HISTORY                PAGE   1 OF    3


  HIC                       LOCAL HOST             DOB               SEX
  CORR              NAME                           DOD            SOURCE 0
  BOI    CMN 1
               INP 0000 OUT 0000 HOS 0000 PTB 0000 DME 0001 HHA 0000 BLK N
   NPI HEADER
   ICN              NUM-LINES    ENTRY CD   CLM FROM           CLM THRU
   DMERC               SURNAME        FI   DOB            SEX    ASSIGNMENT
   IDE NUMBER:                                  ADJ: MASS    CLM
   CLAIM REIM                                                MSP FLAG
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 82
____________________________________________________________________________

   AMT PAID BY BENE             PAY DENIAL IND                MSP AMT
   DED MED                      PAY DENIAL DTE                ACCIDENT
   CASH DED                     CLAIM RECEIPT DTE             PAT REL
   CO INS                       CPT INTEREST               >>SANC-IND S
   UNSOL IND    IHS IND         COMP CARRIER                  WORK RELATED
                                COMP ID NUM                   SIGNATURE
   LIAB IND     NCPDP IND       COMP IND            DOA             CANC
                      REFER UPIN          DIAG CD: PRI        SEC1       SEC
   CLEAN CLM   SPLIT                           BENE DIED      PRIVACY    MIC
   REP PAYEE   SRCE     AUTO ADJ     IND3           IND4      IND5       HCP
   REMARKS:               SUBMITTER                  DEMO NUM            EXA
   OVERRIDE EDIT1:      EDIT2:       EDIT3:       EDIT4:       EDIT5:



           F2=MENU F3=RETURN F4=BENA F5=BENB F7=BWD F8=FWD F12=EXIT



  Event 13.1
  Access the INPH screen in HIMR for a Beneficiary that has an 'S'
  in the 'Sanctioned Provider' Indicator field on a HUIP record.

  Response
  A new one-byte field is displayed in the header of the HUIP record in
  HIMR.


   INPH                    INP HOSPITAL/SNF CLAIM HISTORY         PAGE    1 OF
   HIC                                   LOCAL HOST         DOB                SEX
   CORR                  NAME                               DOD            SOURCE
   CMN 1 HHB 1 HHE 1 MSP 3 REP 2
                 INP 0001 OUT 0003 HOS 0000 PTB 0006 DME 0002 HHA 0003 BLK
   ICN                    NPI                ADJ: MASS_ CLM         FROM
   EXCP/NONEXCP IND 0 PROV            INTER             ACT CD 1 THRU
   ADM DTE           DISCHGDTE            BILL      PATSTAT       FORM   LIAB IND
   DAYS:UTL      NON UTL       CST      CO:YR1      YR2       TOT LFE      LFE
   CANCEL ADJ CODE         ASSOC ADJ CODE         MSP     DESCRIPTION
   KRON                             PASS PER DIEM                   DRG
   RECEIVED DTE             PPROVED DTE                     SCHED PMT DTE
   NOPAY     INP DED                REIM AMT                  DOA           CANC
   PR-DIAG:           DIAG: 2:            3:          4:             5:
   UNSOL IND:                 6:          7:          8:             9:
   PRI-PROC CD/DTE:                       EXT-INJ-DIAG:              PRICER CD 14
   PROC     2:                     3:                    4:
   CD/DTE: 5:                      6:           TRANS 3 SRC 3 >>SANC-IND S
______________________________________________________________________________
Computer Sciences Corporation                                     Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 83
____________________________________________________________________________

   IDE NUM 1           2          3         4         5              6          7
   TREAT AUTH 1)                       2)                       3)
   PRO CONTROL NUM               PAT CTL NUM EVENT 2-1                    DEMO NUMBE
   MEDCAID NUM                      MED REC NUM                          MED STAT CD


      F2=MENU F3=RETURN F4=BENA F5=BENB F7=BWD F8=FWD F12=EXIT               05/17/0

  ***********************************************************************

  Event 13.2
  Access the OUTH screen in HIMR for a Beneficiary that has
  an 'S' in the 'Sanctioned Provider' Indicator field on a HUOP
  record.

  Response
  A new one-byte field is displayed in the header of the HUOP record
  in HIMR.

   OUTH
                              OUTP CLAIM HISTORY            PAGE     1 OF     5
   HIC                                   LOCAL HOST         DOB                 SEX
   CORR                 NAME                                DOD             SOURCE
   CMN 1 HHB 1 HHE 1 MSP 3 REP 2
                 INP 0001 OUT 0003 HOS 0000 PTB 0006 DME 0002 HHA 0003 BLK
   ICN                     PROV                   INTER               FROM
   CANCEL ADJ CODE         NPI              ADJ: MASS_ CLM            THRU
   ADMDT         ASSOC ADJ CODE     BILL      PAT STAT       RIC        LIAB IND
   NO PAY CD:                   ACT CD:       DOA             FORM         CANC
   EXCP/NONEXCP IND             ESRD REIMB METH               LUPA       PRICER CD
   PMT DIST PROV                   TOT CHRG                     DED PT:
   RECEIVED DTE               PMT DIST PAT                      DED OT:
   REIMB AMT              APPROVED DTE                      SCHED PMT DTE 00/00/0
   UNSOL IND                        EXP SUB DED                 DEMO NUMBER
   PRINC DIAG CD:                     SANC IND S                IDE NUMBER 1)
   OTHER DIAG CD 2:          3:          4:          5:                      2)
                  6:         7:          8:          9:                      3)
   EXT-INJ-DIAG:         REASON-PAT-VISIT:                                   4)
   PRINC PROC CD/DTE:                                                        5)
   OTHER PROC CD/DTE: 2:                          3:                         6)
                       4:                         5:                         7)
                       6:                               >>SANC-IND S


     F2=MENU F3=RETURN F4=BENA F5=BENB F7=BWD F8=FWD F12=EXIT              05/17/05

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 84
____________________________________________________________________________

  ***********************************************************************

  Event 13.3
  Access the HHAH screen in HIMR for a Beneficiary that has
  an 'S' in the 'Sanctioned Provider' Indicator field on a HUHH
  record.

  Response
  A new one-byte field is displayed in the header of the HUHH record
  in HIMR.


   HHAH                           HHA CLAIM HISTORY                   PAGE      1
   HIC                                LOCAL HOST               DOB
   CORR                 NAME                                   DOD

   HHB 1 HHE 1 MSP 3
                        INP 0000 OUT 0000 HOS 0000 PTB 0000 DME 0000 HHA 00
   ICN                           PROV                 INTER 00400       FROM
   CANCEL ADJ CODE               NPI                ADJ: MASS   CLM     THRU
   ADMDT           ASSOC ADJ CODE A6 BILL         PAT STAT    RIC     LIAB IND
   NO PAY CD:                  ACT CD:       DOA           FORM       CANC
   EXCP/NONEXCP IND            ESRD REIMB METH             LUPA     PRICER CD
   PMT DIST PROV                       TOT CHRG                 DED PT:
   RECEIVED DTE                   PMT DIST PAT                  DED OT:
   REIMB AMT                      APPROVED DTE                  SCHED PMT DTE
   UNSOL IND                       EXP SUB DED              DEMO NUMBER
   PRINC DIAG CD:                    >>SANC-IND S           IDE NUMBER 1)
   OTHER DIAG CD 2:         3:          4:         5:                    2)
                  6:        7:          8:         9:                    3)
   EXT-INJ-DIAG:         REASON-PAT-VISIT:                               4)
   PRINC PROC CD/DTE:                                                    5)
   OTHER PROC CD/DTE: 2:                        3:                       6)
                       4:                        5:                      7)
                       6:



   F2=MENU F3=RETURN F4=BENA F5=BENB F7=BWD F8=FWD F12=EXIT          07/26/07


  ***********************************************************************

  Event 13.4
  Access the HOSH screen in HIMR for a Beneficiary that has
  an 'S' in the 'Sanctioned Provider' Indicator field on a HUHC
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 85
____________________________________________________________________________

  record.

  Response
  A new one-byte field is displayed in the header of the HOSH record
  in HIMR.

   HOSH                          HOSPICE CLAIM HISTORY                 PAGE      1
   HIC                                 LOCAL HOST               DOB
   CORR                  NAME                                   DOD

   CORR                  NAME                                   DOD
   BOI 1 HOS 1 MSP 3
                         INP 0000 OUT 0000 HOS 0004 PTB 0000 DME 0000 HHA 00
   ICN                           PROV                 INTER              FROM
   CANCEL ADJ CODE       BILL     PAT STAT       RIC     ACT CD          THRU
   PMT DIST PROV                  REIMB AMT             .00     TOT CHRG
   RECEIVED DTE                   APPROVED DTE                    SCHED PMT DTE
   NOPAY CD:           DOA            FORM: UB92     CANC       EXCP/NONEXC IND
   PRI-DIAG:           DIAG: 2:          3:          4:            5:
   DEMO NUMBER                6:         7:          8:            9:
   EXT-INJ-DIAG:                      UNSOL IND    PRICER CD      NPI
   PRI-PRIC CD/DTE                           ADJ: MASS      CLM     LIAB IND
   PROC CD/DTE: 1:                       2:                       >>SANC-IND S
                 3:                      4:
                 5:


   F2=MENU F3=RETURN F4=BENA F5=BENB F7=BWD F8=FWD F12=EXIT           07/26/07


  Event 14.1
  An HUDC record is submitted for a Provider that has been
  sanctioned. The record contains an 'S' in the new one-byte
  'Sanctioned Provider' Indicator field. The Entry Code on the
  record is equal to '1' or '5'. The header and all details of
  the record contains a Payment Denial and Payment Process
  Indicator equal to:

          '12', '13', '14', '15', '16', '17', '18', '25', 26'
          'E', 'F', 'G', 'H', 'J', 'K', 'O', 'Q', 'T', 'U', 'V',
          'X', 'Y', or 'Z'.

  that identify fully denied records. The Beneficiary has a
  COIF File does not contain any inclusions/exclusions. The COIF
  File has a 'P' Test Indicator.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 86
____________________________________________________________________________

  Response
  The incoming record is processed through CWF with the 'S' in
  the new one-byte field. A '29' Trailer is not generated, and
  the record is not crossed over. Page 2 of the DMERC record
  in HIMR does not display any crossover data.

  Event 14.2
  An HUDC record is submitted for a Provider that has been
  sanctioned. The record contains an 'S' in the new one-byte
  'Sanctioned Provider' Indicator field. The Entry Code on the
  record is equal to '1' or '5'. Some of the details on the record
  contain a Payment/Process Indicator equal to 'A', 'R' or 'S'.
  The Beneficiary has a COIF File that does not contain any
  inclusions/exclusions. The COIF File has a 'P' Test Indicator.

  Response
  The incoming record is processed through CWF with the 'S' in
  the new one-byte field. A '29' Trailer is generated, and the
  record is crossed over. Page 2 of the claim in history
  displays the COBA ID and a Crossover Disposition Indicator 'A'.

  Event 15.1
  An HUIP, HUOP, HUHH or HUHC record has been submitted for a
  that has been sanctioned. The record contains an 'S' in the new
  has been sanctioned. The record contains an 'S' in the new
  one-byte 'Sanctioned Provider' Indicator field. The Action Code
  on the record is equal to '1' or '3'. The No-Pay Code on the
  incoming record has a value equal to 'N' or 'B'. All details of
  the record contain a Non-Covered Amount that is equal to the
  Total Charge Amount (fully denied). The Beneficiary has a
  COIF File that does not contain any inclusions/exclusions.
  The COIF File has a 'P' Test Indicator.

  Response
  The incoming record is processed through CWF with the 'S' in
  the new one-byte field. A '29' Trailer is not generated, and
  the record is not crossed over. Page 3 of the Part A record
  in HIMR does not display any crossover data.

  Event 15.2
  An HUIP, HUOP, HUHH or HUHC record has been submitted for a
  that has been sanctioned. The record contains an 'S' in the new
  has been sanctioned. The record contains an 'S' in the new
  one-byte 'Sanctioned Provider' Indicator field. The Action Code
  on the record is equal to '1' or '3'. The No-Pay Code on the
  incoming record has a value equal:
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 87
____________________________________________________________________________

        '12', '13', '14', '15', '16', '17', '18', '25', 26'
        'E', 'F', 'G', 'H', 'J', 'K', 'Q', 'T', 'U', 'V', 'X',
        'Y', or 'Z'.
  All details of the record contain a Non-Covered Amount that
  is equal to the Total Charge Amount (fully denied). The
  Beneficiary has a COIF File that does not contain any
  inclusions/exclusions. The COIF File has a 'P' Test Indicator.

  Response
  The incoming record is processed through CWF with the 'S' in
  the new one-byte field. A '29' Trailer is not generated, and
  the record is not crossed over. Page 3 of the Part A record
  in HIMR does not display any crossover data.


  Event 15.3
  An HUIP, HUOP, HUHH or HUHC record has been submitted for a
  provider that has been sanctioned. The record contains an 'S'
  in the new one-byte 'Sanctioned Provider' Indicator field.
  The Action Code on the record is equal to '1' or '3'. The No-Pay
  Code on the incoming record is blank. Some of the details
  contain Non-Covered Amounts. The Beneficiary has a COIF File
  that does not contain any inclusions/exclusions. The COIF File
  has a 'P' Test Indicator.

  Response
  The incoming record is processed through CWF with the 'S' in
  the new one-byte field. A '29' Trailer is generated, and
  the record is crossed over. Page 3 of the Part A record
  in HIMR displays the COBA ID number and a Crossover Disposition
  Indicator 'A'.

  Event 15.4
  An HUIP, HUOP, HUHH or HUHC record has been submitted for a
  provider that has been sanctioned. The record contains an 'S'
  in the new one-byte 'Sanctioned Provider' Indicator field.
  The Action Code on the record is equal to '1' or '3'. The No-Pay
  Code on the incoming record is blank. None of the details contain
  NON-Covered Amounts. The Beneficiary has a COIF File that does
  not contain any inclusions/exclusions. The COIF File has a 'P'
  Test Indicator.

  Response
  The incoming record is processed through CWF with the 'S' in
  the new one-byte field. A '29' Trailer is generated, and
  the record is crossed over. Page 3 of the Part A record
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 88
____________________________________________________________________________

  in HIMR displays the COBA ID number and a Crossover Disposition
  Indicator 'A'.




  ***.......This is the width of the Release Document.......***

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

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1. Part A
    2. Part B/DMERC

  Solution Criteria: N/A

    EDITS AFFECTED:
  ***.......This is the width of the Release Document......***

  a. Error Code:    0048   (X)New ( )Modified ( )Deleted
  Disposition:      ER

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

  Error Message:
  An invalid value has been entered for the
  'Sanctioned Provider' Indicator.

  Set Condition for edit '0048':

  When the 'SANC IND' field contains a value not equal to 'S'
  or Space, set the '0048' error code.

  When the Action Code is equal to '4', (Cancel) bypass this edit.

  When the Action Code is equal to '7' (History Bill) bypass this edit.

  Trailer Information: '08'

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 89
____________________________________________________________________________



  b. Error Code:    2510   (X)New ( )Modified ( )Deleted
  Disposition:      ER

  Type of Record:   Pt. B Carrier, DMEPOS

  Error Message:
  An invalid value has been entered for the
  'Sanctioned Provider' Indicator.

  Set Condition for edit '2510':

  When the 'SANC IND' field contains a value not equal to 'S'
  or Space, set the '2510' error code.

  When the Entry Code is equal to '3' (Cancel), bypass this edit.

  When the Entry Code is equal to '9' (Add History), bypass this edit.

  Trailer Information:     '08'

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 90
____________________________________________________________________________


   10. 00025482    SNF EDIT 7261 SETTING INAPPROPRIATELY

  DATE ENTERED:    04/05/07

  TITLE:           SNF EDIT 7261 SETTING INAPPROPRIATELY

  PROJECT CODE:    CM01

  PRIORITY:        1

  RELEASE LEVEL: R2008100

  GROUP LEVEL:     2

  HOST SITE ID:    TRANSO1000

  STATUS ON CR:    REQS

  DOC. REQUIRED: Y

  HOST EVAL:       VALIDATE

  DOC RECEIVED:    Y

  ADDENDUM INFO: NONE

  EST. CATEGORY:   3
  EST. HOURS:      0300
  ACT. HOURS:      0182
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  CLAIM WITH DATE OF SERVICE THE SAME AS THE DISCHARGE DATE ON A SNF CLAIM
  ON FILE AT HIMR RECEIVED EDIT 7261. PER THE EDIT DOCUMENTATION, IF
  THE DATE OF SERVICE IS THE SAME AS THE DISCHARGE DATE, THE EDIT SHOULD
  NOT SET. THE EDIT LOGIC NEEDS TO BE UPDATED TO PROCESS THESE CLAIMS
  CORRECTLY AS WE HAVE NO WAY TO OVERRIDE THIS EDIT.


  The CWF Pacific Host has sent the following files to CSC
  via NDM for researching CR25482:
      "CWM.TEST.NDM.PA.CR25482.UTILMOVE"
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 91
____________________________________________________________________________

       "CWM.TEST.NDM.PA.CR25482.CLAIM"
       "CWM.TEST.NDM.PA.CR25482.RESPONSE"

  If you need anything else, please let me know.

  Janet Johnson
  CWF Southeast/Pacific/Great Lakes Hosts

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:          ______25482______    WORK TYPE:   ___   Incidental
  SUBSYSTEM:   _________________                 _x_   Minor
  FUNCTION:    _________________                 ___   Major
  PROGRAM:     _________________                 ___   New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                 Cathy Pflaum
      Telephone:           410-786-3016
      FAX, CMS:            410-786-0271
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     Ofelia Castillo
      Telephone:           469-372-6492
      FAX,Richardson,TX:   469-372-0284
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       Heather Byram
       Telephone:          717-909-2228
       FAX,Baltimore,PA:   717-920-9244
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *              blank line is found.                               *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 92
____________________________________________________________________________

  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (x) Host
  (x) Satellite Part A Inpatient
  ( ) Satellite Part A Outpatient
  (x) Satellite Part B
  ( ) Hospice
  ( ) Home Health
  (x) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  Currently, CWF is rejecting Part B/DMERC non-therapy claims
  incorrectly with A/B Crossover edit '7261' when the From
  Date equals the Discharge Date of the SNF Inpatient Part A
  claim with Patient Status other than '30'.

  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
  CWF should not set A/B Crossover edit '7261' when the
  incoming Part B/DMERC claim From Date equals the Discharge
  Date of a SNF Inpatient Part A claim (21x) posted in history
  when the Patient Status is other than '30'.

  ***.......This is the width of the Release Document.......***

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 93
____________________________________________________________________________


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  *******************************************************************
  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
  * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
  *******************************************************************
    EVENT-RESPONSE LIST: None
  ***.......This is the width of the Release Document.......***

  Event 1.1
  Enter a SNF Inpatient Part A claim (21x) with a Patient
  Status other than '30' (still patient) that is accepted
  and posted to history.

  Enter a Part B/DMERC claim with a non-therapy HCPCS code(s).
  The Part B/DMERC claim From Date equals the Discharge Date
  of the posted SNF Inpatient claim in history.

  Response
  The Part B/DMERC claim does not set A/B Crossover edit '7261'.

  Event 1.2
  Enter a SNF Inpatient Part A claim (21x) with a Patient
  Status that equals '30' (still patient) that is accepted
  and posted to history.

  Enter a Part B/DMERC claim with a non-therapy HCPCS code(s).
  The Part B/DMERC claim From Date equals the Thru Date
  of the posted SNF Inpatient claim in history.

  Response
  The Part B/DMERC claim does set A/B Crossover edit '7261'.


  ***.......This is the width of the Release Document.......***

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

  Entity List: N/A
    1. Entity:
        Description:
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 94
____________________________________________________________________________


0    Areas Affected by the Problem.
      1. A/B Crossover module

    Solution Criteria: N/A

     EDITS AFFECTED:     None

     Edit was not working properly, programming changes needed.

    ***.......This is the width of the Release Document......***

    a. Error Code:     7261     ( )New ( )Modified ( )Deleted
    Disposition:

    Type of Record: DMEPOS, Pt. B Carrier

    Error Message:
    For a DMERC/Part B claim the detail From and Thru Date is
    within the Admission and Discharge Date of a SNF Inpatient
    Part A claim (21x) and a Non-therapy HCPCS code(s) is
    present.

    Set Condition for edit '7261':
    When a DMERC/Part B claim is submitted with a Non-Therapy
    HCPCS code(s) and the detail From and Thru Date is within
    the Admission and Discharge Date of a SNF Inpatient Part A
    claim (21x), set the '7261' error code.

    Incoming DMERC/Part B claim detail From Date equals the
    SNF Inpatient Part A (21x) Discharge Date and the Patient
    Status is other than '30', bypass this edit.

    Incoming DMERC/Part B claim detail Thru Date equals the
    SNF Inpatient Part A (21x) Admission Date, bypass this
    edit.

    Incoming DMERC/Part B claim is submitted with Entry Code
    '3' (cancel only), bypass this edit.

    Incoming DMERC/Part B claim is submitted with Entry Code
    '9' (add to history), bypass this edit.

  Incoming DMERC/Part B claim is submitted with a header
  Payment/Denial Indicator is other than '1', '2', '3', '5',
  '6', '7', '8', '9', 'A', or 'B', bypass this edit.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 95
____________________________________________________________________________


  Incoming DMERC/Part B claim is submitted with a detail
  Payment/Process Indicator is other than 'A', 'R' or 'S',
  bypass this edit.

  Incoming DMERC/Part B claim is submitted with a HCPCS
  code(s) in Category '75', bypass this edit.
  Incoming DMERC/Part B claim is submitted with a HCPCS
  code(s) equal to 'G9017', 'G9018', 'G9020', 'G9033',
  'G9034', 'G9035', or 'G9036', bypass this edit.

  Incoming DMERC/Part B claim is submitted with of the
  following HCPCS code(s) and the Modifier code(s) is other
  than 'NN':
  'A0380', 'A0390', 'A0425', 'A0426', 'A0427', 'A0428',
  'A0429', 'A0430', 'A0431', 'A0432', 'A0433', 'A0434',
  'A0435', 'A0436', 'A0999', 'A0382', 'A0384', 'A0392',
  'A0394', 'A0396', 'A0398', 'A0420', 'A0422', or
  'A0424', bypass this edit.

  Terminated 12/31/2005
  'Q3019', 'Q3020'

  Terminated 03/31/2002
  'A0380', 'A0390'

  Incoming DMERC/Part B claim is submitted with one of the
  following HCPCS code(s) and the Modifier is equal to '26':
  'G0030', 'G0031', 'G0032', 'G0033', 'G0034', 'G0035',
  'G0036', 'G0037', 'G0038', 'G0039', 'G0040', 'G0041',
  'G0042', 'G0043', 'G0044', 'G0045', 'G0046', 'G0047',
  'G0106', 'G0120', 'G0125', 'G0130', 'G0202', 'G0204',
  'G0206', 'G0210', 'G0211', 'G0212', 'G0213', 'G0214',
  'G0215', 'G0216', 'G0217', 'G0218', 'G0220', 'G0221',
  'G0222', 'G0223', 'G0224', 'G0225', 'G0226', 'G0227',
  'G0228', 'G0229', 'G0230', 'G0231', 'G0232', 'G0233',
  'G0234', 'G0253', 'G0254', 'G0296', 'Q0035', '51725',
  '51726', '51736', '51741', '51772', '51784', '51785',
  '51792', '51795', '51797', '54240', '54250', '59020',
  '59025', '62252', '70010', '70015', '70030', '70100',
  '70110', '70120', '70130', '70134', '70140', '70150',
  '70160', '70170', '70190', '70200', '70210', '70220',
  '70240', '70250', '70260', '70300', '70310', '70320',
  '70328', '70330', '70332', '70336', '70350', '70355',
  '70360', '70370', '70371', '70373', '70380', '70390',
  '70360', '70370', '70371', '70373', '70380', '70390',
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 96
____________________________________________________________________________

  '70450', '70460', '70470', '70480', '70481', '70482',
  '70486', '70487', '70488', '70490', '70491', '70492',
  '70496', '70498', '70540', '70542', '70543', '70544',
  '70545', '70546', '70547', '70548', '70549', '70551',
  '70552', '70553', '70557', '70558', '70559', '71010',
  '71015', '71020', '71021', '71022', '71023', '71030',
  '71034', '71035', '71040', '71060', '71090', '71100',
  '71101', '71110', '71111', '71120', '71130', '71250',
  '71260', '71270', '71275', '71550', '71551', '71552',
  '71555', '72010', '72020', '72040', '72050', '72052',
  '72069', '72070', '72072', '72074', '72080', '72090',
  '72100', '72110', '72114', '72120', '72125', '72126',
  '72127', '72128', '72129', '72130', '72131', '72132',
  '72133', '72141', '72142', '72146', '72147', '72148',
  '72149', '72156', '72157', '72158', '72170', '72190',
  '72191', '72192', '72193', '72194', '72195', '72196',
  '72197', '72198', '72200', '72202', '72220', '72240',
  '72255', '72265', '72270', '72275', '72285', '72295',
  '73000', '73010', '73020', '73030', '73040', '73050',
  '73060', '73070', '73080', '73085', '73090', '73092',
  '73100', '73110', '73115', '73120', '73130', '73140',
  '73200', '73201', '73202', '73206', '73218', '73219',
  '73220', '73221', '73222', '73223', '73500', '73510',
  '73520', '73525', '73530', '73540', '73542', '73550',
  '73560', '73562', '73564', '73565', '73580', '73590',
  '73592', '73600', '73610', '73615', '73620', '73630',
  '73650', '73660', '73700', '73701', '73702', '73706',
  '73718', '73719', '73720', '73721', '73722', '73723',
  '73725', '74000', '74010', '74020', '74022', '74150',
  '74160', '74170', '74175', '74181', '74182', '74183',
  '74185', '74190', '74210', '74220', '74230', '74235',
  '74240', '74241', '74245', '74246', '74247', '74249',
  '74250', '74251', '74260', '74270', '74280', '74283',
  '74290', '74291', '74300', '74301', '74305', '74320',
  '74327', '74328', '74329', '74330', '74340', '74350',
  '74355', '74360', '74363', '74400', '74410', '74415',
  '74420', '74425', '74430', '74440', '74445', '74450',
  '74455', '74470', '74475', '74480', '74485', '74710',
  '74740', '74742', '74775', '75552', '75553', '75554',
  '75555', '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', '75751', '75774', '75790',
  '75801', '75803', '75805', '75807', '75809', '75810',
  '75820', '75822', '75825', '75827', '75831', '75833',
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 97
____________________________________________________________________________

  '75840', '75842', '75860', '75870', '75872', '75880',
  '75885', '75887', '75889', '75891', '75893', '75894',
  '75896', '75898', '75900', '75901', '75902', '75940',
  '75945', '75946', '75952', '75953', '75954', '75960',
  '75961', '75962', '75964', '75966', '75968', '75970',
  '75978', '75980', '75982', '75984', '75989', '75992',
  '75993', '75994', '75995', '75996', '75998', '76000',
  '76001', '76003', '76005', '76010', '76012', '76013',
  '76020', '76040', '76061', '76062', '76065', '76066',
  '76070', '76071', '76075', '76076', '76078', '76080',
  '76082', '76083', '76086', '76088', '76090', '76091',
  '76092', '76093', '76094', '76095', '76096', '76098',
  '76100', '76101', '76102', '76120', '76125', '76355',
  '76360', '76362', '76370', '76375', '76380', '76393',
  '76394', '76400', '76496', '76497', '76498', '76499',
  '76506', '76511', '76512', '76513', '76514', '76516',
  '76519', '76529', '76536', '76604', '76645', '76700',
  '76705', '76770', '76775', '76778', '76800', '76801',
  '76802', '76805', '76810', '76811', '76812', '76815',
  '76816', '76817', '76818', '76819', '76825', '76826',
  '76827', '76828', '76830', '76831', '76856', '76857',
  '76870', '76872', '76873', '76880', '76885', '76886',
  '76930', '76932', '76936', '76937', '76940', '76941',
  '76942', '76945', '76946', '76948', '76950', '76965',
  '76970', '76975', '76977', '76986', '76999', '77280',
  '77285', '77290', '77295', '77299', '77300', '77301',
  '77305', '77310', '77315', '77321', '77326', '77327',
  '77328', '77331', '77332', '77333', '77334', '77399',
  '77470', '77499', '77600', '77605', '77610', '77615',
  '77620', '77750', '77761', '77762', '77763', '77776',
  '77777', '77778', '77781', '77782', '77783', '77784',
  '77789', '77790', '77799', '78000', '78001', '78003',
  '78006', '78007', '78010', '78011', '78015', '78016',
  '78018', '78020', '78070', '78075', '78099', '78102',
  '78103', '78104', '78110', '78111', '78120', '78121',
  '78122', '78130', '78135', '78140', '78160', '78162',
  '78170', '78172', '78185', '78190', '78191', '78195',
  '78199', '78201', '78202', '78205', '78206', '78215',
  '78216', '78220', '78223', '78230', '78231', '78232',
  '78258', '78261', '78262', '78264', '78270', '78271',
  '78272', '78278', '78282', '78290', '78291', '78299',
  '78300', '78305', '78306', '78315', '78320', '78350',
  '78399', '78414', '78428', '78445', '78455', '78456',
  '78457', '78458', '78460', '78461', '78464',
  '78465', '78466', '78468', '78469', '78472', '78473',
  '78478', '78480', '78481', '78483', '78494', '78496',
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 98
____________________________________________________________________________

  '78499', '78580', '78584', '78585', '78586', '78587',
  '78588', '78591', '78593', '78594', '78596', '78599',
  '78600', '78601', '78605', '78606', '78607', '78610',
  '78615', '78630', '78635', '78645', '78647', '78650',
  '78660', '78699', '78700', '78701', '78704', '78707',
  '78708', '78709', '78710', '78715', '78725', '78730',
  '78740', '78760', '78761', '78799', '78800', '78801',
  '78802', '78803', '78804', '78805', '78806', '78807',
  '78999', '79200', '79300', '79403', '79440', '79999',
  '83020', '83912', '84165', '84181', '84182', '85390',
  '85576', '86255', '86256', '86320', '86325', '86327',
  '86334', '87164', '87207', '88104', '88106', '88107',
  '88108', '88112', '88125', '88160', '88161', '88162',
  '88172', '88173', '88182', '88199', '88300', '88302',
  '88304', '88305', '88307', '88309', '88311', '88312',
  '88313', '88314', '88318', '88319', '88323', '88331',
  '88332', '88342', '88346', '88347', '88348', '88349',
  '88355', '88356', '88358', '88361', '88362', '88365',
  '88371', '88372', '88380', '88399', '89060', '91000',
  '91010', '91011', '91012', '91020', '91030', '91052',
  '91055', '91060', '91065', '91110', '91122', '91132',
  '91133', '91299', '92060', '92065', '92081', '92082',
  '92083', '92135', '92136', '92235', '92240', '92250',
  '92265', '92270', '92275', '92283', '92284', '92285',
  '92286', '92499', '92541', '92542', '92543', '92544',
  '92545', '92546', '92548', '92585', '92587', '92588',
  '92978', '92979', '93024', '93278', '93303', '93304',
  '93307', '93308', '93312', '93314', '93315', '93317',
  '93318', '93320', '93321', '93325', '93350', '93501',
  '93505', '93508', '93510', '93511', '93514', '93524',
  '93526', '93527', '93528', '93529', '93530', '93531',
  '93532', '93533', '93555', '93556', '93561', '93562',
  '93571', '93572', '93600', '93602', '93603', '93609',
  '93610', '93612', '93615', '93618', '93619', '93620',
  '93621', '93622', '93623', '93624', '93631', '93640',
  '93641', '93642', '93660', '93662', '93701', '93724',
  '93731', '93732', '93733', '93734', '93735', '93736',
  '93741', '93742', '93743', '93744', '93799', '93875',
  '93880', '93882', '93886', '93888', '93922', '93923',
  '93924', '93925', '93926', '93930', '93931', '93965',
  '93970', '93971', '93975', '93976', '93978', '93979',
  '93980', '93981', '93990', '94010', '94060', '94070',
  '94200', '94240', '94250', '94260', '94350', '94360',
  '94370', '94375', '94400', '94450', '94620', '94621',
  '94680', '94681', '94690', '94720', '94725', '94750',
  '94770', '94772', '94799', '95805', '95806', '95807',
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                       Page 99
____________________________________________________________________________

  '94808',   '94810',   '94811',   '95812', '95813',   '95816',
  '94819',   '94822',   '94824',   '95827', '95829',   '95858',
  '95860',   '95861',   '95863',   '95864', '95867',   '95868',
  '95869',   '95870',   '95872',   '95875', '95900',
  '95903',   '95904',   '95920',   '95921', '95922',   '95923',
  '95925',   '95926',   '95927',   '95930', '95933',   '95934',
  '95936',   '95937',   '95950',   '95951', '95953',   '95954',
  '95955',   '95956',   '95957',   '95958', '95961',   '95962',
  '95965',   '95966',   '95967',   bypass this edit.

  Effective 09/15/2004
  '91120', bypass this edit.

  Effective 01/01/2005
  'G0336', 'G0365', '76077', '76510',       '76820', '76821',
  '79005', '79101', '79445',
  '84166', '86335', '88360', '88367',       '88368',
  '91034', '91035', '91037', '91038',       '91040', '91120',
  '93745', '93890', '93892', '93893',       '94452', '94453',
  '95928', '95929', bypass this edit.

  Effective 01/28/2005
  '78459', '78491', '78492', '78608', '78609', '78811',
  '78812', '78813', '78814', '78815', '78816', bypass this
  edit.

  Effective 01/01/2006
  '0067T', '0075T', '0076T',
  '75956', '75957', '75958', '75959', '76376', '76377',
  '77421',
  '88333', '88334', '88384', '88385', '88386',
  '91022', '95865', '95866', '95873', '95874', bypass this
  edit.

  Terminated 12/31/2002
  'G0131', 'G0132', '92599', set the '7261' error code.

  Terminated 12/31/2003
  'G0236', 'G0262', 'G0273', 'G0274', '76085', '76490',
  '89399', set the '7261' error code.

  Terminated 12/31/2004
  '62367', '62368', '79000', '79001', '79020', '79030',
  '79035', '79100', '79400', '79420', '88180', '91032',
  '91033', set the '7261' error code.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 100
____________________________________________________________________________

  Terminated 12/31/2005
  'G0030', 'G0031', 'G0032', 'G0033',   'G0034',   'G0035',   'G0036',
  'G0037', 'G0038', 'G0039', 'G0040',   'G0041',   'G0042',   'G0043',
  'G0044', 'G0045', 'G0046', 'G0047',   'G0125',   'G0210',   'G0211',
  'G0212', 'G0213', 'G0214', 'G0215',   'G0216',   'G0217',   'G0218',
  'G0220', 'G0221', 'G0222', 'G0223',   'G0224',   'G0225',   'G0226',
  'G0227', 'G0228', 'G0229', 'G0230',   'G0231',   'G0232',   'G0233',
  'G0234', 'G0253', 'G0254', 'G0296',   'G0336',
  '76375',
  '78160', '78162', '78170', '78172',   '78455',
  '95858', set the '7261' error code.

  Terminated 12/31/2003
  'G0236', 'G0262', 'G0273', 'G0274',
  '76085', '76490',
  '89399', set the '7261' error code.

  When incoming DMERC claim is submitted with 'MS' in any
  one Modifier fields, bypass this edit.

  When the incoming Part B claim is submitted with 'CB' and
  the Modifier field with the following HCPCS code(s):
  '71010', '71015', '71020', '71021', '71022', '71030',
  '71035', '73120', '75710', '75716', '75774', '75790',
  '75820', '75822', '75893', '75894', '75896', '75898',
  '75901', '75902', '75961', '75962', '75964', '76070',
  '76075', '76080', '76092', '76778', '78070', '78351',
  '80048', '80051', '80053', '80061', '80069', '80074',
  '80076', '80197', '80410', '81000', '81001', '81002',
  '81003', '81005', '81007', '81015', '82009', '82010',
  '82017', '82040', '82108', '82247', '82248', '82306',
  '82307', '82308', '82310', '82330', '82379', '82435',
  '82565', '82570', '82575', '82585', '82728', '82800',
  '82803', '82805', '82810', '82945', '82947', '82948',
  '83540', '83550', '83937', '83970', '83986', '84100',
  '84132', '84134', '84155', '84160', '84295', '84300',
  '84315', '84450', '84460', '84520', '84525', '84540',
  '84545', '85002', '85004', '85007', '85008', '85009',
  '85013', '85014', '85018', '85021', '85022', '85023',
  '85024', '85025', '85027', '85031', '85032', '85041',
  '85044', '85045', '85046', '85048', '85049', '85345',
  '85347', '85348', '85520', '85590', '85595', '85610',
  '85611', '85652', '85730', '85732', '86590', '86645',
  '86687', '86688', '86689', '86692', '86701', '86702',
  '86703', '86704', '86705', '86706', '86707', '86803',
  '86804', '86812', '86813', '86816', '86817', '86900',
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 101
____________________________________________________________________________

  '86903',   '86904',   '86905',   '86906',   '87070', '87071',
  '87073',   '87075',   '87076',   '87077',   '87081', '87084',
  '87086',   '87088',   '87181',   '87184',   '87185', '87186',
  '87187',   '87188',   '87190',   '87197',   '87198', '87199',
  '87205',   '87340',   '87341',   '87350',   '87380', '87390',
  '87391',   '87515',   '87516',   '87517',   '87520', '87521',
  '87522',   '87525',   '87526',   '87527',   '93000', '93005',
  '93010',   '93040',   '93041',   '93042',   '93307', '93308',
  '93922',   '93923',   '93925',   '93926',   '93930', '93931',
  '93965',   '93970',   '93971',   'G0001',   'G0008', 'G0009',
  'G0010',   'G0015',   'G0202',   'P9615',   bypass this edit.

  Incoming Part B claim is submitted with Provider Specialty
  Code '59' and one of the following HCPCS code(s):

  'J0000-J9999', 'Q0163-Q0181', '93005' and '93041', and the
  Modifier is other than 'NN', bypass this edit.

  Incoming Part B claim is submitted with a Demo Number
  '37', bypass this edit.

  When the detail Edit Override Table has '7261' 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


  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 102
____________________________________________________________________________

  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 103
____________________________________________________________________________


   11. 00025527    HCPA TRANSACTION SETTING ZEROS ON HOSPITALS DAYS IN HICR

  DATE ENTERED:    04/30/07

  TITLE:           HCPA TRANSACTION SETTING ZEROS ON HOSPITALS DAYS IN HICR

  PROJECT CODE:    CM01

  PRIORITY:        1

  RELEASE LEVEL: R2008100

  GROUP LEVEL:     2

  HOST SITE ID:    CWFM2000

  STATUS ON CR:    REQS

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   3
  EST. HOURS:      0300
  ACT. HOURS:      0147
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  Here are the HCPA transactions that we were talking about
  recently. The problem is that the HCPA HICR transaction is
  incorrectly removing the Full/Coinsurance Hospital days from
  the BENA Master screen.

  HICs 461xxxxxxA, 460xxxxxxB, and 459xxxxxxA have this problem.

  The following files were sent to you for your review:
   CWM.TEST.NDM.SW.ACT.CABHICR.T416797
   CWM.TEST.NDM.SW.ACT.T416797.UTILMOVE
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 104
____________________________________________________________________________


  Thanks,
  Jack Craig
  x-60796

  UPDATE
  Workaround is to reapply Hospital Full and CO days when HCPA
  is submitted. This will ensure the Days are not set to zero
  in the interim.


  We are working an issue (TRACS 416797), where the HCPA HICR trans
  is incorrectly removing the Full/Coinsurance Hospital days from
  the BENA Master screen.

  A HCPA HICR transaction is processed to remove the inpatient
  deductible from the BENA screen. The transaction is accepted and
  the deductibles are removed. A HICR date is displayed and the
  transaction is posted to the HICR audit report. However, the full
  and coinsurance hospital days are incorrectly being removed
  (changed to 0).

  Gaynell Coulter said that this problem was discovered during
  R2007200 HICR regression testing in SW-ACT, but that it also
  happens in production. According to the screen prints, when she
  has completed the HICR update, the BENA screen shows values in
  the INP DED field, but the next day, the INP DED field is blank.

  I would have sent an example of the HCPA transaction, but I'm not
  sure which of the CABBUMP files would contain this record. Of the
  files that I know to examine, I didn't find any HCPA's.

  Do you have enough information to look at this issue?

  I have NDM'ed a file for your review.

  Process NDMTOCSC, #37454, file CWM.TEST.NDM.SW.T416797.UTILMOVE

  If you have any questions, please let me know.

  Thanks,
  Jack Craig

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 105
____________________________________________________________________________


  CR:          ___25527_________    WORK TYPE:   ___   Incidental
  SUBSYSTEM:   _________________                 XXX   Minor
  FUNCTION:    _________________                 ___   Major
  PROGRAM:     _________________                 ___   New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                 Cathy Pflaum
      Telephone:           410-786-3016
      FAX, CMS:            410-786-0271
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     Janice Maxwell
      Telephone:           773-252-1327
      FAX,Richardson,TX:   773-252-1319
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       Denny Wingert
       Telephone:          717-909-2226
       FAX,Baltimore,MD:   443-436-3803
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *               blank line is found.                              *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (X) Host
  ( ) Satellite Part A Inpatient
  ( ) Satellite Part A Outpatient
  ( ) Satellite Part B
  ( ) Hospice
  ( ) Home Health
  ( ) DMERC
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 106
____________________________________________________________________________

  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  The HCPA HICR transaction (Spell Data Update) is incorrectly
  removing the Full/Coinsurance Hospital days from the BENE
  Master record when the purpose of the transaction is to
  remove Part A deductible.

  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
  HCPA HICR transaction (Spell Data Update) will not remove Full/
  Coinsurance Hospital days from the BENE Master Record when
  removing Part A deductible.
  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  *******************************************************************
  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
  * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
  *******************************************************************
    EVENT-RESPONSE LIST:
  ***.......This is the width of the Release Document.......***

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 107
____________________________________________________________________________

  Event 1.1
  An HCPA HICR transaction (Spell Data Update) is submitted to
  remove Part A deductible.

  Response
  Only Part A deductible is removed.    No on data on BENE Master
  is altered.

  Event 1.2
  An HCPA HICR transaction (Spell Data Update) is submitted to
  change or remove information other than Part A deductible.

  Response
  Appropriate fields are altered. Part A deductible remains
  same.
  ***.......This is the width of the Release Document.......***

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

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1. HICR

  Solution Criteria: N/A

    EDITS AFFECTED: None
  ***.......This is the width of the Release Document......***

  a. Error Code:    XXXX   ( )New ( )Modified ( )Deleted
  Disposition:

  Type of Record:

  Error Message:

  Set Condition for edit '####':

  Trailer Information:


  ***.......This is the width of the Release Document......***

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 108
____________________________________________________________________________

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 109
____________________________________________________________________________


   12. 00025535    5624-ADDITIONAL CWF EDITING FOR SNF CB

  DATE ENTERED:    05/02/07

  TITLE:           5624-ADDITIONAL CWF EDITING FOR SNF CB

  PROJECT CODE:    CM01

  PRIORITY:        1

  RELEASE LEVEL: R2008100

  GROUP LEVEL:     1

  HOST SITE ID:    CWFM1000

  STATUS ON CR:    WORK

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   3
  EST. HOURS:      0300
  ACT. HOURS:      0250
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  These revision will allow CWF SNF CB editing to take into account
  periods of non-coverage when services should be payable outside
  of CB by the Medicare Part B contractor.

  1. Modify a/b crossover edits 7260, 7261, 7269, 7275 to bypass
     when dates of service is within the From/Thru Date of an
     occurrence span code 74, 76, 77, 79, or M1


  2. Modify a/b crossover edits 7260, 7261, 7269, 7275 to bypass
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 110
____________________________________________________________________________

       when dates of service is greater than the occurrence code
       A3, B3, or C3.

  3. Modify a/b crossover edits 7258 and 7259 to bypass
     when dates of service is within the From/Thru Date of an
     occurrence span code 74.

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:           _____25535_______    WORK TYPE:   ___   Incidental
  SUBSYSTEM:    _________________                 _x_   Minor
  FUNCTION:     _________________                 ___   Major
  PROGRAM:      _________________                 ___   New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                  Kathy Woytan
      Telephone:            410-786-4982
      FAX, CMS:             410-786-0271
      Responsibilities:     REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:      Ofelia Castillo
      Telephone:            469-372-6492
      FAX,Richardson,TX:    469-372-0284
      Responsibilities:     DEFINITION, ANALYSIS, SYSTEM TESTING

  2.    PROG ANALYST:       Dan Bromley
        Telephone:          717-909-2224
        FAX,Baltimore,MD:   443-436-3803
        Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                            TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *              blank line is found.                               *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *              after a colon. Try to format as it should appear *
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 111
____________________________________________________________________________

  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (X) Host
  (X) Satellite Part A Inpatient
  ( ) Satellite Part A Outpatient
  (X) Satellite Part B
  ( ) Hospice
  ( ) Home Health
  (X) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  When the beneficiary's benefits have exhausted or the inpatient
  SNF stay is partially non-covered CWF must take into account
  when services should be payable outside SNF Consolidated
  Billing (CB) by the Medicare Part B contractor. CWF will
  add a bypass for benefit exhaust and partially non-covered
  SNF claim for A/B Crossover edits '7258', '7259', '7260',
  '7261', '7269' with Dates of Service on or after 04/01/2001
  and '7275' with Dates of Service on or after 10/01/2004.

  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
  CWF must add a bypass for A/B Crossover edit '7260' when
  the incoming Part B/DMERC claim detail From and Thru Date is
  within the Occurrence Span Code '74', '76', '77', '79', or
  'M1' From and Thru Date of the posted SNF Inpatient claim
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 112
____________________________________________________________________________

  (21x) in history.

  The incoming Part B/DMERC claim is received with non-therapy
  HCPCS code(s) and the detail From and Thru Date is on or
  after 04/01/2001.

  Requirement 2
  CWF must add a bypass for A/B Crossover edit '7261' when
  the incoming Part B/DMERC claim detail From and Thru Date
  is within the Occurrence Span Code '74', '76', '77', '79',
  or 'M1' From and Thru Date of the posted SNF Inpatient claim
  (21x) in history.

  The incoming Part B/DMERC claim is received with a non-therapy
  HCPCS code(s) and the detail From and Thru Date is on or after
  04/01/2001.

  Requirement 3
  CWF must add a bypass for A/B Crossover edit '7269' when the
  incoming Part B claim detail From and Thru Date is within the
  Occurrence Span Code '74', '76', '77', '79', or 'M1' From and
  Thru Date of the posted SNF Inpatient claim (21x) in history.

  The incoming Part B claim is received with a Provider Specialty
  '80' and detail From and Thru Date is on or after 04/01/2001.

  Requirement 4
  CWF must add a bypass for A/B Crossover edit '7275' when the
  incoming Part B claim detail From and Thru Date is within the
  Occurrence Span Code '74', '76', '77', '79', or 'M1' From and
  Thru Date of the posted SNF Inpatient claim (21x) in history.

  The incoming Part B claim is received with a Provider Specialty
  '59' and origin/destination Modifier is equal to 'DN' or 'ND'.
  The detail From and Thru Date is on or after 10/01/2004.

  Requirement 5
  CWF must add a bypass for A/B Crossover edit '7260' when
  the incoming Part B/DMERC claim detail From and Thru Date is
  greater than the Occurrence Code 'A3', 'B3', or 'C3' Date of
  the posted SNF Inpatient claim (21x) in history.

  The incoming Part B/DMERC claim is received with non-therapy
  HCPCS code(s) and the detail From and Thru Date is on or
  after 04/01/2001.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 113
____________________________________________________________________________

  Requirement 6
  CWF must add a bypass for A/B Crossover edit '7261' when
  the incoming Part B/DMERC claim detail From and Thru Date is
  greater than the Occurrence Code 'A3', 'B3', or 'C3' Date of
  the posted SNF Inpatient claim (21x) in history.

  The incoming Part B/DMERC claim is received with non-therapy
  HCPCS code(s) and the detail From and Thru Date is on or
  after 04/01/2001.

  Requirement 7
  CWF must add a bypass for A/B Crossover edit '7269' when the
  incoming Part B claim detail From and Thru Date is greater
  than the Occurrence Code 'A3', 'B3', or 'C3' Date of the
  posted SNF Inpatient claim (21x) in history.

  The incoming Part B claim is received with a Provider Specialty
  '80' and detail From and Thru Date is on or after 04/01/2001.

  Requirement 8
  CWF must add a bypass for A/B Crossover edit '7275' when the
  incoming Part B claim detail From and Thru Date is greater
  than the Occurrence Code 'A3', 'B3', or 'C3' Date of the
  posted SNF Inpatient claim (21x) in history.

  The incoming Part B claim is received with a Provider Specialty
  '59' and origin/destination Modifier is equal to 'DN' or 'ND'.
  The detail From and Thru Date is on or after 10/01/2004.

  Requirement 9
  CWF must add a bypass for A/B Crossover edit '7258' when
  the incoming Part B claim detail From and Thru Date is
  within the Occurrence Span Code '74' From and Thru Date of
  the posted SNF Inpatient claim (21x) in history.

  The incoming Part B claim is received with a therapy HCPCS
  code(s) and the detail From and Thru Date is on or after
  04/01/2001.

  Requirement 10
  CWF must add a bypass for A/B Crossover edit '7259' when
  the incoming Part B claim detail From and Thru Date is
  within the Occurrence Span Code '74' From and Thru Date of
  the posted SNF Inpatient claim (21x) in history.

  The incoming Part B claim is received with a therapy HCPCS
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 114
____________________________________________________________________________

  code(s) and the detail From and Thru Date is on or after
  04/01/2001.

  Requirement 11
  CWF must modify the informational unsolicited process to
  not generate a response for A/B Crossover edit '7260' when
  a Part B/DMERC claim with a non-therapy HCPCS code(s) is
  posted in history with Dates of Service on or after 04/01/2001.

  When the Part B/DMERC From and Thru Date is within the
  Occurrence Span Code '74', '76', '77', '79', or 'M1' From and
  Thru Date of the incoming SNF Inpatient claim (21x).

  Requirement 12
  CWF must modify the informational unsolicited process to
  not generate a response for A/B Crossover edit '7261' when
  a Part B/DMERC claim with a non-therapy HCPCS code(s) is
  posted in history with Dates of Service on or after 04/01/2001.

  When the Part B/DMERC From and Thru Date is within the
  Occurrence Span Code '74', '76', '77', '79', or 'M1' From and
  Thru Date of the incoming SNF Inpatient claim (21x).

  Requirement 13
  CWF must modify the informational unsolicited process to
  not generate a response for A/B Crossover edit '7269' when
  a Part B claim with a Provider Specialty '80' is posted in
  history with Dates of Service on or after 04/01/2001.

  When the Part B From and Thru Date is within the Occurrence
  Span Code '74', '76', '77', '79', or 'M1' From and Thru Date
  of the incoming SNF Inpatient claim (21x).

  Requirement 14
  CWF must modify the informational unsolicited process to
  not generate a response for A/B Crossover edit '7275' when
  a Part B claim with a Provider Specialty '59' and origin/
  destination Modifier is equal to 'DN' or 'ND' is posted in
  history with Dates of Service on or after 10/01/2004.

  When the Part B From and Thru Date is within the Occurrence
  Span Code '74', '76', '77', '79', or 'M1' From and Thru Date
  of the incoming SNF Inpatient claim (21x).

  Requirement 15
  CWF must modify the informational unsolicited process to
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 115
____________________________________________________________________________

  not generate a response for A/B Crossover edit '7260' when
  a Part B/DMERC claim with a non-therapy HCPCS code(s) is
  posted in history with Dates of Service on or after 04/01/2001.

  When the Part B/DMERC From and Thru Date is greater than
  Occurrence Code 'A3', 'B3', or 'C3' Date of the incoming
  SNF Inpatient claim (21x).

  Requirement 16
  CWF must modify the informational unsolicited process to
  not generate a response for A/B Crossover edit '7261' when
  a Part B/DMERC claim with a non-therapy HCPCS code(s) is
  posted in history with Dates of Service on or after 04/01/2001.

  When the Part B/DMERC From and Thru Date is greater than
  Occurrence Code 'A3', 'B3', or 'C3' Date of the incoming
  SNF Inpatient claim (21x).

  Requirement 17
  CWF must modify the informational unsolicited process to
  not generate a response for A/B Crossover edit '7269' when
  a Part B claim with a Provider Specialty '80' is posted in
  history with Dates of Service on or after 04/01/2001.

  When the Part B From and Thru Date is greater than
  Occurrence Code 'A3', 'B3', or 'C3' Date of the incoming
  SNF Inpatient claim (21x).

  Requirement 18
  CWF must modify the informational unsolicited process to
  not generate a response for A/B Crossover edit '7275' when
  a Part B claim with a Provider Specialty '59' and origin/
  destination Modifier is equal to 'DN' or 'ND' is posted in
  history with Dates of Service on or after 10/01/2004.

  When the Part B From and Thru Date is greater than
  Occurrence Code 'A3', 'B3', or 'C3', Date of the incoming
  SNF Inpatient claim (21x).

  Requirement 19
  CWF must modify the informational unsolicited process to
  not generate a response for A/B Crossover edit '7258' when
  a Part B claim with a therapy HCPCS code(s) is posted in
  history with Dates of Service on or after 04/01/2001.

  When the Part B From and Thru Date is within the Occurrence
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 116
____________________________________________________________________________

 Span Code '74' From and Thru Date of the incoming SNF
 Inpatient claim (21x).

 Requirement 20
 CWF must modify the informational unsolicited process to
 not generate a response for A/B Crossover edit '7259' when
 a Part B claim with a therapy HCPCS code(s) is posted in
 history with Dates of Service on or after 04/01/2001.

 When the Part B From and Thru Date is within the Occurrence
 Span Code '74' From and Thru Date of the incoming SNF
 Inpatient claim (21x).

 ***.......This is the width of the Release Document.......***


 The Event-Response List provides a description of the way
 that the system should function AFTER the change.

 *******************************************************************
 * If you want the EVENT-RESPONSES printed in the release document *
 * remove the word "None" and delete the delimiter line. Number    *
 * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
 * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
 *******************************************************************
   EVENT-RESPONSE LIST: None
 ***.......This is the width of the Release Document.......***

 Event   1.1
 Enter   an SNF Inpatient claim (21x) and the Dates of Service
 is on   or after 04/01/2001 with an Occurrence Span Code
 '74',   '76', '77', '79' or 'M1' Date.

 Enter a Part B/DMERC claim with a non-therapy HCPCS code(s)
 and the detail From and Thru Date is within the Occurrence
 Span Code Date of the posted SNF Inpatient claim in history.

 Response
 The Part B/DMERC claim does not set A/B Crossover edit '7260'.

 Event   2.1
 Enter   an SNF Inpatient claim (21x) and the Dates of Service
 is on   or after 04/01/2001 with an Occurrence Span Code
 '74',   '76', '77', '79' or 'M1' Date.

  Enter a Part B/DMERC claim with a non-therapy HCPCS code(s)
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 117
____________________________________________________________________________

  and the detail From and Thru Date is within the Occurrence
  Span Code Date of the posted SNF Inpatient claim in history.

  Response
  The Part B/DMERC claim does not set A/B Crossover edit '7261'.

  Event   3.1
  Enter   an SNF Inpatient claim (21x) and the Dates of Service
  is on   or after 04/01/2001 with an Occurrence Span Code
  '74',   '76', '77', '79' or 'M1' Date.

  Enter a Part B claim with Provider Specialty '80' and the detail
  From and Thru Date is within the Occurrence Span Code Date of
  the posted SNF Inpatient claim in history.

  Response
  The Part B claim does not set A/B Crossover edit '7269'.

  Event   4.1
  Enter   an SNF Inpatient claim (21x) and the Dates of Service
  is on   or after 10/01/2004 with an Occurrence Span Code
  '74',   '76', '77', '79' or 'M1' Date.

  Enter a Part B claim with Provider Specialty '59'. The Modifier
  equals 'DN' or 'ND'. The detail From and Thru Date is within
  the Occurrence Span Code Date of the posted SNF Inpatient claim
  in history.

  Response
  The Part B claim does not set A/B Crossover edit '7275'.

  Event   5.1
  Enter   an SNF Inpatient claim (21x) and the Dates of Service
  is on   or after 04/01/2001 with an Occurrence Code 'A3',
  'B3',   or 'C3' Date.

  Enter a Part B/DMERC claim with a non-therapy HCPCS code(s)
  and the detail From and Thru Date is greater than the
  Occurrence Code Date of the posted SNF Inpatient claim in
  history.

  Response
  The Part B/DMERC claim does not set A/B Crossover edit '7260'.

  Event 6.1
  Enter an SNF Inpatient claim (21x) and the Dates of Service
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 118
____________________________________________________________________________

 is on or after 04/01/2001 with an Occurrence Code 'A3',
 'B3', or 'C3' Date.

 Enter a Part B/DMERC claim with a non-therapy HCPCS code(s)
 and the detail From and Thru Date is greater than the
 Occurrence Code Date of the posted SNF Inpatient claim in
 history.

 Response
 The Part B/DMERC claim does not set A/B Crossover edit '7261'.

 Event   7.1
 Enter   an SNF Inpatient claim (21x) and the Dates of Service
 is on   or after 04/01/2001 with an Occurrence Code 'A3',
 'B3',   or 'C3' Date.

 Enter a Part B claim with Provider Specialty '80' and the
 detail From and Thru Date is greater than the Occurrence
 Code Date of the posted SNF Inpatient claim in history.

 Response
 The Part B claim does not set A/B Crossover edit '7269'.

 Event   8.1
 Enter   an SNF Inpatient claim (21x) and the Dates of Service
 is on   or after 10/01/2004 with an Occurrence Code 'A3',
 'B3',   or 'C3' Date.

 Enter a Part B claim with Provider Specialty '59'. The
 Modifier equals 'DN' or 'ND'. The detail From and Thru Date
 is greater than the Occurrence Code Date of the posted SNF
 Inpatient claim in history.

 Response
 The Part B claim does not set A/B Crossover edit '7275'.

 Event 9.1
 Enter an SNF Inpatient claim (21x) and the Dates of Service
 is on or after 04/01/2001 with an Occurrence Span Code '74'
 Date.

 Enter a Part B claim with a therapy HCPCS code(s) and the
 detail From and Thru Date is within the Occurrence Span Code
 Date of the posted SNF Inpatient claim in history.

  Response
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 119
____________________________________________________________________________

 The Part B claim does not set A/B Crossover edit '7258'.

 Event 10.1
 Enter an SNF Inpatient claim (21x) and the Dates of Service
 is on or after 04/01/2001 with an Occurrence Span Code '74'
 Date.

 Enter a Part B claim with a therapy HCPCS code(s) and the
 detail From and Thru Date is within the Occurrence Span Code
 Date of the posted SNF Inpatient claim in history.

 Response
 The Part B claim does not set A/B Crossover edit '7259'.

 Event 11.1
 Enter a Part B/DMERC claim that is accepted and posted to
 history. The Part B/DMERC claim Date of Service is on or
 after 04/01/2001 with a non-therapy HCPCS code(s). The
 Part B/DMERC From and Thru Date is within the Occurrence
 Span Code Date of the incoming SNF Inpatient claim.

 Enter an SNF Inpatient claim (21x) with an Occurrence Span
 Code '74', '76', '77', '79' or 'M1' Date.

 Response
 The SNF Inpatient claim (21x) is accepted and no informational
 unsolicited response is generated for the Part B/DMERC claim
 for A/B Crossover edit '7260'.

 Event 12.1
 Enter a Part B/DMERC claim that is accepted and posted to
 history. The Part B/DMERC claim Date of Service is on or
 after 04/01/2001 with a non-therapy HCPCS code(s). The
 Part B/DMERC From and Thru Date is within the Occurrence
 Span Code Date of the incoming SNF Inpatient claim.

 Enter an SNF Inpatient claim (21x) with an Occurrence Span
 Code '74', '76', '77', '79' or 'M1' Date.

 Response
 The SNF Inpatient claim (21x) is accepted and no informational
 unsolicited response is generated for the Part B/DMERC claim
 for A/B Crossover edit '7261'.

  Event 13.1
  Enter a Part B claim that is accepted and posted to history.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 120
____________________________________________________________________________

  The Part B claim Date of Service is on or after 04/01/2001
  with Provider Specialty '80'. The Part B From and Thru Date
  is within the Occurrence Span Code Date of the incoming
  SNF Inpatient claim.

  Enter an SNF Inpatient claim (21x) with an Occurrence Span
  Code '74', '76', '77', '79' or 'M1' Date.

  Response
  The SNF Inpatient claim (21x) is accepted and no informational
  unsolicited response is generated for the Part B claim for
  A/B Crossover edit '7269'.

  Event 14.1
  Enter a Part B claim that is accepted and posted to history.
  The Part B claim Date of Service is on or after 10/01/2004
  with Provider Specialty '59'. The Modifier equals 'DN' or
  'ND'. The Part B From and Thru Date is within the Occurrence
  Span Code Date of the incoming SNF Inpatient claim.

  Enter an SNF Inpatient claim (21x) with an Occurrence Span
  Code '74', '76', '77', '79' or 'M1' Date.

  Response
  The SNF Inpatient claim (21x) is accepted and no informational
  unsolicited response is generated for the Part B claim for
  A/B Crossover edit '7275'.

  Event 15.1
  Enter a Part B/DMERC claim that is accepted and posted to
  history. The Part B/DMERC claim Date of Service is on or
  after 04/01/2001 with a non-therapy HCPCS code(s). The Part
  B/DMERC From and Thru Date is greater than the Occurrence
  Code Date of the incoming SNF Inpatient claim.

  Enter an SNF Inpatient claim (21x) with an Occurrence Code
  'A3', 'B3', or 'C3' Date.

  Response
  The SNF Inpatient claim (21x) is accepted and no informational
  unsolicited response is generated for the Part B/DMERC claim
  for A/B Crossover edit '7260'.

  Event 16.1
  Enter a Part B/DMERC claim that is accepted and posted to
  history. The Part B/DMERC claim Date of Service is on or
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 121
____________________________________________________________________________

  after 04/01/2001 with a non-therapy HCPCS code(s). The Part
  B/DMERC From and Thru Date is greater than the Occurrence
  Code Date of the incoming SNF Inpatient claim.

  Enter an SNF Inpatient claim (21x) with an Occurrence Code
  'A3', 'B3', or 'C3' Date.

  Response
  The SNF Inpatient claim (21x) is accepted and no informational
  unsolicited response is generated for the Part B/DMERC claim
  for A/B Crossover edit '7261'.

  Event 17.1
  Enter a Part B claim that is accepted and posted to history.
  The Part B claim Date of Service is on or after 04/01/2001
  with Provider Specialty '80'. The Part B From and Thru Date
  is within the Occurrence Code Date of the incoming SNF
  Inpatient claim.

  Enter an SNF Inpatient claim (21x) with an Occurrence Code
  'A3, 'B3', or 'C3', Date.

  Response
  The SNF Inpatient claim (21x) is accepted and no informational
  unsolicited response is generated for the Part B claim for
  A/B Crossover edit '7269'.

  Event 18.1
  Enter a Part B claim that is accepted and posted to history.
  The Part B claim Date of Service is on or after 10/01/2004
  with Provider Specialty '59'. The Modifier equals 'DN' or
  'ND'. The Part B From and Thru Date is within the Occurrence
  Code Date of the incoming SNF Inpatient claim.

  Enter an SNF Inpatient claim (21x) with an Occurrence Code
  'A3', 'B3', or 'C3' Date.

  Response
  The SNF Inpatient claim (21x) is accepted and no informational
  unsolicited response is generated for the Part B claim for
  A/B Crossover edit '7275'.

  Event 19.1
  Enter a Part B claim that is accepted and posted to history.
  The Part B claim Date of Service is on or after 04/01/2001
  with a therapy HCPCS code(s). The Part B From and Thru
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 122
____________________________________________________________________________

  Date is within the Occurrence Span Code Date of the incoming
  SNF Inpatient claim.

  Enter an SNF Inpatient claim (21x) with an Occurrence Span
  Code '74' Date.

  Response
  The SNF Inpatient claim (21x) is accepted and no informational
  unsolicited response is generated for the Part B claim for
  A/B Crossover edit '7258'.

  Event 20.1
  Enter a Part B claim that is accepted and posted to history.
  The Part B claim Date of Service is on or after 04/01/2001
  with a therapy HCPCS code(s). The Part B From and Thru
  Date is within the Occurrence Span Code Date of the incoming
  SNF Inpatient claim.

  Enter an SNF Inpatient claim (21x) with an Occurrence Span
  Code '74' Date.

  Response
  The SNF Inpatient claim (21x) is accepted and no informational
  unsolicited response is generated for the Part B claim for
  A/B Crossover edit '7259'.


  ***.......This is the width of the Release Document.......***

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

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1. A/B Crossover module
    2. Informational unsolicited process

  Solution Criteria: N/A

    EDITS AFFECTED: None
  ***.......This is the width of the Release Document......***

  a. Error Code: 7258 ( )New (X)Modified ( )Deleted
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 123
____________________________________________________________________________

  Disposition: CR

  Type of Record: Pt. B Carrier

  Error Message:
  For a Part B claim, the detail From and Thru Date overlaps
  the Admission and Discharge Date of a SNF Inpatient Part A
  claim (21x) and a Therapy HCPCS code(s) is present.

  OR

  For a Part B claim, the detail from or Thru Date overlaps
  the detail line item Date of Service of a SNF Inpatient
  Part B claim (22x) and a Therapy HCPCS code(s) is present.

  Set Condition for edit   '7258': Under development
  When a Part B claim is   submitted with a Therapy HCPCS
  code(s) and the detail   From and Thru Date overlaps the
  Admission or Discharge   Date of a SNF Inpatient Part A
  claim (21x),

  OR

  When a Part B claim is submitted with a Therapy HCPCS
  code(s) and the detail From and Thru Date overlaps the
  Admission or Discharge Date of a SNF Inpatient Part B
  claim (22x), set the '7258' error code.

  When the incoming Part B claim detail Thru Date equals the
  SNF Inpatient Part A (21x) Admission Date, bypass this
  edit.

  When the incoming Part B claim detail From Date equals the
  SNF Inpatient Part A (21x) Discharge Date, and the Patient
  Status is other than '30', bypass this edit.

  When the incoming Part B claim detail From Date equals the
  SNF Inpatient Part B (22x) Thru Date, bypass this edit.

  When the incoming Part B claim detail Thru Date equals the
  SNF Inpatient Part B (22x) From Date, bypass this edit.

  When an incoming Part B claim is submitted with Entry Code
  '3' (cancel only), bypass this edit.

  When an incoming Part B claim is submitted with Entry Code
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 124
____________________________________________________________________________

  '9' (add to history), bypass this edit.

  When an incoming Part B claim is submitted with a header
  Payment/Denial Indicator is other than '1', '2', '3', '5',
  '6', '7', '8', '9', 'A', or 'B', bypass this edit.

  When an incoming Part B claim is submitted with a detail
  Payment/Process Indicator is other than 'A', 'R', or 'S',
  bypass this edit.

  When the detail Edit Override Table has '7258' present,
  bypass this edit.

  When the incoming Part B claim is submitted with one of
  the following HCPCS code(s) and the Provider Specialty is
  not equal to '65', '67', or '88'. The detail From or Thru
  Date is on, or after 07/01/2004 and until 12/31/2004 and
  overlaps the posted SNF Inpatient A claim (21x), bypass
  this edit.

  Effective 07/01/2004

  '29065',   '29075', '29085',     '29086',   '29105',   '29125',
  '29126',   '29130', '29131',     '29200',   '29220',   '29240',
  '29260',   '29280', '29345',     '29365',   '29405',   '29445',
  '29505',   '29515', '29520',     '29540',   '29550',   '29580',
  '29590',   or '64550'.

  Terminated 12/31/2004

  '29065',   '29075',   '29085',   '29086',   '29105',   '29125',
  '29126',   '29130',   '29131',   '29200',   '29220',   '29240',
  '29260',   '29280',   '29345',   '29365',   '29405',   '29445',
  '29505',   '29515',   '29520',   '29540',   '29550',   '29580',
  '29590'.

  When the incoming Part B claim is submitted with one of
  the following HCPCS code(s) and the Provider Specialty is
  not equal to '65', '67', or '88'. The detail From or Thru
  Date is on, or after 07/01/2004 and until 12/31/2004 and
  overlaps the posted SNF Inpatient B claim (22x), bypass
  this edit.
  Effective 07/01/2004

  '29065', '29075', '29085', '29086', '29105', '29125',
  '29126', '29130', '29131', '29200', '29220', '29240',
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 125
____________________________________________________________________________

 '29260', '29280', '29345', '29365', '29405', '29445',
 '29505', '29515', '29520', '29540', '29550', '29580',
 '29590', or '64550'.

 Terminated 12/31/2004

 '29065',   '29075',   '29085',   '29086',   '29105',   '29125',
 '29126',   '29130',   '29131',   '29200',   '29220',   '29240',
 '29260',   '29280',   '29345',   '29365',   '29405',   '29445',
 '29505',   '29515',   '29520',   '29540',   '29550',   '29580',
 '29590'.

 When the incoming Part B claim is submitted with one of
 the following HCPCS code(s) and the Provider Specialty is
 not equal to '65', '67', or '88'. The detail From or Thru
 Date is on, or after 07/01/2004 and until 12/31/2004 and
 overlaps the posted SNF Inpatient B claim (22x), bypass
 this edit.

 Effective 07/01/2004

 '29065',   '29075', '29085',     '29086',   '29105',   '29125',
 '29126',   '29130', '29131',     '29200',   '29220',   '29240',
 '29260',   '29280', '29345',     '29365',   '29405',   '29445',
 '29505',   '29515', '29520',     '29540',   '29550',   '29580',
 '29590',   or '64550'.

 Terminated 12/31/2004

 '29065',   '29075',   '29085',   '29086',   '29105',   '29125',
 '29126',   '29130',   '29131',   '29200',   '29220',   '29240',
 '29260',   '29280',   '29345',   '29365',   '29405',   '29445',
 '29505',   '29515',   '29520',   '29540',   '29550',   '29580',
 '29590'.

 When the history SNF Inpatient Part A (21x) claim Cancel
 Date is greater than zero, bypass this edit.

 When the history SNF Inpatient Part A (21x) claim has a
 No-Pay Code equal to 'B', 'C', 'N', or 'R', bypass this
 edit.

 When the history SNF Inpatient Part B (22x) claim Cancel
 Date is greater than zero, bypass this edit.

  When the history SNF Inpatient Part B (22x) claim Action
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 126
____________________________________________________________________________

  Code is equal to '7' (add to history), bypass this edit.

  When the history SNF Inpatient Part B (22x) claim has a
  No-Pay Code equal to 'B' or 'N', bypass this edit.

  Trailer Information: 08, 13, 31

  b. Error Code:    7259   ( )New (X)Modified ( )Deleted
  Disposition: CR

  Type of Record: Pt. B Carrier

  Error Message:
  For the Part B claim, the detail From and Thru Date is
  within the Admission and Discharge Date of a SNF Inpatient
  Part A claim (21x) and a Therapy HCPCS code(s) is present.

  OR

  For the Part B claim, the detail From and Thru Date is
  within the detail line item Date of Service (if not present
  use the From or Thru Date) of a SNF Inpatient Part B claim
  (22x) and a Therapy HCPCS code(s) is present.

  Set Condition for edit '7259': Under development
  When a Part B claim is submitted with a Therapy HCPCS
  code(s) and the detail From and Thru Date is within the
  Admission and Discharge Date of a SNF Inpatient Part A
  claim (21x), set the '7259' error code.

  OR

  When a Part B claim is submitted with a Therapy HCPCS
  code(s) and the detail From and Thru Date is within the
  Admission and Discharge Date of a SNF Inpatient Part B
  claim (22x), set the '7259' error code.
  When an incoming Part B claim detail From Date equals the
  SNF Inpatient Part A (21x) Discharge Date and the Patient
  Status is other than '30', bypass this edit.

  When an incoming Part B claim detail From Date equals the
  SNF Inpatient Part B (22x) Thru Date, bypass this edit.

  When an incoming Part B claim detail Thru Date equals the
  SNF Inpatient Part A (21x) Admission Date, bypass this
  edit.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 127
____________________________________________________________________________


  When the incoming Part B claim detail Thru Date equals the
  SNF Inpatient Part B (22x) From Date, bypass this edit.

  When an incoming Part B claim is submitted with Entry Code
  '3' (cancel only), bypass this edit.
  When an incoming Part B claim is submitted with Entry Code
  '9' (add to history), bypass this edit.

  When an incoming Part B claim is submitted with a header
  Payment/Denial Indicator is other than '1', '2', '3', '5',
  '6', '7', '8', '9', 'A', or 'B', bypass this edit.

  When an incoming Part B claim is submitted with a detail
  Payment/Process Indicator is other than 'A', 'R', or 'S',
  bypass this edit.

  When the detail Edit Override Table has '7259' present,
  bypass this edit.

  When the incoming Part B claim is submitted with
  one of the following HCPCS code(s) and the Provider
  Specialty is not equal to '65', '67', or '88'. The
  detail From or Thru Date is on, or after 07/01/2004,
  and overlaps the posted SNF Inpatient Part A claim
  (21x).

  Effective 07/01/2004

  '29065', '29075', '29085',   '29086',   '29105',   '29125',
  '29126', '29130', '29131',   '29200',   '29220',   '29240',
  '29260', '29280', '29345',   '29365',   '29405',   '29445',
  '29505', '29515', '29520',   '29540',   '29550',   '29580',
  '29590', or '64550'.
  Terminated 12/31/2004

  '29065', '29075', '29085', '29086', '29105', '29125',
  '29126', '29130', '29131', '29200', '29220', '29240',
  '29260', '29280', '29345', '29365', '29405', '29445',
  '29505', '29515', '29520', '29540', '29550', '29580',
  '29590'.
  When the incoming Part B claim is submitted with one of
  the following HCPCS code(s) and the Provider Specialty is
  not equal to '65', '67', or '88'. The detail From or Thru
  Date is on, or after 07/01/2004 and until 12/31/2004 and
  overlaps the posted SNF Inpatient B claim (22x), bypass
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 128
____________________________________________________________________________

  this edit.

  Effective 07/01/2004

  '29065',   '29075', '29085',       '29086',   '29105',   '29125',
  '29126',   '29130', '29131',       '29200',   '29220',   '29240',
  '29260',   '29280', '29345',       '29365',   '29405',   '29445',
  '29505',   '29515', '29520',       '29540',   '29550',   '29580',
  '29590',   or '64550'.

  Terminated 12/31/2004

  '29065',   '29075',    '29085',    '29086',   '29105',   '29125',
  '29126',   '29130',    '29131',    '29200',   '29220',   '29240',
  '29260',   '29280',    '29345',    '29365',   '29405',   '29445',
  '29505',   '29515',    '29520',    '29540',   '29550',   '29580',
  '29590'.

  When the history SNF Inpatient Part A (21x) claim Cancel
  Date is greater than zero, bypass this edit.

  When the history SNF Inpatient Part A (21x) claim has
  an No-Pay Code equal to 'B', 'C', 'N', or 'R', bypass this
  edit.

  When   the history SNF       Inpatient Part B (22x) claim Cancel
  Date   is greater than       zero, bypass this edit.
  When   the history SNF       Inpatient Part B (22x) claim Action
  Code   is equal to '7'       (add to history), bypass this edit.

  When the history SNF Inpatient Part B (22x) claim has a
  No-Pay Code equal to 'B' or 'N', bypass this edit.

  Trailer Information: 08, 13, 31

  c. Error Code:        7260    ( )New (X)Modified ( )Deleted
  Disposition: CR

  Type of Record: DMEPOS, Pt. B Carrier

  Error Message:
  For a DMERC/Part B claim the detail From and Thru Date
  overlaps the Admission or Discharge Date of a SNF
  Inpatient Part A claim (21x) and a Non-therapy HCPCS
  code(s) is present.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 129
____________________________________________________________________________

  Set Condition for edit '7260': Under development
  When a DMERC/Part B claim is submitted with a Non-Therapy
  HCPCS code(s) and the detail From and Thru Date overlaps
  the Admission or Discharge Date of a SNF Inpatient Part A
  claim (21x), set the '7260' error code.

  Incoming DMERC/Part B claim detail From Date equals the
  SNF Inpatient Part A (21x) Discharge Date and the Patient
  Status is other than '30', bypass this edit.

  Incoming DMERC/Part B claim detail Thru Date equals the
  SNF Inpatient Part A (21x) Admission Date, bypass this
  edit.

  Incoming DMERC/Part B claim is submitted with Entry Code
  '3' (cancel only), bypass this edit.

  Incoming DMERC/Part B claim is submitted with Entry Code
  '9' (add to history), bypass this edit.
  Incoming DMERC/Part B claim is submitted with a header
  Payment/Denial Indicator is other than '1', '2', '3', '5',
  '6', '7', '8', '9', 'A', or 'B', bypass this edit.

  Incoming DMERC/Part B claim is submitted with a detail
  Payment/Process Indicator is other than 'A', 'R', or 'S',
  bypass this edit.

  Incoming DMERC/Part B claim is submitted with a HCPCS
  code(s) in Category '75', bypass this edit.

  Incoming DMERC/Part B claim is submitted with a HCPCS
  code(s) equal to 'G9017', 'G9018', 'G9019', 'G9020',
  'G9033', 'G9034', 'G9035', or 'G9036', bypass this edit.

  Incoming DMERC/Part B claim is submitted with one of the
  following HCPCS code(s) and the Modifier Code(s) is other
  than 'NN':

  'A0380',   'A0390', 'A0425',   'A0426',   'A0427',   'A0428',
  'A0429',   'A0430', 'A0431',   'A0432',   'A0433',   'A0434',
  'A0435',   'A0436', 'A0999',   'A0382',   'A0384',   'A0392',
  'A0394',   'A0396', 'A0398',   'A0420',   'A0422',   or
  'A0424',   bypass this edit.

  Terminated 12/31/2005
  'Q3019', 'Q3020'
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 130
____________________________________________________________________________


  Terminated 03/31/2002
  'A0380', 'A0390'
  Incoming DMERC/Part B claim is submitted with one of the
  following HCPCS code(s) listed below and the Modifier is
  equal to '26':
  'G0030', 'G0031', 'G0032', 'G0033', 'G0034', 'G0035',
  'G0036', 'G0037', 'G0038', 'G0039', 'G0040', 'G0041',
  'G0042', 'G0043', 'G0044', 'G0045', 'G0046', 'G0047',
  'G0106', 'G0120', 'G0125', 'G0130', 'G0202', 'G0204',
  'G0206', 'G0210', 'G0211', 'G0212', 'G0213', 'G0214',
  'G0215', 'G0216', 'G0217', 'G0218', 'G0220', 'G0221',
  'G0222', 'G0223', 'G0224', 'G0225', 'G0226', 'G0227',
  'G0228', 'G0229', 'G0230', 'G0231', 'G0232', 'G0233',
  'G0234', 'G0253', 'G0254', 'G0296', 'Q0035', '51725',
  '51726', '51736', '51741', '51772', '51784', '51785',
  '51792', '51795', '51797', '54240', '54250', '59020',
  '59025', '62252', '70010', '70015', '70030', '70100',
  '70110', '70120', '70130', '70134', '70140', '70150',
  '70160', '70170', '70190', '70200', '70210', '70220',
  '70240', '70250', '70260', '70300', '70310', '70320',
  '70328', '70330', '70332', '70336', '70350', '70355',
  '70360', '70370', '70371', '70373', '70380', '70390',
  '70450', '70460', '70470', '70480', '70481', '70482',
  '70486', '70487', '70488', '70490', '70491', '70492',
  '70496', '70498', '70540', '70542', '70543', '70544',
  '70545', '70546', '70547', '70548', '70549', '70551',
  '70552', '70553', '70557', '70558', '70559', '71010',
  '71015', '71020', '71021', '71022', '71023', '71030',
  '71034', '71035', '71040', '71060', '71090', '71100',
  '71101', '71110', '71111', '71120', '71130', '71250',
  '71260', '71270', '71275', '71550', '71551', '71552',
  '71555', '72010', '72020', '72040', '72050', '72052',
  '72069', '72070', '72072', '72074', '72080', '72090',
  '72100', '72110', '72114', '72120', '72125', '72126',
  '72127', '72128', '72129', '72130', '72131', '72132',
  '72149', '72156', '72157', '72158', '72170', '72190',
  '72191', '72192', '72193', '72194', '72195', '72196',
  '72197', '72198', '72200', '72202', '72220', '72240',
  '72255', '72265', '72270', '72275', '72285', '72295',
  '73000', '73010', '73020', '73030', '73040', '73050',
  '73060', '73070', '73080', '73085', '73090', '73092',
  '73100', '73110', '73115', '73120', '73130', '73140',
  '73200', '73201', '73202', '73206', '73218', '73219',
  '73220', '73221', '73222', '73223', '73500', '73510',
  '73520', '73525', '73530', '73540', '73542', '73550',
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 131
____________________________________________________________________________

  '73560', '73562', '73564', '73565', '73580', '73590',
  '73592', '73600', '73610', '73615', '73620', '73630',
  '73650', '73660', '73700', '73701', '73702', '73706',
  '73718', '73719', '73720', '73721', '73722', '73723',
  '73725', '74000', '74010', '74020', '74022', '74150',
  '74160', '74170', '74175', '74181', '74182', '74183',
  '74185', '74190', '74210', '74220', '74230', '74235',
  '74240', '74241', '74245', '74246', '74247', '74249',
  '74250', '74251', '74260', '74270', '74280', '74283',
  '74290', '74291', '74300', '74301', '74305', '74320',
  '74327', '74328', '74329', '74330', '74340', '74350',
  '74355', '74360', '74363', '74400', '74410', '74415',
  '74420', '74425', '74430', '74440', '74445', '74450',
  '74455', '74470', '74475', '74480', '74485', '74710',
  '74740', '74742', '74775', '75552', '75553', '75554',
  '75555', '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', '75751', '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', '75901', '75902', '75940',
  '75945', '75946', '75952', '75953', '75954', '75960',
  '75961', '75962', '75964', '75966', '75968', '75970',
  '75978', '75980', '75982', '75984', '75989', '75992',
  '75993', '75994', '75995', '75996', '75998', '76000',
  '76001', '76003', '76005', '76010', '76012', '76013',
  '76020', '76040', '76061', '76062', '76065', '76066',
  '76070', '76071', '76075', '76076', '76078', '76080',
  '76082', '76083', '76086', '76088', '76090', '76091',
  '76092', '76093', '76094', '76095', '76096', '76098',
  '76100', '76101', '76102', '76120', '76125', '76355',
  '76360', '76362', '76370', '76375', '76380', '76393',
  '76394', '76400', '76496', '76497', '76498', '76499',
  '76506', '76511', '76512', '76513', '76514', '76516',
  '76519', '76529', '76536', '76604', '76645', '76700',
  '76705', '76770', '76775', '76778', '76800', '76801',
  '76802', '76805', '76810', '76811', '76812', '76815',
  '76816', '76817', '76818', '76819', '76825', '76826',
  '76827', '76828', '76830', '76831', '76856', '76857',
  '76870', '76872', '76873', '76880', '76885', '76886',
  '76930', '76932', '76936', '76937', '76940', '76941',
  '76942', '76945', '76946', '76948', '76950', '76965',
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 132
____________________________________________________________________________

  '76970', '76975', '76977', '76986', '76999', '77280',
  '77285', '77290', '77295', '77299', '77300', '77301',
  '77305', '77310', '77315', '77321', '77326', '77327',
  '77328', '77331', '77332', '77333', '77334', '77399',
  '77470', '77499', '77600', '77605', '77610', '77615',
  '77620', '77750', '77761', '77762', '77763', '77776',
  '77777', '77778', '77781', '77782', '77783', '77784',
  '77789', '77790', '77799', '78000', '78001', '78003',
  '78006', '78007', '78010', '78011', '78015', '78016',
  '78018', '78020', '78070', '78075', '78099', '78102',
  '78103', '78104', '78110', '78111', '78120', '78121',
  '78122', '78130', '78135', '78140', '78160', '78162',
  '78170', '78172', '78185', '78190', '78191', '78195',
  '78199', '78201', '78202', '78205', '78206', '78215',
  '78216', '78220', '78223', '78230', '78231', '78232',
  '78258', '78261', '78262', '78264', '78270', '78271',
  '78272', '78278', '78282', '78290', '78291', '78299',
  '78300', '78305', '78306', '78315', '78320', '78350',
  '78399', '78414', '78428', '78445', '78455', '78456',
  '78457', '78458', '78460', '78461', '78464', '78465',
  '78466', '78468', '78469', '78472', '78473', '78478',
  '78480', '78481', '78483', '78494', '78496', '78499',
  '78580', '78584', '78585', '78586', '78587', '78588',
  '78591', '78593', '78594', '78596', '78599', '78600',
  '78601', '78605', '78606', '78607', '78610', '78615',
  '78630', '78635', '78645', '78647', '78650', '78660',
  '78699', '78700', '78701', '78704', '78707', '78708',
  '78709', '78710', '78715', '78725', '78730', '78740',
  '78760', '78761', '78799', '78800', '78801', '78802',
  '78803', '78804', '78805', '78806', '78807', '78999',
  '79200', '79300', '79403', '79440', '79999', '83020',
  '83912', '84165', '84181', '84182', '85390', '85576',
  '86255', '86256', '86320', '86325', '86327', '86334',
  '87164', '87207', '88104', '88106', '88107', '88108',
  '88112', '88125', '88160', '88161', '88162', '88172',
  '88173', '88182', '88199', '88300', '88302', '88304',
  '88305', '88307', '88309', '88311', '88312', '88313',
  '88314', '88318', '88319', '88323', '88331', '88332',
  '88342', '88346', '88347', '88348', '88349', '88355',
  '88356', '88358', '88361', '88362', '88365', '88371',
  '88372', '88380', '88399', '89060', '91000', '91010',
  '91011', '91012', '91020', '91030', '91052', '91055',
  '91060', '91065', '91110', '91122', '91132', '91133',
  '91299', '92060', '92065', '92081', '92082', '92083',
  '92135', '92136', '92235', '92240', '92250', '92265',
  '92270', '92275', '92283', '92284', '92285', '92286',
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 133
____________________________________________________________________________

  '92499',   '92541', '92542',     '92543',   '92544',   '92545',
  '92546',   '92548', '92585',     '92587',   '92588',   '92978',
  '92979',   '93024', '93278',     '93303',   '93304',   '93307',
  '93308',   '93312', '93314',     '93315',   '93317',   '93318',
  '93320',   '93321', '93325',     '93350',   '93501',   '93505',
  '93508',   '93510', '93511',     '93514',   '93524',   '93526',
  '93527',   '93528', '93529',     '93530',   '93531',   '93532',
  '93533',   '93555', '93556',     '93561',   '93562',   '93571',
  '93572',   '93600', '93602',     '93603',   '93609',   '93610',
  '93612',   '93615', '93618',     '93619',   '93620',   '93621',
  '93622',   '93623', '93624',     '93631',   '93640',   '93641',
  '93642',   '93660', '93662',     '93701',   '93724',   '93731',
  '93732',   '93733', '93734',     '93735',   '93736',   '93741',
  '93742',   '93743', '93744',     '93799',   '93875',   '93880',
  '93882',   '93886', '93888',     '93922',   '93923',   '93924',
  '93925',   '93926', '93930',     '93931',   '93965',   '93970',
  '93971',   '93975', '93976',     '93978',   '93979',   '93980',
  '93981',   '93990', '94010',     '94060',   '94070',   '94200',
  '94240',   '94250', '94260',     '94350',   '94360',   '94370',
  '94375',   '94400', '94450',     '94620',   '94621',   '94680',
  '94681',   '94690', '94720',     '94725',   '94750',   '94770',
  '94772',   '94799', '95805',     '95806',   '95807',   '94808',
  '94810',   '94811', '95812',     '95813',   '95816',   '94819',
  '94822',   '94824', '95827',     '95829',   '95858',   '95860',
  '95861',   '95863', '95864',     '95867',   '95868',   '95869',
  '95870',   '95872', '95875',     '95900',   '95903',   '95904',
  '95920',   '95921', '95922',     '95923',   '95925',   '95926',
  '95927',   '95930', '95933',     '95934',   '95936',   '95937',
  '95950',   '95951', '95953',     '95954',   '95955',   '95956',
  '95957',   '95958', '95961',     '95962',   '95965',   '95966',
  '95967',   bypass this edit.

  Effective 09/15/2004
  '91120', bypass this edit.

  Effective 01/01/2005

  'G0336',   'G0365',   '76077',   '76510',   '76820', '76821',
  '79005',   '79101',   '79445',   '84166',   '86335', '88360',
  '88367',   '88368',   '91034',   '91035',   '91037', '91038',
  '91040',   '91120',   '93745',   '93890',   '93892', '93893',
  '94452',   '94453',   '95928',   '95929',   bypass this edit.

  Effective 01/28/2005
  '78459', '78491', '78492', '78608', '78609', '78811',
  '78812', '78813', '78814', '78815', '78816', bypass this
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 134
____________________________________________________________________________

  edit.

  Effective 01/01/2006
  '0067T', '0075T', '0076T',
  '75956', '75957', '75958', '75959', '76376', '76377',
  '77421',
  '88333', '88334', '88384', '88385', '88386',
  '91022', '95865', '95866', '95873', '95874', bypass this edit.

  Terminated 12/31/2002

  'G0131', 'G0132', '92599', set the '7260' error code.

  Terminated 12/31/2003

  'G0236', 'G0262', 'G0273', 'G0274', '76085', '76490',
  '89399', set the '7260' error code.

  Terminated 12/31/2004

  '62367', '62368', '79000', '79001', '79020', '79030',
  '79035', '79100', '79400', '79420', '88180', '91032',
  '91033', set the '7260' error code.

  Terminated 12/31/2005

  'G0030',   'G0031',   'G0032',   'G0033',   'G0034',   'G0035',   'G0036',
  'G0037',   'G0038',   'G0039',   'G0040',   'G0041',   'G0042',   'G0043',
  'G0044',   'G0045',   'G0046',   'G0047',   'G0125',   'G0210',   'G0211',
  'G0212',   'G0213',   'G0214',   'G0215',   'G0216',   'G0217',   'G0218',
  'G0220',   'G0221',   'G0222',   'G0223',   'G0224',   'G0225',   'G0226',
  'G0227',   'G0228',   'G0229',   'G0230',   'G0231',   'G0232',   'G0233',
  'G0234',   'G0253',   'G0254',   'G0296',   'G0336',
  '76375',
  '78160',   '78162', '78170', '78172', '78455',
  '95858',   set the '7260' error code.

  Terminated with Date of Service 12/31/2003

  'G0236', 'G0262', 'G0273', 'G0274',

  '76085', '76490',

  '89399', set the '7260' error code.

  When incoming DMERC claim detail From Date is prior to
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 135
____________________________________________________________________________

  the SNF Inpatient Part A (21x) Admission Date regardless
  of the Thru Date, bypass this edit.

  When incoming DMERC claim detail From Date is prior to
  the SNF Inpatient Part A (21x) Admission Date regardless
  of the Thru Date, bypass this edit.

  When incoming DMERC claim is submitted with 'MS' in any
  one Modifier fields, bypass this edit.

  When the incoming Part B claim is submitted with 'CB' and
  the Modifier field with the following HCPCS code(s):
  '71010', '71015', '71020', '71021', '71022', '71030',
  '71035', '73120', '75710', '75716', '75774', '75790',
  '75820', '75822', '75893', '75894', '75896', '75898',
  '75901', '75902', '75961', '75962', '75964', '76070',
  '76075', '76080', '76092', '76778', '78070', '78351',
  '80048', '80051', '80053', '80061', '80069', '80074',
  '80076', '80197', '80410', '81000', '81001', '81002',
  '81003', '81005', '81007', '81015', '82009', '82010',
  '82017', '82040', '82108', '82247', '82248', '82306',
  '82307', '82308', '82310', '82330', '82379', '82435',
  '82565', '82570', '82575', '82585', '82728', '82800',
  '82803', '82805', '82810', '82945', '82947', '82948',
  '83540', '83550', '83937', '83970', '83986', '84100',
  '84132', '84134', '84155', '84160', '84295', '84300',
  '84315', '84450', '84460', '84520', '84525', '84540',
  '84545', '85002', '85004', '85007', '85008', '85009',
  '85013', '85014', '85018', '85021', '85022', '85023',
  '85024', '85025', '85027', '85031', '85032', '85041',
  '85044', '85045', '85046', '85048', '85049', '85345',
  '85347', '85348', '85520', '85590', '85595', '85610',
  '85611', '85652', '85730', '85732', '86590', '86645',
  '86687', '86688', '86689', '86692', '86701', '86702',
  '86703', '86704', '86705', '86706', '86707', '86803',
  '86804', '86812', '86813', '86816', '86817', '86900',
  '86903', '86904', '86905', '86906', '87070', '87071',
  '87073', '87075', '87076', '87077', '87081', '87084',
  '87086', '87088', '87181', '87184', '87185', '87186',
  '87187', '87188', '87190', '87197', '87198', '87199',
  '87205', '87340', '87341', '87350', '87380', '87390',
  '87391', '87515', '87516', '87517', '87520', '87521',
  '87522', '87525', '87526', '87527', '93000', '93005',
  '93010', '93040', '93041', '93042', '93307', '93308',
  '93922', '93923', '93925', '93926', '93930', '93931',
  '93965', '93970', '93971', 'G0001', 'G0008', 'G0009',
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 136
____________________________________________________________________________

  'G0010', 'G0015', 'G0202', 'P9615', bypass this edit.

  When the detail Edit Override Table has '7260' present,
  bypass this edit.

  Incoming Part B claim is submitted with a Demo Number
  '37', 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.

  When the incoming Part B claim is submitted with Provider
  Specialty Code '59' and one of the following HCPCS code(s):
  'J0000-J9999', 'Q0163-Q0181', '93005', and '93041',
  and the Modifier is not equal to 'NN', bypass this edit.

  Trailer Information: 08, 13, 31

  d. Error Code:    7261   ( )New (X)Modified ( )Deleted
  Disposition: CR

  Type of Record: DMEPOS, Pt. B Carrier

  Error Message:
  For a DMERC/Part B claim the detail From and Thru Date is
  within the Admission and Discharge Date of a SNF Inpatient
  Part A claim (21x) and a Non-therapy HCPCS code(s) is
  present.

  Set Condition for edit '7261': Under development
  When a DMERC/Part B claim is submitted with a Non-Therapy
  HCPCS code(s) and the detail From and Thru Date is within
  the Admission and Discharge Date of a SNF Inpatient Part A
  claim (21x), set the '7261' error code.

  Incoming DMERC/Part B claim detail From Date equals the
  SNF Inpatient Part A (21x) Discharge Date and the Patient
  Status is other than '30', bypass this edit.

  Incoming DMERC/Part B claim detail Thru Date equals the
  SNF Inpatient Part A (21x) Admission Date, bypass this
  edit.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 137
____________________________________________________________________________

 Incoming DMERC/Part B claim is submitted with Entry Code
 '3' (cancel only), bypass this edit.
 Incoming DMERC/Part B claim is submitted with Entry Code
 '9' (add to history), bypass this edit.

 Incoming DMERC/Part B claim is submitted with a header
 Payment/Denial Indicator is other than '1', '2', '3', '5',
 '6', '7', '8', '9', 'A', or 'B', bypass this edit.

 Incoming DMERC/Part B claim is submitted with a detail
 Payment/Process Indicator is other than 'A', 'R' or 'S',
 bypass this edit.

 Incoming DMERC/Part B claim is submitted with a HCPCS
 code(s) in Category '75', bypass this edit.

 Incoming DMERC/Part B claim is submitted with a HCPCS
 code(s) equal to 'G9017', 'G9018', 'G9020', 'G9033',
 'G9034', 'G9035', or 'G9036', bypass this edit.

 Incoming DMERC/Part B claim is submitted with of the
 following HCPCS code(s) and the Modifier code(s) is other
 than 'NN':
 'A0380', 'A0390', 'A0425', 'A0426', 'A0427', 'A0428',
 'A0429', 'A0430', 'A0431', 'A0432', 'A0433', 'A0434',
 'A0435', 'A0436', 'A0999', 'A0382', 'A0384', 'A0392',
 'A0394', 'A0396', 'A0398', 'A0420', 'A0422', or
 'A0424', bypass this edit.

 Terminated 12/31/2005
 'Q3019', 'Q3020'

 Terminated 03/31/2002
 'A0380', 'A0390'

  Incoming DMERC/Part B claim is submitted with one of the
  following HCPCS code(s) and the Modifier is equal to '26':
  'G0030', 'G0031', 'G0032', 'G0033', 'G0034', 'G0035',
  'G0036', 'G0037', 'G0038', 'G0039', 'G0040', 'G0041',
  'G0042', 'G0043', 'G0044', 'G0045', 'G0046', 'G0047',
  'G0106', 'G0120', 'G0125', 'G0130', 'G0202', 'G0204',
  'G0206', 'G0210', 'G0211', 'G0212', 'G0213', 'G0214',
  'G0215', 'G0216', 'G0217', 'G0218', 'G0220', 'G0221',
  'G0222', 'G0223', 'G0224', 'G0225', 'G0226', 'G0227',
  'G0228', 'G0229', 'G0230', 'G0231', 'G0232', 'G0233',
  'G0234', 'G0253', 'G0254', 'G0296', 'Q0035', '51725',
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 138
____________________________________________________________________________

  '51726', '51736', '51741', '51772', '51784', '51785',
  '51792', '51795', '51797', '54240', '54250', '59020',
  '59025', '62252', '70010', '70015', '70030', '70100',
  '70110', '70120', '70130', '70134', '70140', '70150',
  '70160', '70170', '70190', '70200', '70210', '70220',
  '70240', '70250', '70260', '70300', '70310', '70320',
  '70328', '70330', '70332', '70336', '70350', '70355',
  '70360', '70370', '70371', '70373', '70380', '70390',
  '70450', '70460', '70470', '70480', '70481', '70482',
  '70486', '70487', '70488', '70490', '70491', '70492',
  '70496', '70498', '70540', '70542', '70543', '70544',
  '70545', '70546', '70547', '70548', '70549', '70551',
  '70552', '70553', '70557', '70558', '70559', '71010',
  '71015', '71020', '71021', '71022', '71023', '71030',
  '71034', '71035', '71040', '71060', '71090', '71100',
  '71101', '71110', '71111', '71120', '71130', '71250',
  '71260', '71270', '71275', '71550', '71551', '71552',
  '71555', '72010', '72020', '72040', '72050', '72052',
  '72069', '72070', '72072', '72074', '72080', '72090',
  '72100', '72110', '72114', '72120', '72125', '72126',
  '72127', '72128', '72129', '72130', '72131', '72132',
  '72133', '72141', '72142', '72146', '72147', '72148',
  '72149', '72156', '72157', '72158', '72170', '72190',
  '72191', '72192', '72193', '72194', '72195', '72196',
  '72197', '72198', '72200', '72202', '72220', '72240',
  '72255', '72265', '72270', '72275', '72285', '72295',
  '73000', '73010', '73020', '73030', '73040', '73050',
  '73060', '73070', '73080', '73085', '73090', '73092',
  '73100', '73110', '73115', '73120', '73130', '73140',
  '73200', '73201', '73202', '73206', '73218', '73219',
  '73220', '73221', '73222', '73223', '73500', '73510',
  '73520', '73525', '73530', '73540', '73542', '73550',
  '73560', '73562', '73564', '73565', '73580', '73590',
  '73592', '73600', '73610', '73615', '73620', '73630',
  '73650', '73660', '73700', '73701', '73702', '73706',
  '73718', '73719', '73720', '73721', '73722', '73723',
  '73725', '74000', '74010', '74020', '74022', '74150',
  '74160', '74170', '74175', '74181', '74182', '74183',
  '74185', '74190', '74210', '74220', '74230', '74235',
  '74240', '74241', '74245', '74246', '74247', '74249',
  '74250', '74251', '74260', '74270', '74280', '74283',
  '74290', '74291', '74300', '74301', '74305', '74320',
  '74327', '74328', '74329', '74330', '74340', '74350',
  '74355', '74360', '74363', '74400', '74410', '74415',
  '74420', '74425', '74430', '74440', '74445', '74450',
  '74455', '74470', '74475', '74480', '74485', '74710',
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 139
____________________________________________________________________________

  '74740', '74742', '74775', '75552', '75553', '75554',
  '75555', '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', '75751', '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', '75901', '75902', '75940',
  '75945', '75946', '75952', '75953', '75954', '75960',
  '75961', '75962', '75964', '75966', '75968', '75970',
  '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', '75901', '75902', '75940',
  '75945', '75946', '75952', '75953', '75954', '75960',
  '75961', '75962', '75964', '75966', '75968', '75970',
  '75978', '75980', '75982', '75984', '75989', '75992',
  '75993', '75994', '75995', '75996', '75998', '76000',
  '76001', '76003', '76005', '76010', '76012', '76013',
  '76020', '76040', '76061', '76062', '76065', '76066',
  '76070', '76071', '76075', '76076', '76078', '76080',
  '76082', '76083', '76086', '76088', '76090', '76091',
  '76092', '76093', '76094', '76095', '76096', '76098',
  '76100', '76101', '76102', '76120', '76125', '76355',
  '76360', '76362', '76370', '76375', '76380', '76393',
  '76394', '76400', '76496', '76497', '76498', '76499',
  '76506', '76511', '76512', '76513', '76514', '76516',
  '76519', '76529', '76536', '76604', '76645', '76700',
  '76705', '76770', '76775', '76778', '76800', '76801',
  '76802', '76805', '76810', '76811', '76812', '76815',
  '76816', '76817', '76818', '76819', '76825', '76826',
  '76827', '76828', '76830', '76831', '76856', '76857',
  '76870', '76872', '76873', '76880', '76885', '76886',
  '76930', '76932', '76936', '76937', '76940', '76941',
  '76942', '76945', '76946', '76948', '76950', '76965',
  '76970', '76975', '76977', '76986', '76999', '77280',
  '77285', '77290', '77295', '77299', '77300', '77301',
  '77305', '77310', '77315', '77321', '77326', '77327',
  '77328', '77331', '77332', '77333', '77334', '77399',
  '77470', '77499', '77600', '77605', '77610', '77615',
  '77620', '77750', '77761', '77762', '77763', '77776',
  '77777', '77778', '77781', '77782', '77783', '77784',
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 140
____________________________________________________________________________

  '77789', '77790', '77799', '78000', '78001', '78003',
  '78006', '78007', '78010', '78011', '78015', '78016',
  '78018', '78020', '78070', '78075', '78099', '78102',
  '78103', '78104', '78110', '78111', '78120', '78121',
  '78122', '78130', '78135', '78140', '78160', '78162',
  '78170', '78172', '78185', '78190', '78191', '78195',
  '78199', '78201', '78202', '78205', '78206', '78215',
  '78216', '78220', '78223', '78230', '78231', '78232',
  '78258', '78261', '78262', '78264', '78270', '78271',
  '78272', '78278', '78282', '78290', '78291', '78299',
  '78300', '78305', '78306', '78315', '78320', '78350',
  '78399', '78414', '78428', '78445', '78455', '78456',
  '78457', '78458', '78460', '78461', '78464',
  '78465', '78466', '78468', '78469', '78472', '78473',
  '78478', '78480', '78481', '78483', '78494', '78496',
  '78499', '78580', '78584', '78585', '78586', '78587',
  '78588', '78591', '78593', '78594', '78596', '78599',
  '78600', '78601', '78605', '78606', '78607', '78610',
  '78615', '78630', '78635', '78645', '78647', '78650',
  '78660', '78699', '78700', '78701', '78704', '78707',
  '78708', '78709', '78710', '78715', '78725', '78730',
  '78740', '78760', '78761', '78799', '78800', '78801',
  '78802', '78803', '78804', '78805', '78806', '78807',
  '78999', '79200', '79300', '79403', '79440', '79999',
  '83020', '83912', '84165', '84181', '84182', '85390',
  '85576', '86255', '86256', '86320', '86325', '86327',
  '86334', '87164', '87207', '88104', '88106', '88107',
  '88108', '88112', '88125', '88160', '88161', '88162',
  '88172', '88173', '88182', '88199', '88300', '88302',
  '88304', '88305', '88307', '88309', '88311', '88312',
  '88313', '88314', '88318', '88319', '88323', '88331',
  '88332', '88342', '88346', '88347', '88348', '88349',
  '88355', '88356', '88358', '88361', '88362', '88365',
  '88371', '88372', '88380', '88399', '89060', '91000',
  '91010', '91011', '91012', '91020', '91030', '91052',
  '91055', '91060', '91065', '91110', '91122', '91132',
  '91133', '91299', '92060', '92065', '92081', '92082',
  '92083', '92135', '92136', '92235', '92240', '92250',
  '92265', '92270', '92275', '92283', '92284', '92285',
  '92286', '92499', '92541', '92542', '92543', '92544',
  '92545', '92546', '92548', '92585', '92587', '92588',
  '92978', '92979', '93024', '93278', '93303', '93304',
  '93307', '93308', '93312', '93314', '93315', '93317',
  '93318', '93320', '93321', '93325', '93350', '93501',
  '93505', '93508', '93510', '93511', '93514', '93524',
  '93526', '93527', '93528', '93529', '93530', '93531',
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 141
____________________________________________________________________________

  '93532', '93533', '93555',   '93556', '93561',   '93562',
  '93571', '93572', '93600',   '93602', '93603',   '93609',
  '93610', '93612', '93615',   '93618', '93619',   '93620',
  '93621', '93622', '93623',   '93624', '93631',   '93640',
  '93641', '93642', '93660',   '93662', '93701',   '93724',
  '93731', '93732', '93733',   '93734', '93735',   '93736',
  '93741', '93742', '93743',   '93744', '93799',   '93875',
  '93880', '93882', '93886',   '93888', '93922',   '93923',
  '93924', '93925', '93926',   '93930', '93931',   '93965',
  '93970', '93971', '93975',   '93976', '93978',   '93979',
  '93980', '93981', '93990',   '94010', '94060',   '94070',
  '94200', '94240', '94250',   '94260', '94350',   '94360',
  '94370', '94375', '94400',   '94450', '94620',   '94621',
  '94680', '94681', '94690',   '94720', '94725',   '94750',
  '94770', '94772', '94799',   '95805', '95806',   '95807',
  '94808', '94810', '94811',   '95812', '95813',   '95816',
  '94819', '94822', '94824',   '95827', '95829',   '95858',
  '95860', '95861', '95863',   '95864', '95867',   '95868',
  '95869', '95870', '95872',   '95875', '95900',
  '95903', '95904', '95920',   '95921', '95922',   '95923',
  '95925', '95926', '95927',   '95930', '95933',   '95934',
  '95936', '95937', '95950',   '95951', '95953',   '95954',
  '95955', '95956', '95957',   '95958', '95961',   '95962',
  '95965', '95966', '95967',   bypass this edit.
  Effective 09/15/2004

  '91120', bypass this edit.

  Effective 01/01/2005
  'G0336', 'G0365', '76077', '76510',   '76820', '76821',
  '79005', '79101', '79445', '
  '84166', '86335', '88360', '88367',   '88368',
  '91034', '91035', '91037', '91038',   '91040', '91120',
  '93745', '93890', '93892', '93893',   '94452', '94453',
  '95928', '95929', bypass this edit.

  Effective 01/28/2005
  '78459', '78491', '78492', '78608', '78609', '78811',
  '78812', '78813', '78814', '78815', '78816', bypass this
  edit.

  Effective 01/01/2006
  '0067T', '0075T', '0076T',
  '75956', '75957', '75958', '75959', '76376', '76377',
  '77421',
  '88333', '88334', '88384', '88385', '88386',
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 142
____________________________________________________________________________

 '91022', '95865', '95866', '95873', '95874', bypass this
 edit.

 Terminated 12/31/2002

 'G0131', 'G0132', '92599', set the '7261' error code.
 Terminated 12/31/2003

 'G0236', 'G0262', 'G0273', 'G0274', '76085', '76490',
 '89399', set the '7261' error code.
 Terminated 12/31/2004

 '62367', '62368', '79000', '79001', '79020', '79030',
 '79035', '79100', '79400', '79420', '88180', '91032',
 '91033', set the '7261' error code.

 Terminated 12/31/2005

 'G0030',   'G0031',   'G0032',   'G0033',   'G0034',   'G0035',   'G0036',
 'G0037',   'G0038',   'G0039',   'G0040',   'G0041',   'G0042',   'G0043',
 'G0044',   'G0045',   'G0046',   'G0047',   'G0125',   'G0210',   'G0211',
 'G0212',   'G0213',   'G0214',   'G0215',   'G0216',   'G0217',   'G0218',
 'G0220',   'G0221',   'G0222',   'G0223',   'G0224',   'G0225',   'G0226',
 'G0227',   'G0228',   'G0229',   'G0230',   'G0231',   'G0232',   'G0233',
 'G0234',   'G0253',   'G0254',   'G0296',   'G0336',
 '76375',
 '78160',   '78162', '78170', '78172', '78455',

 '95858', set the '7261' error code.

 Terminated 12/31/2003

 'G0236', 'G0262', 'G0273', 'G0274',
 '76085', '76490',
 '89399', set the '7261' error code.

 When incoming DMERC claim is submitted with 'MS' in any
 one Modifier fields, bypass this edit.

  When the incoming Part B claim is submitted with 'CB' and
  the Modifier field with the following HCPCS code(s):
  '71010', '71015', '71020', '71021', '71022', '71030',
  '71035', '73120', '75710', '75716', '75774', '75790',
  '75820', '75822', '75893', '75894', '75896', '75898',
  '75901', '75902', '75961', '75962', '75964', '76070',
  '76075', '76080', '76092', '76778', '78070', '78351',
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 143
____________________________________________________________________________

  '80048', '80051', '80053', '80061', '80069', '80074',
  '80076', '80197', '80410', '81000', '81001', '81002',
  '81003', '81005', '81007', '81015', '82009', '82010',
  '82017', '82040', '82108', '82247', '82248', '82306',
  '82307', '82308', '82310', '82330', '82379', '82435',
  '82565', '82570', '82575', '82585', '82728', '82800',
  '82803', '82805', '82810', '82945', '82947', '82948',
  '83540', '83550', '83937', '83970', '83986', '84100',
  '84132', '84134', '84155', '84160', '84295', '84300',
  '84315', '84450', '84460', '84520', '84525', '84540',
  '84545', '85002', '85004', '85007', '85008', '85009',
  '85013', '85014', '85018', '85021', '85022', '85023',
  '85024', '85025', '85027', '85031', '85032', '85041',
  '85044', '85045', '85046', '85048', '85049', '85345',
  '85347', '85348', '85520', '85590', '85595', '85610',
  '85611', '85652', '85730', '85732', '86590', '86645',
  '86687', '86688', '86689', '86692', '86701', '86702',
  '86703', '86704', '86705', '86706', '86707', '86803',
  '86804', '86812', '86813', '86816', '86817', '86900',
  '86903', '86904', '86905', '86906', '87070', '87071',
  '87073', '87075', '87076', '87077', '87081', '87084',
  '87086', '87088', '87181', '87184', '87185', '87186',
  '87187', '87188', '87190', '87197', '87198', '87199',
  '87205', '87340', '87341', '87350', '87380', '87390',
  '87391', '87515', '87516', '87517', '87520', '87521',
  '87522', '87525', '87526', '87527', '93000', '93005',
  '93010', '93040', '93041', '93042', '93307', '93308',
  '93922', '93923', '93925', '93926', '93930', '93931',
  '93965', '93970', '93971', 'G0001', 'G0008', 'G0009',
  'G0010', 'G0015', 'G0202', 'P9615', bypass this edit.
  Incoming Part B claim is submitted with Provider Specialty
  Code '59' and one of the following HCPCS code(s):

  'J0000-J9999', 'Q0163-Q0181', '93005' and '93041', and the
  Modifier is other than 'NN', bypass this edit.

  Incoming Part B claim is submitted with a Demo Number
  '37', bypass this edit.
  When the detail Edit Override Table has '7261' 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.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 144
____________________________________________________________________________


  Trailer Information: 08, 13, 31

  e. Error Code:    7269   ( )New (X)Modified ( )Deleted
  Disposition: CR

  Type of Record: Pt. B Carrier

  Error Message:
  For a Part B claim the detail From or Thru Date is within
  or overlaps the Admission or Discharge Date of a SNF
  Inpatient Part A claim (21x) and a Provider Specialty
  Code '80' is present.

  Set Condition for edit '7269': Under development
  Part B (HUBC) claim is received with the Provider Specialty
  code of '80' and the detail From and Thru Date overlaps or
  is within the Admission or Discharge Date of a posted SNF
  Inpatient Part A (21x) claim in history, set the '7269'
  error code.

  Note:   This edit will apply to Date of Service on, or
          after, 04/01/2001.

  Note:   A/B Crossover edit '7269' will set before '7260' and
          '7261' for a Part B claim.

  Incoming Part B claim detail From Date equals the SNF
  Inpatient Part A (21x) Discharge Date and the Patient
  Status is other than '30', bypass this edit.

  Incoming Part B claim detail Thru Date equals the SNF
  Inpatient Part A (21x) Admission Date, bypass this edit.

  Incoming Part B claim is submitted with Entry Code '3'
  (cancel only), bypass this edit.

  Incoming Part B claim is   submitted with Entry Code '9' (add
  to history), bypass this   edit.
  Incoming Part B claim is   submitted and the header
  Payment/Denial Indicator   is not equal to '1', '2', '3',
  '5', '6', '7', '8', '9',   'A', or 'B', bypass this edit.

  Incoming Part B claim is submitted and the detail
  Payment/Process Indicator is not equal to 'A', 'R', or 'S',
  bypass this edit.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 145
____________________________________________________________________________


  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.

  When the detail Edit Override Table has '7269' present,
  bypass this edit.

  Trailer Information: 08, 13, 31

  f. Error Code:    7275   ( )New (X)Modified ( )Deleted
  Disposition: CR

  Type of Record: Pt. B Carrier

  Error Message:
  For a Part B claim the detail From or Thru Date is within
  or overlaps the Admission or Discharge Date of a SNF
  Inpatient Part A claim (21x) and a Provider Specialty
  Code '59' and the origin/destination Modifier of 'DN'
  or 'ND' is present.

  Set Condition for edit '7275': Under development
  Part B (HUBC) claim is received with the Provider Specialty
  code of '59'and the origin/destination Modifier of 'DN' or
  'ND' is present. The detail From and Thru Date overlaps or
  is within the Admission or Discharge Date of a posted SNF
  Inpatient Part A claim (21x) in history, set the '7275'
  error code.

  Note:   This edit will apply to Date of Service on, or
          after, 10/01/2004.

  Note:   A/B Crossover edit '7275' will set before '7260',
          '7261', and '7269' for a Part B claim.

  Incoming Part B claim detail From Date equals the SNF
  Inpatient Part A claim (21x) Discharge Date and the Patient
  Status is other than '30', bypass this edit.

  Incoming Part B claim detail Thru Date equals the SNF
  Inpatient Part A claim (21x) Admission Date, bypass this
  edit.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 146
____________________________________________________________________________

  Incoming Part B claim is submitted with Entry Code '3'
  (cancel only), bypass this edit.

  Incoming Part B claim is submitted with Entry Code '9' (add
  to history), bypass this edit.

  Incoming Part B claim is submitted and the header
  Payment/Denial Indicator is not equal to '1', '2', '3',
  '5', '6', '7', '8', '9', 'A', or 'B', bypass this edit.

  Incoming Part B claim is submitted and the detail
  Payment/Process Indicator is not equal to 'A', 'R', or 'S',
  bypass this edit.

  Incoming Part B claim is submitted with Provider Specialty
  '59' and one of the following HCPCS code (s): 'J0000-
  J9999', 'Q0163-Q0181', '93005' and '93041', and the
  Modifier is not equal to 'NN', bypass this edit.

  History SNF Inpatient Part A claim (21x) Cancel Date is
  greater than zero, bypass this edit.

  History SNF Inpatient Part A claim (21x) has a No-Pay Code
  equal to 'B', 'C', 'N', or 'R', bypass this edit.

  When the detail Edit Override Table has '7275' present,
  bypass this edit.

  Trailer Information: 08, 13, 31

  g. Error Code:    XXXX   ( )New ( )Modified ( )Deleted
  Disposition:

  Type of Record:

  Error Message:

  Set Condition for edit '####':

  Trailer Information:


  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 147
____________________________________________________________________________

    RISK/DESIGN ISSUE:



  *************************************************
  Vicki and Ofelia,

  Can we discuss prior to your response to Leslie? I will let Leslie know
  you will respond to her no later than Wednesday, May 30th.

  Thanks,

  Kathy Woytan
  Business Applications Management Group
  Division of Business Application Analysis
  Common Working File Group Team Lead
  Kathryn.Woytan@cms.hhs.gov
  410-786-4982
  ________________________________

  From: Trazzi, Leslie C. (CMS/CMM)
  Sent: Thursday, May 24, 2007 2:38 PM
  To: OFELIA.CASTILLO@trailblazerhealth.com; VICKI L SOMMERS
  Cc: Woytan, Kathryn A. (CMS/OIS)
  Subject: E-CHIMP for 5624

  I am re-sending this message that I originally sent on 5/22. This
  response from me to you is in E-CHIMP and I need you to respond to me in
  E-CHIMP. Can you please let me know when I may expect a response?

  Thanks.

  Ofelia and Vicki:

  For your convenience, I am forwarding you the response I just put in
  E-CHIMP plus the other issue from Patricia Gallagher for which I need a
  CWF response. However, please enter your response in E-CHIMP.

  Thanks.
  Replies
  ********************************************************************

   -----Original Message-----
  From: VICKI.SOMMERS
  Sent: Tuesday, May 22, 2007 9:05 AM
  To: OFELIA.CASTILLO
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 148
____________________________________________________________________________

  Subject: FW: CR #5624 Comment 'CR#5624 (Additional Common Working File (

   -----Original Message-----
  From: echimp@cms.hhs.gov.TBHE
  Sent: Tuesday, May 22, 2007 8:29 AM
  To: donna.sanders@cms.hhs.gov.TBHE; rose.salloum-byram@cms.hhs.gov.TBHE;
  Subject: CR #5624 Comment 'CR#5624 (Additional Common Working File (CWF)

  A new comment has been posted to CR #5624's POC review forum:
   Contractor:
   Author: Trazzi, Leslie
   Date: 05/22/2007
   Subject: Re: Response to Leslie Trazzi

     The first 750 characters of the comment are the following: We need t
  that the Pt. B service should not have been paid because payment for the
  made.

   The BRs in CR 5624 say to bypass the edits listed.   This is to allow t

   The situation here would be that the information indicating that the

   Go to eChimp 2.0 for more comment details, or to offer feedback.     Plea

   Best regards,

  DCOM
   https://echimp.cmsnet

  *******************************************************************
  Ofelia and Vicki:

  For your convenience, I am forwarding you the response I just put in
  E-CHIMP plus the other issue from Patricia Gallagher for which I need a
  CWF response. However, please enter your response in E-CHIMP.

  Thanks.
  Replies:

  Subject: Re: Response to Leslie Trazzi
  Posted by: Trazzi, Leslie
  Posted: 05/22/2007 00:00
  Comments:

  We need to think about this. Currently, the unsolicited response is
  generated when a Pt. B claim has been paid and then the Pt. A claim for
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 149
____________________________________________________________________________

  the SNF stay is submitted. It is then determined that the Pt. B service
  should not have been paid because payment for the service would be
  included in the bundled payment made to the SNF. The unsolicited
  response is then generated so the carriers know to take back the Pt. B
  payment that they already made.

  The BRs in CR 5624 say to bypass the edits listed. This is to allow the
  Part B payment to be correctly made during periods of time the person is
  out of the SNF.

  The situation here would be that the information indicating that the
  beneficiary was not in the SNF stay has not yet been received.
  Therefore, the carrier subjects the claims to SNF consolidated billing,
  and does not pay the claim. The bill from the SNF then gets recorded
  onto CWF and it is determined that the service should have been
  separately paid.

  This is the only situation I can see that would then, perhaps, require
  an unsolicited response. However, I do not believe anything like this
  currently exists. Carriers would need a different number response to
  know that the funds would have to be paid in this case, rather than
  recouped. Would that not be correct?

  The only situation that would be similar was what may happen when a
  beneficiary is discharged from the SNF or moves into a Part B stay.
  Until CWF receives the bill from the SNF showing the departure date, it
  would be assumed that the beneficiary was still in the SNF and the bill
  would be subjected to the SNF consolidated billing edits. Then, when the
  final bill is submitted showing the discharge date, we would have
  already denied the services. I do not believe at that point am
  unsolicited response is sent that would let carriers know to pay the
  incorrectly denied claim. Is that correct?

  Subject: Re: Response to Leslie Trazzi on IUR for CWF
  Posted by: Trazzi, Leslie
  Posted: 05/21/2007 00:00
  Comments:

  Can CWF please reply to this comment?


  Posted by: Gallagher, Patricia
  Posted: 05/18/2007 00:00
  Comments:

  NHIC has the following comment regarding CMS CR 5624.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 150
____________________________________________________________________________


  Business Requirement 5624.5 states the following: ?Contractors shall
  re-open and re-process inappropriately denied claims for dates of
  service on or after 04/01/2002 through 01/02/2008 when brought to their
  attention.?

  Comment: Would it be possible for CWF to produce a report identifying
  the claims that inappropriately denied in order to assess the potential
  impact to Contractor workload.

  Thanks for this opportunity comment.

  **************************************************************
  From: VICKI.SOMMERS
  Sent: Monday, May 21, 2007 3:06 PM
  To: OFELIA.CASTILLO
  Subject: FW: CR #5624 Comment 'CR#5624 (Additional Common Working File
  (CWF) E


   -----Original Message-----
  From: echimp@cms.hhs.gov.TBHE
  Sent: Monday, May 21, 2007 2:47 PM
  To: donna.sanders@cms.hhs.gov.TBHE; rose.salloum-byram@cms.hhs.gov.TBHE;
  Subject: CR #5624 Comment 'CR#5624 (Additional Common Working File (CWF)

  A new comment has been posted to CR #5624's POC review forum:

   Contractor:
   Author: SOMMERS, VICKI
   Date: 05/21/2007
   Subject: Response to Leslie Trazzi

   The first 750 characters of the comment are the following: Per
   Ofelia Castillo:
   Yes the IUR process will need to be indicated since modification will
   need to be made to the existing process for the additional criteria.

   Go to eChimp 2.0 for more comment details, or to offer feedback.
   Please do not reply back to this message.

     Best regards,
   DCOM
   https://echimp.cmsnet
  *************************************************************
  Contractor:
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 151
____________________________________________________________________________

 Author: SOMMERS, VICKI
 Date: 05/08/2007
 Subject: Response to Lelslie Trazzi on IUR for CWF

 The first 750 characters of the comment are the following:
 Response from Ofelia Castillo
 Should the requirements include the IUR process for any changes being
  made to the same edits?
 Also need clarification from initial questions on CWF Comments.

 Contractor:
 Author: Trazzi, Leslie
 Date: 05/08/2007
 Subject: Re: Add'l CWF Comment

 The first 750 characters of the comment are the following:
 Your comment does not provide me with enough information to respond.
 What specifically do you want to see addressed? Do you foresee that
 this CR would change the unsolicited response process?

 Contractor:
 Author: SOMMERS, VICKI
 Date: 05/02/2007
 Subject: Add'l CWF Comment

 The first 750 characters of the comment are the following:
 Ofelia Castillo has the following comment:
 The CMS CR does not address the IUR (Informational Unsolicited Response)
 process in the REQs, should this be included with the edits?

 Contractor:
 Author: SOMMERS, VICKI
 Date: 05/02/2007
 Subject: CWF Comments

 The first 750 characters of the comment are the following:
 Ofelia Castillo has the following comments:
 SNF CB was implemented with Dates of Service 4/1/2001 and not 4/1/2002.
 Should this be changed to be 2001? Also edit 7275 was implemented with
 Dates of Service 4/1/2005 and should the requirement state this?



 ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 152
____________________________________________________________________________

  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 153
____________________________________________________________________________


   13. 00025551    CONVERT CWF SOFTWARE TO RUN UNDER CICS TRANS SERVER V2.3

  DATE ENTERED:    05/14/07

  TITLE:           CONVERT CWF SOFTWARE TO RUN UNDER CICS TRANS SERVER V2.3

  PROJECT CODE:    CM01

  PRIORITY:        1

  RELEASE LEVEL: R2008100

  GROUP LEVEL:     2

  HOST SITE ID:    CWFM1000

  STATUS ON CR:    WALK

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   3
  EST. HOURS:      0300
  ACT. HOURS:      0288
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  CONVERT CWF MAINTENANCE SOFTWARE TO FUNCTION UNDER CICS
  TRANSACTION SERVER v2.3.

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:         25551____________   WORK TYPE: ___ Incidental
  SUBSYSTEM: _________________                ___ Minor
  FUNCTION:   _________________               _x_ Major
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 154
____________________________________________________________________________

  PROGRAM:     _________________                ___ New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                 Kathy Woytan
      Telephone:           410-786-4982
      FAX, CMS:            410-786-0210
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST: Tech Only
      Telephone:
      FAX,Richardson,TX:
      Responsibilities: DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       Joe Shanabrough
       Telephone:          443-436-6718
       FAX,Baltimore,MD:   443-436-0819
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *              blank line is found.                               *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT_ Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  * after a colon. Please try to format as it should appear in the *
  * Release Document.                                               *
  *******************************************************************
    IMPACT:
  (X) Host
  (X) Satellite Part A Inpatient
  (X) Satellite Part A Outpatient
  (X) Satellite Part B
  (X) RHHI
  (X) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  As of the spring of 2007, CICS Transaction Server Release v2.2
  is the CWF standard CICS release. To adhere to IBM maintenance
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 155
____________________________________________________________________________

  release support, TS v2.2 will no longer be supported as of 04/01/2008.
  Thus, all CWF Host datacenters will be migrating to the next higher
  level of maintainability for CICS, which is TS v2.3.

  CICS Transaction Server Release v2.3 will then be the CWF standard
  CICS release. All Hosts and Satellites are expected to be at that
  CICS Release level when release R2008100 is implemented in
  January 2008.

  All CWF CICS application programs will be recompiled at the TS v2.3
  level using the Transaction Server v2.3 pre-processor.

  Note: During the summer of 2007, all CWF Hosts will convert and
        implement a minimal TS level of v2.3. The Hosts will test
        CWF functionality with no CWF modifications to ensure the
        existing TS v2.2 level remains functional at all CWF Host
        sites. The Alabama Host sites have complied with this
        expectation by converting to TS v2.3 and have been processing
        CWF without technical incident.

  Alternative Solutions: N/A

  Delays in completion due to noncompliance of the CWF system
  software will not be a problem. The existing TS v2.2 level of the
  CWF system software is currently processing at the Alabama datacenter
  without incident. The Trailblazer Hosts datacenter is converting
  to TS v2.3 and will report on the results of CWF functionality system
  testing.

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT replaces the ACTION statement.     *
  * It will be extracted, as written, for the release document.     *
  * Numerically list statements that reflect the NEW BUSINESS REQS. *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
  Convert the CWF maintainer's CICS regions to Transaction
  Server v2.3. The Production Support environment will
  be converted at the time R2008100 is promoted to production
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 156
____________________________________________________________________________

  in January 2008.

  Requirement 2
  Install Transaction Server v2.3 pre-compiler into the CWF
  ENDEVOR processors. The Production Support environment
  processors will be converted when R2007400 is promoted
  in October 2007. Special compile/link JCL will be used by
  the Production Support Group to support the CICS TS v2.2
  Production environment at CWFM, STCBETA and Host sites
  until the CICS TS v2.3 changes are promoted to production.

  CWFM ENDEVOR element processors requiring changes for
  CICS TS v2.3 include:

     AHPCMLG4
     AHPCXMG4
     AHPXXHG4
     AHPXXMG4
     BSUXXLG4
     BSUXXMG4
     C2PCXMG4
     C2PXXMG4
     C2TCXMG4
     C2TXXRG4

  Coordination of these changes will be made by request from CWFM
  to South Carolina Data Center personnel who are authorized
  to update ENDEVOR processors in production.

  Requirement 3
  Recompile all CICS programs using the v2.3 pre-compiler into
  the various CWF environments, culminating in an Alpha, Beta,
  UAT and production release of entirely v2.3 compiled modules.
  This will be accomplished in a mass-generate package created
  by CWFM CM group personnel using the changed processors.

  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  ******************************************************************
  * If you want the EVENT-RESPONSEs printed in the release document*
  * remove the word "None" and delete the delimeter line           *
  * Number Events to correspond with the NEW BUSINESS REQUIRMENTS. *
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 157
____________________________________________________________________________

  * NBR 1, Event would be 1.1, NBR 2,Events would be 2.1, 2.2, etc.*
  ******************************************************************
    EVENT-RESPONSE LIST:

   *******************************************************
   * IMPORTANT NOTE: The objective of CWFM testing is to *
   * verify the application of CICS region startup deck *
   * JCL and program translation, assembly/compile and   *
   * link-edit changes. There are no functional changes *
   * being made to the CWF system applications.          *
   *******************************************************

  Event 1.1
  Bring up the various CICS regions as each is converted to
  TS v2.3.

  Response
  Each region should activate correctly, issuing standard
  startup and status messages.

  Event 2.1
  Compile a CICS program under the pre-compiler for TS v2.3.
  Compare the same program under the current pre-compiler
  as a baseline.

  Response
  The TS v2.3 CICS program should receive the same compiler
  errors/messages as the baseline compile. This will be
  verified through a side-by-side manual comparison by
  CWFM technical staff.

  Event 3.1
  CWFM will establish CICS TS v2.2 test region cycle outputs
  for use in file compares.

  Response
  Test files will be identified and saved for comparison
  to equivalent files generated by CICS TS v2.3 testing.

  Event 3.2
  After all compiles are complete:
  Run CWF baseline cycles with CICS TS v2.3 compiled modules.

  Response
  Outputs from the CICS TS v2.2 cycle and the v2.3 cycle should
  match. This will be verified through the use of file compare
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 158
____________________________________________________________________________

  jobs.

  Event 3.3
  Inquire using transactions HIMR, HIHO, HIQA, HIQB, HUQA,
  and HIQH.

  Response
  Data on each of the screens is correctly displayed. This
  will be compared to screen displays of the same transactions
  captured prior to the CICS TS v2.3 compiles.

  Event 3.4
  Create correction transactions using HICR.

  Response
  Corrections through HICR are properly applied to all files.
  This will be verified by both technical and Business Analyst
  staff by examination of record layouts and validation reports
  as produced by the system.

  ***.......This is the width of the Release Document.......***

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

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1.

  Solution Criteria: N/A

    EDITS AFFECTED: None
  ***.......This is the width of the Release Document......***

  a. Error Code:    XXXX   ( )New ( )Modified ( )Deleted
  Disposition:

  Type of Record:

  Error Message:

  Set Condition for edit '####':

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 159
____________________________________________________________________________

 Trailer Information:




 ***.......This is the width of the Release Document......***

 ISSUE/ANSWERS:
 --------------
   RISK/DESIGN ISSUE:

 ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo      *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example       *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".               *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************
  TENTATIVE SCHEDULE OF HOST DATACENTER ACTIVITIES FOR MIGRATION
  TO SUPPORT A MINIMAL LEVEL OF CICS TRANSACTION SERVER 2.3
      ---------------------------------------------------------
      - All information below was from CR 25027 for reference -
      - First contact between CSC and the SC Datacenter:
        Bruce Parker will coordinate this activity
        Jam Grimes will be the Endevor contact
      ---------------------------------------------------------
  A. BACKGROUND - AS OF JULY 2006:
   ALABAMA DATACENTER, PROCESSING SOUTH, SOUTHEAST, PACIFIC HOSTS
     ARE OPERATING AT CICS TRANSACTION SERVER 2.3
     ALABAMA SATELLITES AR BEING POLLED TO COLLECT THEIR CURRENT
     LEVEL OF CICS TRANSACTION SERVER INFORMATION
   TRAILBLAZERS, SOUTH CAROLINA DATACENTER, PROCESSING SOUTHWEST,
   MID-ATLANTIC, KEYSTONE, NORTHEAST, GREAT LAKES,
     ARE OPERATING AT CICS TRANSACTION SERVER 1.8
     TRAILBLAZERSATELLITES ARE BEING POLLED TO COLLECT THEIR CURRENT
     LEVEL OF CICS TRANSACTION SERVER INFORMATION
   STCBETA, UTILIZING THE SOUTH CAROLINA DATACENTER,
     IS OPERATING AT CICS TRANSACTION SERVER 1.8
   CSC, UTILIZING THE SOUTH CAROLINA DATACENTER, FOR CWFM MAINTENANCE,
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 160
____________________________________________________________________________

     IS OPERATING AT CICS TRANSACTION SERVCER 1.8
  B. SCHEDULE:
   ALABAMA DATACENTER HOSTS - NO UPDATE ACTIVITY REQUIRED
   ALABAMA SATELLITES MUST UPGRADE TO MINIMAL CICS TRANSACTION
   SERVER 2.2 BY NOVEMBER 1, 2006 (TEST REGIONS), JANUARY 1, 2007
   (PRODUCTION REGIONS)
   TRAILBLAZERS SOUTH CAROLINA DATACENTER HOSTS MUST UPGRADE TO
   CICS TRANSACTION SERVER 2.2 BY OCTOBER 1, 2006
   TRAILBLAZER SATELLITES NUST UPGRADE TO MINIMAL CICS TRANSACTION
   SERVER 2.2 BY NOVEMBER 1, 2006 (TEST REGIONS), JANUARY 1, 2007.

   07/24: Trailblazer CICS Test regions are converted to TS 2.2
   07/31: Trailblazer CICS UAT regions will be converted to TS 2.2
   08/14: Trailblazer CICS Production CICS regions will be
          converted to TS 2.2

   (PRODUCTION REGIONS)
  --- RECEIVED FROM CSC.CF00041 443-436-6704          06-07-21 13.55
    -> CSC.CF00090           JOHN ALEXANDER                 469
    -> CSC.RCSTAFF           RELEASE COORDINATORS

    -> CSC.PSG               CSC PRODUCTION SUPPORT GROUP


  HI JOHN,

  I HAVE RETREIVED ALL OF THE ENDEVOR PROCESSORS, AND THEY ARE IN
  THE FOLLOWING TWO DATASETS:

      CWM.TEST.ENDEVOR.PROC
      CWM.TEST.ENDEVOR.PROCESS

  IN ENDEVOR, THESE CAN ALL BE FOUND UNDER CWFPROD ENVIRONMENT,
  ENDEVOR SYSTEM, AND EITHER PROC OR PROCESS SUBSYSTEM.

  IN THE PAST, WHEN UPDATES WERE NEEDED TO THE PROCESSORS, ONLY THE
  PROC SUBSYSTEM MEMBERS NEEDED TO BE UPDATED. HOWEVER, ALL OF THE
  PROCESS SUBSYSTEM MEMBERS WERE LAST GENERATED ON 28APR03, WITH
  THE COMMENT 'REGEN FOR V39', SO THESE MAY NEED TO BE UPDATED FOR
  THE UPGRADE AS WELL.

  FEEL FREE TO TAKE A LOOK WHEN YOU GET A CHANCE, AND LET ME KNOW
  IF/WHEN YOU NEED ME TO DO ANYTHING.

  CHRIS
  --- RECEIVED FROM CSC.CF00090 443-436-6751          06-07-21 12.21
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 161
____________________________________________________________________________

   -> CSC.CF00051           JERRY WEAVER                   CSC
   -> CSC.RCSTAFF           RELEASE COORDINATORS
 JERRY,

 DO YOU KNOW IF SMARTTEST ALSO NEEDS CHANGES AS A RESULT OF THE
 PLANNED CICS TS V2.2 UPGRADE WE ARE PLANNING? WITH THE REMOVAL
 OF COMMAREA ADDRESSING ISSUES, IT MIGHT BE A CONSIDERATION.

 CAN YOU PLEASE PUT THIS ON YOUR LIST OF THINGS TO CHECK WHEN
 YOU CONTACT THE SC FOLKS NEXT TIME? THANKS.

 JOHN
 PLEASE NOTE: CMS HAS DECIDED, BASED ON INFORMATION COLLECTED BY
 (08/01/2006) BOTH TRAILBLAZERS AND ALABAMA HOSTS, THAT ALL OF
              THE HOSTS SATELLITES AND ALL OF THE HOSTS ARE EITHER
              CURRENTLY AT A MINIMUM LEVEL FOR CICS TRANSACTION SERVER
              2.1 OR GREATER, OR WILL BE PRIOR TO OCTOBER 1, 2006.
              THUS, THIS CR WILL BE A JANUARY RELEASE USER CR, NOT
              A CMS MANDATE CR. IF THE TECHNICAL INFORMATION
              PROVIDED BY THE HOSTS ON THE CICS TRANSACTION SERVER
              LEVELS IS NOT ACCURATE FOR ALL HOSTS AND SATELLITE
              ENVIRONMENTS, THIS CR COULD BE THE ORIGIN OF CWF
              APPLICATION SOFTWARE FAILURES.
 --- RECEIVED FROM CSC.CF00051 443 436-6698          06-08-03 12.14
   -> CMSCO.CMSCO           CMS CENTRAL OFFICE PERSONNEL
   -> CSC.CSCMGT            CSC MANAGEMENT
   -> CSC.CSCBA             BUSINESS ANALYSTS
   -> CSC.RCSTAFF           RELEASE COORDINATORS
   -> CSC.CSCPROD           CSC PRODUCTION
 TO: ALL PARTICIPANTS INVOLVED WITH THE CICS TS 2.2 UPGRADE

  THIS IS A FOLLOW-UP NOTE FOR THE UPCOMING JANUARY RELEASE
  CR25027-CONVERT CWF SOFTWARE TO RUN UNDER CICS TRANS SERVER 2.2.
  I'M REQUESTING THE REGRESSION TEST PLAN BE SPECIFICED IN THE CR'S
  TEST PLAN.
  THE TIMELINE FOR THE INITIAL PHASES OF THIS TECH ONLY CR IS AS
  FOLLOWS:
  AUGUST 21-23; CHRIS AND JOHN WILL BE APPLYING ALL ENDEVOR
                PROCESSOR MODIFICATIONS SPECIFIED BY SC DATACENTER.
                JOE WILL RECOMPILE ALL CWF ONLINE MODULES INTO
                THE BSI TEST REGION.
  AUGUST 24-25: MEREDITH/KAREN WILL PERFORM THE REGRESSION TEST
                PLAN IN THE BSI REGION.
  WEEKEND OF SEPTEMBER 29: CHRIS WILL PROMOTE THE OCTOBER RELEASE
                TO PRODUCTION.
  OCTOBER 2;    OCTOBER QUARTERLY RELEASE BECOMES PRODUCTION
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 162
____________________________________________________________________________

  OCTOBER 2-3;   JOE WILL RECOMPILE THE ENTIRE INVENTORY OF CWF
                 MODULES INTO THE DEVT REGION.
  OCTOBER 4-5;   MEREDITH/KAREN WILL REGRESSION TEST IN THE DEVT
                 REGION.
  OCTOBER 6;     RELINQUISH THE DEVT REGION TO THE JANUARY RELEASE
                 TEAM.
  JANUARY 2;     CHRIS AND JOHN WILL MAKE THE PRODUCTION REGION
                 PROCESSOR CHANGES PROVIDED BY THE SC DATACENTER.

  ED,
  THANKS VERY MUCH FOR TALKING WITH US THIS MORNING. AS YOU REQUESTED, HER
  - THE ACTUAL PROGRAM NAMES FOR THESE UTILITY PROGRAMS
  - STEPLIB AND/OR SYSLIB DDS WITH THE DSNS YOU ARE PLANNING TO USE
  - EXEC STATEMENT PARM VALUES (ESPECIALLY IF ANY HAVE CHANGED FROM THE PR
  WE WOULD ALSO LIKE TO KNOW ABOUT ANY NECESSARY CHANGES TO THE CICS START
  ALL THIS INFORMATION WILL ALLOW US TO START ON THE ENDEVOR PROCESSOR CHA
  THANKS AGAIN, AND WE LOOK FORWARD TO YOUR RESPONSE.
  JOHN ALEXANDER
  CWF RELEASE COORDINATOR
    HI JOHN,
  CICS DATASETS FOR V2.2
  -          COMPILE: SYS3.CICS.CICSTS22.PROD.SDFHLOAD
  -          COBOL: SYS3.CICS.CICSTS22.ADFHCOB
  -          ASM:              SYS3.CICS.CICSTS22.ADFHMAC
  PLEASE LET US KNOW WITH THIS INFORMATION AND STATUS.
  JAM GRIMES
  ENDEVOR ADMINISTRATOR
  PROGRAMMING SUPPORT
  PHONE: 803-788-0222 EXT. 44503
  CELL: 803-546-0218
  JAMRIENG.GRIMES@BCBSSC.COM
  ------------------( FORWARDED LETTER 1 FOLLOWS )---------------------
  DATE: TUESDAY, 15 AUGUST 2006 5:07PM ET
  TO: JAMRIENG.GRIMES
  FROM: ED.MCINTOSH
  SUBJECT: FW:RE: FW: CICS TS 2.2 MIGRATION NEEDS
  I NEED YOU TO CONTACT THE CSC GROUP.
  THANKS,
  ED MCINTOSH
  PROGRAMMING SUPPORT
  EXT 42722
  JAM & ED,
  08/17/2006 11:20 AM
  JAM & ED,
  WILL YOU BE CONTACTING US TODAY REGARDING THESE PIECES OF INFORMATION
  WE NEED TO CONFIRM?
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 163
____________________________________________________________________________

  AS DISCUSSED IN A PRIOR CONFERENCE CALL, OUR GOAL IS TO COMPLETE
  MODIFICATIONS TO PROCESSORS
  AND BEGIN TESTING SOON. WE URGENTLY NEED TO KNOW:
  - DID PROGRAM NAMES FOR THE CICS TRANSLATOR(S), ASSEMBLER,
    COBOL COMPILER AND LINK EDITOR CHANGE?
  - DID ANY OF THE ABOVE PROGRAMS HAVE EXEC STATEMENT PARM CHANGES
0    WHICH WE NEED TO ACCOMODATE?
  - WHICH DSNS OF THE LIST YOU SENT ARE STEPLIBS AND WHICH ARE SYSLIBS?
     - COMPILE: SYS3.CICS.CICSTS22.PROD.SDFHLOAD
   - COBOL:    SYS3.CICS.CICSTS22.ADFHCOB
   - ASM:      SYS3.CICS.CICSTS22.ADFHMAC
  - ARE ANY OF THE DSNS IN THE LIST YOU SENT NEEDED AS RUNTIME LIBRARIES
    IN BATCH JOBS OR CICS REGIONS?
  OUR EFFORTS TO CHANGE THE ENDEVOR PROCESSORS AND PASS THEM BACK TO YOU
  FOR UPDATE ARE DEPENDENT ON THE ANSWERS TO THESE QUESTIONS
  AND WE NEED TO HEAR ROM YOU TODAY. WE VERY MUCH APPRECIATE YOUR HELP!
  THANK YOU.
  JOHN ALEXANDER
  08/17/2006 11:38 AM
  JOHN,
  NOTHING ELSE CHANGE EXCEPT DATASETS NEEDED. IF YOU HAVE THE DATASETS
  EXISTING
  IN YOUR PROCESSORS, THEY SHOULD REPLACE BY THE NEW ONES DEPENDS YOUR
  YOUR PLAN OF
  WORKING ON PROCESSORS.
  PLEASE PROVIDE THE NAME OF PROCESSOR THAT I COULD LOOK INTO IT,
  FOR EXAMPLE...
  NAME OF PROCESSOR, WHERE IT IS IN CURRENTLY ENDEVOR.
  THANKS
  JAM GRIMES
  ENDEVOR ADMINISTRATOR
  PROGRAMMING SUPPORT
  PHONE: 803-788-0222 EXT. 44503
  CELL: 803-546-0218
  JAMRIENG.GRIMES@BCBSSC.COM
  08/17/2006 12:13 PM
  JAM,
  THANKS. THIS CONFIRMATION IS JUST WHAT WE NEEDED TO PROCEED. WE WILL
  CONTACT YOU WITH ANY FURTHER QUESTIONS AND TO ADVISE OF OUR PROGRESS.
  THANKS AGAIN FOR THE INFORMATION.
  JOHN
  08/21/2006 08:41 AM
  CHRIS,
  I NEED A FAVOR, PLEASE. CAN YOU PULL DIRECTLY FROM ENDEVOR (WHEREVER THE
  THE SOURCE FOR THE FOLLOWING PROCESSORS?:
  C2PCXEG4
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 164
____________________________________________________________________________

  C2PCXMG4
  C2PXXEG4
  C2PXXMG4

  I NEED TO COMPARE THESE WITH THE CONTENTS OF THE TWO LIBRARIES THAT WERE
  VERSION FOR THE CICS TS 2.2 CHANGES ONCE I KNOW WHAT IT IS. PLEASE PLACE
  MANY THANKS!
  JOHN
  08/21/2006 09:02 AM
  HI JOHN,
  THE REQUESTED PROCESSORS HAVE BEEN REPULLED. I PULLED BOTH THE 'PROC' A
  CWM.TEST.ENDEVOR.ADD.PROC
  CWM.TEST.ENDEVOR.ADD.PROCESS
  LET ME KNOW IF YOU NEED ANYTHING ELSE.
  CHRIS
  08/21/2006 11:06 AM
  ALL,
  THE SCDC CREW WAS ABOUT A WEEK LATE IN COMMUNICATING DSN AND OTHER
  INFORMATION WE REQUESTED. THERE WAS ANOTHER DAY SPENT IN CLARIFYING AN
  ISSUE SCDC DIDN'T RESPOND TO ORIGINALLY. ALL TOLD, WE'RE A LITTLE OVER
  A WEEK BEHIND WHERE WE PLANNED TO BE.
  I'M SCANNING THROUGH THE TWO GROUPS OF PROCESSORS IN ENDEVOR. OVER THE
  YEARS, WE HAVE PROCESSORS WITH THE SAME NAMES UNDER TWO DIFFERENT
  SUBSYSTEMS. I'M GOING THROUGH THE LIST TO DETERMINE WHICH ONES ARE THE
  MOST CURRENT AND WHICH WE WOULD NEED TO MODIFY.
  THE DATASET NAMES I MENTIONED PREVIOUSLY HAVE INDEED CHANGED. THERE ARE
  SDFH* AND ADFH* LIBRARIES. THE NEW DSNS WE WERE GIVEN ARE ADFH*.
  WE NEED TO MODIFY PROCESSORS FOR THAT AS WELL. THIS WILL MAKE THE JOB
  MORE FAR-REACHING THAN ORIGINALLY PLANNED, TOO.
  THIS IS GOING TO BE ABOUT 4-5 DAYS WORK, SO WE'RE LOOKING AT THE END OF
  THE WEEK UNLESS SOMETHING REALLY WONDERFUL HAPPENS IN THE MEANTIME.
  THAT'S FULL-TIME, UNINTERRUPTED BY VA, NPI OR OTHER RC-RELATED STUFF I
  WOULD NORMALLY BE DOING
  WHAT'S OUR PRIORITY? DO WE STILL WANT TO KEEP TO THE ORIGINAL SCHEDULE?
  JOHN
  08/22/2006 07:45 AM
  CHRIS,
  I NEED TO MEET WITH YOU THIS MORNING TO REVIEW SOME SYMBOLIC PARM SETTIN
  TYPE DEFINITIONS IN ENDEVOR. WE HAVE A BUNCH OF PROCESSORS WITH DEFAULT
  ON SYMBOLICS THAT LOOK TO BE OLD. THESE CAN BE OVERRIDDEN IN ENDEVOR AT
  DEFINITION.
  LET ME KNOW WHEN YOU HAVE SOME TIME THIS MORNING, PLEASE. THANKS.
  JOHN
  --- RECEIVED FROM CSC.CF00090 443-436-6751          06-08-22 16.04
    -> CSC.RCSTAFF           RELEASE COORDINATORS
    -> CSC.CF00072           JOSEPH SHANABROUGH             469
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 165
____________________________________________________________________________

    -> CSC.CF00051           JERRY WEAVER                   CSC
  ALL,

  PROGRESS ON THIS IS SLOW. THERE ARE MULTIPLE PROCESSORS THAT
  DON'T APPEAR TO HAVE BEEN UPDATED IN YEARS. THEY STILL APPEAR TO
  BE IN USE AND ARE ONLY WORKING BY THE FACT THAT SCDC HAS NOT
  DELETED OLD VERSION DATASETS FOR CICS VERSIONS 4.1, 3.3, 2.1.2,
  THE IBM ASSEMBLER, THE IBM LINK EDITOR, ETC. SOME OF THESE
  LIBRARIES FOR THESE GO ALL THE WAY BACK TO 2002 ON THEIR CREATION
  DATES.

  I'M ESSENTIALLY RE-WRITING SECTIONS OF OLD PROCESSORS BY COPYING
  SECTIONS OF NEWER ONES INTO THOSE SECTIONS. I DO NOT WANT TO
  ATTEMPT REWRITING THESE FROM SCRATCH. I ALSO DON'T WANT TO JUST
  LEAVE THEM FROM THE NEXT POOR GUY SINCE CICS TS 2.2 UPGRADES
  INCLUDE:
   (A) DIFFERENT MANAGEMENT OF COMMAREA STORAGE THAN EARLIER
       VERSIONS, AND;
   (B) WE'RE PLANNING TO RECOMPILE/REASSEMBLE THE ENTIRE SYSTEM.

   I BELIEVE THIS CAN STILL BE DONE BY THE END OF THE WEEK. BUT
   WE SHOULD CONTINUE TO PLAN ON THE FULL AMOUNT OF TESTING.

   JOHN
  ALL,
  I WANT TO DOCUMENT MY APPROACH.
  HERE'S A STATUS/HISTORY OF WHAT'S OCCURRED TO DATE:
  I ANALYZED THE CONTENTS OF THE CONRPT07 REPORT FROM ENDEVOR FOR BOTH
  THE EDEVT-TO-EPROD AND EFIX1-TO-EPROD PROMOTION PATHS. ALL SUBSYSTEMS
  WEREINCLUDED. THE REPORT ITSELF IS PRETTY ROUGH TO WORK WITH,
  SO I WROTE AN EZ+ PROGRAM TO PARE DOWN JUST WHAT WAS IMPORTANT RELATED
  TO THIS TASK--NAMELY, FINDING WHICH PROCESSORS EXECUTE FOR WHICH
  TYPES. THE JCL TO RUN A CONRPT07 CAN BE FOUND IN
  CWM.CF00090.JCLLIB(ENDRPT07). THE JCL TO RUN THE EZ+ PROGRAM
  CAN BE FOUND IN CWM.CF00090.DEVEL.JCLLIB(EZEND07R).
  THE LIST OF PROCESSORS WAS USED TO CONSTRUCT THE FOLLOWING LIBRARIES:
  CWM.CF00090.NEW.LIB.PROC (WHICH CAME FROM THE CWM.TEST.ENDEVOR.PROC
  LIBRARY CHRIS CONSTRUCTED)
  CWM.CF00090.NEW.LIB.PROCESS (WHICH CAME FROM THE
  CWM.TEST.ENDEVOR.PROCESS LIBRARY CHRIS CONSTRUCTED)
  THERE WERE A NUMBER OF ISSUES RE: WHICH VERSIONS OF PROCESSORS FOUND IN
  BOTH THESE ORIGINAL LIBRARIES WERE MOST CURRENT. SINCE ALL PROCESSOR
  GENERATIONS RESULT IN A LOAD MODULE AND ALL THOSE LOADS
  ARE STORED IN A SINGLE LOADLIB, WE WOULD BE USING THE VERSION WITH
  THE MOST CURRENT GENERATE DATE. I PULLED THESE VERSIONS DOWN
  INTO THE "NEW" LIBRARIES ABOVED AND PROCEEDED TO MODIFY THEM.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 166
____________________________________________________________________________

  THE "PROC" VERSIONS OF PROCESSORS WERE FAIRLY CURRENT AND MAINTENANCE
  LOOKED CONSISTENT. THE "PROCESS" VERSIONS, HOWEVER, WERE
  MORE OUT-OF-DATE AND NEEDED ABOUT A DAY AND HALF TO CLEAN-UP THE
  TEN OF THEM I COULD FIND IN USE--YES, THEY ARE STILL IN USE, AND IN MOST
  CASES HAVEN'T BEEN MAINTAINED IN YEARS. THEY MAY STILL PRESENT PROBLEMS.
  AT THIS POINT, WE ARE READY TO DISCUSS SETTING UP THE GENERATION
  OR THE CWF SYSTEM ELEMENTS. THINGS TO KEEP IN MIND ARE:
  - ONCE WE UPDATE/GENERATE A PROCESSOR AND DO A LLA (LOOKASIDE UPDATE)
  COMMAND, THAT PROCESSOR IS LIVE AND WILL EXECUTE ACROSS THE SYSTEM FOR
  ANY TYPE USING IT. FOR THIS REASON, WE SOULD PICK A REPRESENTATIVE
  NUMBER OF ELEMENTS THAT WE KNOW WILL HIT ALL THE PROCESSORS THAT WERE
  MODIFIED AND THEN:
  - PICK A TIME THAT SCDC CAN ASSIST AND GET EVERYBODY ELSE IN CWFM OFF
  THE SYSTEM
  - UPDATE/GENERATE ALL THE PROCESSORS
  - DO A LLA COMMAND ON THE SYSTEM (WILL HAVE TO COORDINATE THESE TWO
  STEPS WITH SCDC)
  - UPDATE/GENERATE THE REPRESENTATIVE ELEMENTS
  - CHECK THE RESULTS TO MAKE SURE ALL SYMBOLICS RESOLVED CORRECTLY
  AND THAT LOADS GENERATED
  - GO BACK TO THE CURRENT VERSIONS OF PROCESSORS (FROM CHRIS' LIBRARIES
  THAT I BUILT MY VERSIONS FROM),
  - DO ANOTHER LLA AND WAIT UNTIL WE'RE READY TO DO THIS AGAIN, BUT
  WITH THE WHOLE CWF SYSTEM
  THE BIGGEST PROBLEM IN TESTING IS THAT THESE PROCESSORS ARE USED
  ACROSS EDEVT, EFIX1 & 2, ESWIT, ESYST AND SO ON. WE CANNOT JUST PICK
  ONES USED IN EDEVTXR BECAUSE THEY ARE USED ELSEWHERE, TOO.
  ALTERNATIVELY, WE COULD RENAME THE 22 PROCESSORS I WORKED
  ON AND CONSTRUCT NEW TYPES IN ENDEVOR IN
  EDEVTXR, BUT THAT WOULD BE TIME-CONSUMING AND PRONE TO ADDITIONAL ERRORS
  IF WE MIS-DEFINE ANYTHING. WE MIGHT ALSO HAVE TO FURTHER ADJUST THE
  PROCESSORS FOR THEM TO WORK IN LOCATIONS OF ENDEVOR IN WHICH
  THEY DON'T CURRENTLY WORK OR APPLY. SO, LET'S DISCUSS. THANKS. JOHN
  08/30/2006 SC DATACENTER CONFERENCE CALL ISSUES
  CSC FIRST TASK IS TO TEMPORARILY UPDATE THE PROCESSORS,
  RUN TESTS ON THEM IN OUR ENDEVOR ENVIRONMENTS TO ENSURE
  THE CHANGES ARE CORRECT, THEN IMMEDIATELY
  RETURN TO THE CURRENT VERSIONS. WE WANT TO DO THIS QUICKLY--IN
  ABOUT A 2-3 HOUR WINDOW ON A WEEKEND AND ARE CURRENTLY LOOKING AT
  9/9/06. WE NEED TO CONFIRM SUPPORT WITH SC DATA CENTER.
  WE DO NOT EXPECT THIS TEST TO IMPACT DEVELOPMENT OR PRODUCTION
  SUPPORT EFFORTS AND CAN ALWAYS RESCHEDULE IF EXTRAORDINARY
  CIRCUMSTANCES ARISE.
  09/01/2006 02:02 PM
  CHRIS & JOE,
  I NOTED THAT PROCESSOR C2PCXMD4 IS USED ON L1COB2C AND SOME OTHER TYPES
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 167
____________________________________________________________________________

  I AM ASSUMING THAT WE WILL CHOOSE THE OPTION(S) ON THE ADD/UPDATES WHICH
  JOHN
  MINUTES FROM CONFERENCE CALL ON 8/31
  HELLO ED/JAM,
  10:00 A.M. ON THURSDAY, AUGUST 31, WORKS GREAT FOR EVERYONE HERE,
  SO WE WILL PLAN ON TALKING TO YOU THEN.
  THE CONFERENCE DIAL IN INFO IS AS FOLLOWS:
  CONFERENCE NUMBER: 877-807-4596
  PARTICIPANT CODE: 785329
  AGAIN, WE WILL BE DISCUSSING OUR NEEDS FOR OFF-HOUR SUPPORT, MOST LIKELY
  ON SATURDAY 9/9. SO IF YOU NEED TO HAVE ANYONE ELSE FROM SC ON THE CALL
  PLEASE PASS ALONG THE MEETING INVITE.
  LET ME KNOW IF YOU HAVE ANY QUESTIONS, OTHERWISE, I WILL SPEAK TO YOU ON
  THURSDAY AT 10:00.
  THANKS,
  CHRIS
  JOHN-PROCESSOR CHANGES ARE READY FOR TEST ON SAT, 9/9
     REQUESTED SC TO APPLY PROCESSOR CHANGES
  JERRY-CSC WILL WAIT UNTIL OCT. TO ROLL IN THE ACTUAL PROCESSOR CHANGES
  JOHN/CHRIS-SEND PLAN TO SC GROUP-
  ED-REQUESTED CSC TO SUBMIT A REQUEST FOR A RCF RULE CHANMGE
     FOR THE ENDEVOR PLAN ADMINISTRATOR, KAREN PRICE
     CWML.*
  ED-INSTRUCTED CSC TO USE CCID:ENDEVOR
  CHRIS-WILL PREBUILD A COMPLETE PACKAGE FOR PROCESSOR PROMOTION
  *************************************
  ****TEST PLAN FOR SAT. 09/09/2006****
  ****Start 7:00am thru noon       ****
  *************************************
  1) CSC WILL ANNOUNCE TO ITS STAFF THAT TEST IS STARTING
  AND ENDEVOR SHOULD NOT BE USED UNTIL FURTHER NOTICE
  2) SCDC ENDEVOR ADMIN STAFF WILL UPDATE THE FOLLOWING
  ENDEVOR PROCESSORS FROM LIBRARY CWM.CF00090.UPD.LIB.PROC
  AHPCMLG4
  AHPCXMG4
  AHPXXHG4
  AHPXXMG4
  BSUXXLG4
  BSUXXMG4
  C2PCXMG4
  C2PXXMG4
  C2TCXMG4
  C2TXXRG4
  THESE WILL BE PROMOTED TO THE APPROPRIATE LEVEL USING
  PACKAGES CREATED BY CSC
  3) SCDC ENDEVOR ADMIN STAFF WILL UPDATE THE FOLLOWING
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 168
____________________________________________________________________________

  ENDEVOR PROCESSORS FROM LIBRARY CWM.CF00090.UPD.LIB.PROCESS
  AHSCXMB4 (NO LONGER REQUIRED--CONFIRM W/J.SHANABROUGH)
  C2PCXMD4
  C2PXXMD4
  THESE WILL BE PROMOTED TO THE APPROPRIATE LEVEL USING
  PACKAGES CREATED BY CSC
  4) SCDC ENDEVOR ADMIN STAFF OR OPERATIONS WILL EXECUTE
  THE LLA (LIBRARY LOOKASIDE) CONSOLE COMMAND TO REFRESH
  LIBRARY POINTERS AND NOTIFY CSC THAT TESTING CAN BEGIN
  5) CSC WILL TEST THE CHANGED PROCESSORS USING ELEMENTS
  SELECTED BY J.SHANABROUGH - A DETAILED TEST PLAN INCLUDING
  SPECIFIC ELEMENT NAMES AND EXPECTED RESULTS IS UNDER
  CONSTRUCTION
  6) CSC WILL TRAP OUTPUTS FROM ALL TESTS IN DATASETS FOR
  REVIEW AND WILL RECORD ANY NON-ZERO RETURN CODES OR
  UNEXPECTED RESULTS
  8) SCDC ENDEVOR ADMIN STAFF WILL UPDATE THE FOLLOWING
  ENDEVOR PROCESSORS FROM LIBRARY CWM.CF00090.ORIG.LIB.PROC
  AHPCMLG4
  AHPCXMG4
  AHPXXHG4
  AHPXXMG4
  BSUXXLG4
  BSUXXMG4
  C2PCXMG4
  C2PXXMG4
  C2TCXMG4
  C2TXXRG4
  9) SCDC ENDEVOR ADMIN STAFF WILL UPDATE THE FOLLOWING
  ENDEVOR PROCESSORS FROM LIBRARY CWM.CF00090.ORIG.LIB.PROCESS
  AHSCXMB4 (NO LONGER REQUIRED--CONFIRM W/J.SHANABROUGH)
  C2PCXMD4
  C2PXXMD4
  10) SCDC ENDEVOR ADMIN STAFF OR OPERATIONS WILL EXECUTE
  THE LLA (LIBRARY LOOKASIDE) CONSOLE COMMAND TO REFRESH
  LIBRARY POINTERS AND NOTIFY CSC THAT ORIGINAL PROCESSORS
  ARE BACK IN EFFECT
  11) SC WILL TEST THE ORIGINAL PROCESSORS USING ELEMENTS
  SELECTED BY J.SHANABROUGH - A DETAILED TEST PLAN INCLUDING
  SPECIFIC ELEMENT NAMES AND EXPECTED RESULTS IS UNDER
  CONSTRUCTION
  12) CSC WILL TRAP OUTPUTS FROM ALL TESTS IN DATASETS FOR
  REVIEW AND WILL RECORD ANY NON-ZERO RETURN CODES OR
  UNEXPECTED RESULTS
  13) CSC WILL ANNOUNCE TO ITS STAFF THAT ENDEVOR IS AGAIN
  AVAILABLE FOR NORMAL USE
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 169
____________________________________________________________________________

  09/01/2006 03:20 PM
  HI KAREN,
  THIS EMAIL IS TO REQUEST THAT YOU GRANT TEMPORARY READ ACCESS TO C1ADMN
  ID FOR THE FOLLOWING DATASETS:
  CWML.PROD.*
  CWMV.PROD.*.MCF
  THE ID WILL NEED TO HAVE THE READ ACCESS FOR NEXT WEEKEND (9/9-9/10).
  THE REASON FOR THIS IS THAT WE ARE PERFORMING A TEST OF PROCESSOR
  CHANGES RELATED TO THE TRANSACTION SEVER UPGRADE OVER THAT WEEKEND,
  AND WE MAY NEED THE SC ENDEVOR GROUP'S SUPPORT IN TROUBLE SHOOTING
  ANY ISSUES.
  PLEASE LET ME KNOW IF YOU HAVE ANY QUESTIONS OR CONCERNS. OTHERWISE, PL
  THANKS, AND HAVE A GREAT HOLIDAY WEEKEND.
  CHRIS SHERIDAN CSC-CWFM
  (443) 436-6704
  09/06/2006 03:05 PM
  HI JAM,
  KAREN PRICE IS OUT OF THE OFFICE ON VACATION THIS WEEK, BUT HER BACK-UP,
  DAWN ERICKSON, HAS REPLIED TO MY REQUEST. SHE SAID THAT THEY ARE
  SHOWING THAT C1ADMN ALREADY HAS ALTER ACCESS TO THOSE DATASETS.
  CAN YOU PLEASE TRY BROWSING ONE OR MORE OF THESE DATASETS AND THEN GET B
  THANKS,
  CHRIS
  --- RECEIVED FROM CSC.CF00090 443-436-6751          06-09-07 13.49
    -> CSC.CF00072           JOSEPH SHANABROUGH             469
    -> CSC.RCSTAFF           RELEASE COORDINATORS
    -> CSC.CF00051           JERRY WEAVER                   CSC

  NO BA INVOLVEMENT IS REQUIRED FOR THIS WEEKEND'S TEST OF
  PROCESSORS. NO APPLICATION TESTING WILL OCCUR THIS WEEKEND.

  APPLICATION TESTING WILL TAKE PLACE IN LATE SEPTEMBER WHEN WE
  PROMOTE THE OCTOBER RELEASE TO EPROD ON OR ABOUT 9/28 OR 9/29.

  IMMEDIATELY FOLLOWING PROMOTION, THE PROCESSOR CHANGES WILL BE
  PERMANENTLY IMPLEMENTED AND A MASS-COMPILE/ASSEMBLY EFFORT WILL
  BEGIN. THIS IS EXPECTED TO LAST 1-2 DAYS AND WILL BEGIN IN EDEVT
  WITH SOFTWARE PROMOTED UP THROUGH ESYST. WE WILL THEN NEED HELP
  FROM THE BAS IN TESTING ONLINE TRANSACTIONS AND IN REVIEW OF A
  BASELINE CYCLE. WE ARE ASSUMING THE POST-IMPLEMENTATION BASELINE
  CYCLE WILL RUN IN THE 9/28 & 29 TIMEFRAME.

  SO, I DON'T EXPECT THE BAS TO BE INVOLVED ANY EARLIER THAN LATE
  ON 9/29, OR MAYBE THE WEEKEND OF 9/30-10/1, IF THEY ARE WILLING
  TO BE AVAILABLE. THEIR MOST LIKELY INVOLVEMENT WILL BEGIN ON
  MONDAY, 10/2.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 170
____________________________________________________________________________

 09/09/2006 08:50 AM
 HI JAM,
 OUR TEST OF THE UPDATED PROCESSORS IS COMPLETE, AND EVERYTHING
 APPEARS TO BE WORKING PROPERLY. WE DID RECEIVE A FEW
 BAD RETURN CODES, BUT THEY WERE ALL FOR
 ACCOUNTABLE REASONS, AND AFTER THE ISUES WERE FIXED,
 WE COMPILED THEM AGAIN AND RECEIVED GOOD RETURN CODES.
 THE OLD ORIGINAL PROCESSORS HAVE NOW BEEN PUT BACK IN PLACE AND
 WE ARE BACK TO NORMAL. WE HAVE RUN SOME MORE TEST
 COMPILES TO ENSURE THAT WE DID NOT
 BREAK ANYTHING WITH THE TEST, AND THEY ALL RECEIVED GOOD RETURN CODES
 AS WELL. SO IT LOOKS LIKE WE ARE GOOD TO GO UNTIL
 THE END OF THE MONTH WHEN WE WILL MAKE THE
 UPDATES TO TS2.2 FOR GOOD.
 THE EXACT DATES FOR THE FULL SYSTEM CONVERSION ARE YET TO BE
 DETERMINED, BUT IT WILL BE SOMETIME AT THE END OF SEPTEMBER,
 OR AT THE VERY LATEST, THE BEGINNING OF
 OCTOBER. WE WILL BE IN CONTACT IN A FEW WEEKS TO WORK OUT THE
 DETAILS, BUT FOR NOW WE ARE IN GOOD SHAPE.
 THANK YOU VERY MUCH FOR YOUR SUPPORT THIS MORNING.
 IF YOU NEED ANYTHING ELSE FROM US FOR YOUR RECORD KEEPING OR AUDITING
 PURPOSES, PLEASE LET ME KNOW. BUT AS FAR AS WE ARE CONCERNED,
 TODAY'S TEST WAS A SUCCESS.
 THANKS, CHRIS
 09/09/2006 09:36 AM
 CHRIS AND TEAM,
 CONGRATULATIONS ON THE SUCCESSFUL PROCESSORS UPGRADE TESTING.!
 ATTACHED IS THE ACTIVITIES PLAN THAT I PUT TOGETHER FROM YOUR INPUT FOR
 DOCUMENTATION ON THE TESTING UPGRADE PROCESSORS IMPLEMENTATION. WE CAN
 DEVELOP THE SIMILAR OR GUIDLINE PLAN WHEN WE HAVE THE PRODUCTION
 PROCESSORS UPGRADE IMPLEMENTATION.
 THANK YOU ALL
 JAM
 09/25/2006 - W/T WAILVER GRANTED BY KATHY WOYTON
 --- RECEIVED FROM CSC.CF00080 443-436-6734           06-09-27 16.03
   -> CSC.CSCBA              BUSINESS ANALYSTS
   -> CSC.CSCPRG             PROGRAMMERS
   -> CSC.RCSTAFF            RELEASE COORDINATORS
 ALL:
 THE R20064HF RELEASE NDM IS NEARING DELIVERY.

 AFTERWARDS, CHRIS WILL MOVE THE R2006400 MODULES TO EPROD AND
 PROMOTE THE INTERNAL CONTROL CARDS FOR THE R2007100 RELEASE.

  ON 9/28, SHAILAN WILL RUN THE R2007100 BASELINE CYCLE AS
  THE SOUTH CAROLINA DATACENTER UPDATES THE ENDEVOR PROCESSORS AND
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 171
____________________________________________________________________________

  JOE LOADS CR 25027 MODULES INTO EDEVT.

  EVERYONE ELSE, SHOULD REMAIN OUT OF THE EDEVT ENVIRONMENT AND
  AVOID ANY COMPILES IN ANY OF THE ENDEVOR ENVIRONMENTS UNTIL
  FURTHER NOTICE.

  THANK YOU,
  CHET
  09/27/2006
  ALL,
  ATTACHED IS A FLOWCHART SHOWING KEY TASKS AND BACKGROUND INFORMATION
  THAT WE'LL BE REVIEWING IN THIS MORNING'S MEETING AT 11AM.
  THANKS.
  JOHN
  1)     ENDEVOR WILL BE OUT OF SERVICE
       FROM 0800 (ET) ON 9/28/2006 THROUGH
       1700 (ET) ON 9/29/2006. THIS PERIOD MAY
       VARY BASED ON PROBLEM ACTIVITY.

  2)     ALL SE STAFF MUST NOT USE ANY
       LOCATION IN ENDEVOR FOR
       ADD/UPDATE/GENERATE ACTIVITY.

  3)     CM WILL BE DOING MASS-GENERATES
       AND MOVES ACROSS MULTIPLE
       LOCATIONS. WE CANNOT RISK HAVING
       UNEXPECTED VERSIONS OF ELEMENTS
       APPEAR IN EDEVT DURING THIS PHASE.

  4)    FOLLOWING REGENERATION, A TEST
      CYCLE AND CICS TRANSACTIONS WILL
      BE EXECUTED AND RESULTS REVIEWED.
  5)    FOLLOWING SUCCESSFUL TEST AND
      RESOLUTION OF PROBLEMS, ENDEVOR
      WILL BE OPENED AGAIN FOR NORMAL
      USE. CICS TRANSLATIONS/COMPILES/
      LINKS WILL BE AT THE TS V2.2 LEVEL.
   6)    SPECIALIZED COMPILE JCL WILL BE USED
       BY PSG DURING THE 10/1/06 - 1/2/07
      INTERIM PERIOD TO DELIVER CICS TS
      V1.8.
  7)    PULL ELEMENTS FROM ESYST AND APPLY
      ANY RETROFITS, CR CODING, ETC. TO
      ENSURE ELEMENT INTEGRITY IS
      MAINTAINED.
   UNLESS OTHERWISE NOTED, ALL TASKS WILL BE PERFORMED BY CWFM
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 172
____________________________________________________________________________

      TASK                                                       DATE DUE
  1. CWFM PREPARES INTERIM COMPILE/ASSEMBLY JOBS FOR PSG USE     9/22/2006
  2. CWFM TRANSMITS R20064GF FOLLOWUP                            9/25/2006
  3. CWFM TRANSMITS FINAL FOLLOWUP FOR R20064                    9/27/2006
  4. CWFM CM PROMOTES R2006400 TO EPROD                          9/27/2006
  5. CWFM RUNS POST-R20064 BASELINE CYCLE                        9/27-28
  6. CWFM SENDS NOTE TO STAFF TO DISCONTINUE USE OF EDEVT        9/28/2006
  7. SCDC ROLLS OUT (PROMOTES) NEW PROCESSORS                    9/28/2006
  8. PULL ALL ONLINE ELEMENTS DOWN TO EDEVT                      9/28/2006
  9. ADD MODLOG TAGS                                             9/28/2006
  10.CONSTRUCT PACKAGES                                          9/28/2006
  11.CAST PACKAGES                                               9/28/2006
  12.EXECUTE PACKAGES                                            9/28/2006
  13.CHECK RESULTS                                               9/28/2006
  14.PROMOTE EDEVT CONTENTS TO ESWIT                             9/28/2006
  15.CHECK RESULTS                                               9/28/2006
  16.PROMOTE ESWIT CONTENTS TO ESYST                             9/28/2006
  17.CHECK RESULTS                                               9/28/2006
  18.SCDC PROMOTES CICS STARTUP DECK CHANGES FOR TS 2.2          9/29/2006
  19.RUN BASELINE CYCLE IN CMY* REGIONS                          9/29/2006
        A.CSC SES WILL TEST 1.1.1, 2.1.1
        B.KAREN WILL TEST 3.1.2 THRU 3.1.25(ITF & CYCLE OUTPUT)
  20.CHECK RESULTS                                               9/29/2006
  21.EXECUTE ONLINE TRANSACTIONS IN CMY* REGIONS                 9/29/2006
        A.CSC SE WILL TEST 1.1.1, 2.1.1
        B.MEREDITH WILL TEST 3.2.1 THRU 3.2.8 (INQUIRY)
        C.CSC WILL TEST 3.2.9 (HUQA)
        D.MEREDITH WILL TEST 3.3.1 THRU 3.3.12
        E.(HICR)
  22.CHECK RESULTS                                               9/29/2006
  23.CORRECT PROBLEMS, IF ANY                                    9/29/2006
  24.RE-TEST IF ANY PROBLEMS                                     9/29/2006
  25.REPEAT #19 & #20 UNTIL RESULTS OKAY                         9/29/2006
  26.SEND NOTE TO RE-OPEN EDEVT FOR USE                          9/29/2006
  27.CONTINUE WITH JANUARY RELEASE (R2007100) DEVELOPMENT        9/29/2006
  --- RECEIVED FROM CSC.CF00072 443-436-6718           06-09-27 11.36
    -> CSC.PSG                CSC PRODUCTION SUPPORT GROUP

  AS PART OF THE UPGRADE TO TRANSACTION SERVER 2.2 AND MAINTAINING
  PRODUCTION AT TRANSACTION SERVER 1.8 UNTIL JANUARY 1 2007.

  TWO NEW COMPILE STREAMS IN CWML.PROD.EFIX1.HOST.JCL ARE TO BE
  USED IN COMPILING PRODUCTION CHANGES, THEY ARE "COMPILE2 -
  STANDARD COMPILE" AND "COMPIL2S - FOR SMARTTEST COMPILES".

  MODIFY THE SET VALUES FOR YOUR COMPILE.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 173
____________________________________________________________________________


   SET   ELEMENT='PROGRAM NAME'
   SET   SUBSYS=HOST OR SATL
   SET   SYSTEM=CWFM
   SET   LOADC=CWM.TEST.EFIX1.&SUBSYS..LOADC
   SET   SOURCE='SOURCE LOCATION'


  THE LOAD MODULE CREATED FOR THESE ONLINE COMPILES WILL BE MOVED
  THRU THE FIX1/FIX2 PATH. THE ENDEVOR WILL BE USED TO TRACK THE
  SOURCE CODE CHANGES.

  --- RECEIVED FROM CSC.CF00041 443-436-6704          06-09-27 17.35
    -> CSC.PSG               CSC PRODUCTION SUPPORT GROUP
    -> CSC.CSCPRG            PROGRAMMERS
    -> CSC.RCSTAFF           RELEASE COORDINATORS

  ATTENTION ALL,

  ALL OF THE OCTOBER SOFTWARE HAS NOW BEEN SUCCESFULLY PROMOTED TO
  EPROD.

  ALL OF THE CSCINT MODULES (BOTH THE OCTOBER RELATED ONES THAT
  HAD BEEN IN EBETA, AS WELL AS THE PROC AND JCL CHANGES FROM SRI
  NEEDED FOR THE BASELINE CYCLE) HAVE BEEN PROMOTED TO EPROD.CSCINT

  ALL OF THE OCTOBER ARCHIVED MODULES HAVE BEEN DELETED FROM
  ENDEVOR.

  AS FAR AS I AM CONCERNED, OCTOBER RELASE ACTIVITY IS COMPLETE,
  AND THE BASELINE CYCLE MAY BEGIN.

  TOMMORROW WE WILL BEGIN THE CR25027 WORK FOR THE TRANSACTION
  SERVER UPGRADE
  LET ME KNOW IF ANYONE HAS ANY QUESTIONS OR CONCERNS.
  CHRIS
  --- RECEIVED FROM CSC.CF00090 443-436-6751           06-09-28 09.24
    -> CSC.CSCPRG            PROGRAMMERS
    -> CSC.CSCBA             BUSINESS ANALYSTS
    -> CSC.RCSTAFF           RELEASE COORDINATORS
  ALL,

  WE WILL BE ROLLING OUT THE CICS TS 2.2 PROCESSOR CHANGES IN
  ENDEVOR VERY SHORTLY. ACTIVITY IS BEING COORDINATED WITH
  SCDC AS I WRITE THIS.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 174
____________________________________________________________________________

 AT THIS TIME, CEASE ALL ADD/UPDATE/GENERATE ACTIVITY IN ALL
 ENDEVOR LOCATIONS. YOU CAN STILL CODE IN YOUR WIP LIB AND
 CAN RETRIEVE, RUN COMPARES AND SCANS, ETC.

 WE EXPECT TO COMPLETE PROMOTION OF THE NEWLY GENERATED CWF
 ELEMENTS LATER TODAY. PLANS CALL FOR ONLINE TESTING AND A
 CYCLE TO RUN TOMORROW. ONCE THIS ACTIVITY HAS BEEN COMPLETED
 SUCCESSFULLY, WE'LL BE READY TO RETURN ENDEVOR TO YOU.

 IF AT ANY TIME YOU HAVE A QUESTION REGARIND ENDEVOR AVAILABILITY,
 PLEASE CONTACT RCSTAFF, CHRIS SHERIDAN OR JERRY WEAVER.
 THANKS.
 09/28/2006 09:23 AM
 HI JAM,
 WE HAVE COMPLETED THE NECESSARY TASKS, AND ARE NOW READY FOR YOU TO
 PROMOTE THE UPDATED PROCESSORS IN ENDEVOR.
 PLEASE SUBMIT THE FOLLOWING PACKAGE:
 PROCESS001
 AFTER THAT PACKAGE IS SUCCESSFULLY EXECUTED, I WILL CAST THE MOVE
 PACKAGE, AND THEN HAVE YOU SUBMIT THAT ONE AS WELL. THE MOVE
 PACKAGE WILL BE NAMED:
 PROCESS001A
 LET ME KNOW IF YOU HAVE ANY QUESTIONS.
 CHRIS
 --- RECEIVED FROM CSC.CF00090 443-436-6751          06-09-28 14.49
   -> CSC.CF00051           JERRY WEAVER                   CSC
   -> CSC.RCSTAFF           RELEASE COORDINATORS
   -> CSC.CF00072           JOSEPH SHANABROUGH             469
   -> CSC.CF00041           CHRISTOPHER J SHERIDAN         CSC
 CHRIS & JOE,

 IT APPEARS THE MOVES FROM EDEVT TO ESWIT HAVE BEGUN.
 I'M WATCHING MEMBER COUNTS IN LOADC LIBS CHANGING.

 WHAT'S YOUR FEELING THAT PROMOTION OF ALL ELEMENTS WILL
 BE COMPLETED UP TO ESYST TODAY? PLEASE ADVISE.

 JOHN
 --- RECEIVED FROM CSC.CF00041 443-436-6704             06-09-28 15.03
   -> CSC.RCSTAFF           RELEASE COORDINATORS
   -> CSC.CF00051           JERRY WEAVER                     CSC
   -> CSC.CF00072           JOSEPH SHANABROUGH               469
   -> CSC.CF00090           JOHN ALEXANDER                   469

  YES, THEY WILL BE COMPLTED SOMETIME TODAY...I'LL MAKE SURE I
  EITHER STAY HERE, OR MONITOR THE JOBS FROM HOME...BUT I'LL FOLLOW
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 175
____________________________________________________________________________

  IT THROUGH AND MAKE SURE EVERYHTING IS MOVED TO SYST SOMETIME
  TONIGHT.

  AS FAR AS EXACT TIMING...IT'S HARD TO SAY. DEPENDS ON HOW THE
  SYSTEM RUNS. RIGHT NOW IT APPEARS TO BE SMOOTH SAILING...BUT AS
  YOU KNOW, THINGS HAVE A WAY OF CHANGING

  --- RECEIVED FROM CWFSW.CF90213 (469) 372-1022      06-09-28 14.56
    -> CSC.CSCMGT            CSC MANAGEMENT
    -> CSC.CSCBA             BUSINESS ANALYSTS
    -> CSC.RCSTAFF           RELEASE COORDINATORS
    -> CSC.CF00055           SHAILAN MANDAYAM               CSC
  I AM REVIEWING THE HICR REGRESSION FOR THE BASELINE CYCLE IN
  PREPARATION FOR CR25027'S IMPLEMENTATION AND TOMORROW'S CYCLE AND
  I HAVE FOUND AONE HICR ISSUE AND THAT IS WITH THE HCAP
  TRANSACTION FOR ADD'S AND UPDATES HICS:
  324713102A-ADD,HIC 324713106A-UPDATE...THEY ARE SHOWING UP ON THE
  AUDIT REPORT AND RELFECT A HICR DATE BUT NO UPDATE IS BEING MADE
  TO THE AUX FILE. THESE WERE BOTH FINE IN THE REVIEW OF REGRESSION
  FOR OCT IN THE 7/12/2006 RELEASE.

  MEREDITH
  ------------------------------------------------------------------
  --- RECEIVED FROM CSC.CF00041 443-436-6704          06-09-28 17.07
    -> CSC.PSG               CSC PRODUCTION SUPPORT GROUP
    -> CSC.RCSTAFF           RELEASE COORDINATORS

  HI ALL,

  ALL OF THE COMPILES AND MOVES FOR CR 25027 (TS 2.2 UPGRADE) HAVE
  BEEN COMPLETED.

  ALL EXTERNAL SOFTWARE (534 MEMBERS, PLUS 2 COPYBOOKS THAT NEEDED
  TO BE RE-INTRODUCED TO THE SYSTEM) IS NOW IN ESYST.

  ALL CSC INTERNAL SOFTWARE (32 MEMBERS) IS NOW IN EBETA.

  I GUESS THE NEXT STEP IS WAITINIG FOR WORD FROM BRUCE PARKER THAT
  THE START-UP DECKS HAVE BEEN CONVERTED TOMMORROW MORNING, THEN
  START CYCLING.

  LET ME KNOW IF ANYONE SEES ANY PROBLEMS.

  CHRIS

  --- RECEIVED FROM CSC.CF00090 443-436-6751          06-09-29 07.27
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 176
____________________________________________________________________________

    -> CSC.CSCBA             BUSINESS ANALYSTS
    -> CSC.CF00051           JERRY WEAVER                   CSC
    -> CSC.CF00072           JOSEPH SHANABROUGH             469
    -> CSC.RCSTAFF           RELEASE COORDINATORS
    -> CSC.CF00041           CHRISTOPHER J SHERIDAN         CSC
  BRUCE PARKER HAD A MESSAGE WAITING WHEN I ARRIVED TO SAY THAT
  OUR TEST REGIONS ARE ALL CONVERTED AND THAT CMUTEST, CMYTEST,
  CMYACT AND CMXTEST ARE ALL UP AND RUNNING. I'VE CONFIRMED THIS
  BY CHECKING THE GMTEXT PARM IN THE SIT AND SCANNING FOR THE
  CISCTS22 NODE IN STEPLIBS AND OTHER DDS.

  LOOKS LIKE WE ARE READY TO DO THE ONLINE AND CYCLE TESTING NOW.
  JOHN
  --- RECEIVED FROM CSC.CF00090 443-436-6751          06-09-29 08.02
    -> CSC.CF00041           CHRISTOPHER J SHERIDAN         CSC
    -> CSC.CSCPRG            PROGRAMMERS
    -> CSC.CSCMGT            CSC MANAGEMENT
  ALL,

  PLEASE REMEMBER THAT OUR TESTING OF THE ROLLOUT FOR ENDEVOR
  PROCESSOR CHANGES FOR THE CICS TS V2.2 UPGRADE IS STILL IN
  PROGRESS.

  WE HAVE COMPLETED THE PROCESSOR ROLLOUT ITSELF AS WELL AS
  THE ONLINE PRORGRAM RECOMPILES AND SUCCESSFULLY PROMOTED
  THESE TO ESYST.

  THE CMYACT, CMYTEST, CMXTEST AND CMUTEST REGIONS HAVE ALL
  BEEN UPGRADED BY SCDC TO BE COMPLIANT WITH CICS TS V2.2.
  THESE REGIONS WILL BE IN USE TODAY BY THE BAS AND FOR A
  TEST CYCLE. WE'LL KEEP YOU POSTED ON PROGRESS.

  PLEASE CONTINUE TO STAY OUT OF ENDEVOR UNTIL AN ALL-CLEAR
  IS SENT. THANKS FOR YOUR COOPERATION DURING THIS IMPORTANT
  TESTING ACTIVITY.
  JOHN
  --- RECEIVED FROM CSC.CF00090 443-436-6751          06-09-29 08.38
    -> CSC.CF00072           JOSEPH SHANABROUGH              469
    -> CSC.RCSTAFF           RELEASE COORDINATORS
    -> CSC.CF00051           JERRY WEAVER                    CSC
    -> CSC.CSCBA             BUSINESS ANALYSTS
    -> CWFSW.CF90213         MEREDITH L. REVIER              469
  JOE--NEED YOU TO CHECK INTO THIS ASAP, PLEASE.



______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 177
____________________________________________________________________________

  ------------------------------------------------------------------
  --- RECEIVED FROM CWFSW.CF90213 (469) 372-1022      06-09-29 08.34
    -> CSC.CSCBA             BUSINESS ANALYSTS
    -> CSC.RCSTAFF           RELEASE COORDINATORS
    -> CSC.CF00090           JOHN ALEXANDER                 469
  HI JOHN,
  I STARTED KEYING SOME TRANSACTIONS IN CMYACT AND MY FIRST ONE IS
  AN HUIP CLAIM UNDER HIC 250271000A IT RECEIVED THE FOLLOWING
  MESSAGE:
  FHAC2206 08:32:36 A70QCMY TRANSACTION HIIP FAILED WITH ABEND ASRA.
  LOCAL RECOVERABLE RESOURCES BACKED OUT.
  IS THE REGION NOT READY FOR THE BA'S YET?
  MEREDITH
  --- RECEIVED FROM CWFSW.CF90213 (469) 372-1022      06-09-29 08.51
    -> CSC.CF00072           JOSEPH SHANABROUGH             469
    -> CSC.CF00051           JERRY WEAVER                   CSC
    -> CSC.CSCBA             BUSINESS ANALYSTS
    -> CSC.RCSTAFF           RELEASE COORDINATORS
    -> CSC.CF00090           JOHN ALEXANDER                 469
  I WENT AHEAD AND KEYED THE REMAINING CLAIM TYPES:HUOP,HUBC,HUDC,
  HUHH,HUHC AND ALL TRANSACTIONS ARE WORKING INCLUDING ADJUSTMENTS
  AND CANCELS. SO FOR SOME GOOD NEWS THIS MORNING, ONLY THE HUIP
  TRANSACTION SEEMS TO BE HAVING AN ISSUE. ONCE THAT IS RESOLVED WE
  CAN RUN THE CYCLE.

  MEREDITH
  --- RECEIVED FROM CSC.CF00090 443-436-6751          06-09-29 08.54
    -> CSC.CF00072           JOSEPH SHANABROUGH             469
    -> CSC.CF00051           JERRY WEAVER                   CSC
    -> CSC.RCSTAFF           RELEASE COORDINATORS
    -> CSC.CSCBA             BUSINESS ANALYSTS

  THANKS, MEREDITH.

  I'VE STARTED AN ALPHA ISSUES LOG AND THE HIIP ITEM YOU REPORTED
  IS #1. JOE IS ANALYZING NOW.
  --- RECEIVED FROM CWFSW.CF90213 (469) 372-1022      06-09-29 09.49

    -> CSC.CF00051            JERRY WEAVER                  CSC
    -> CSC.CSCBA              BUSINESS ANALYSTS
    -> CSC.RCSTAFF            RELEASE COORDINATORS
    -> CSC.CF00072            JOSEPH SHANABROUGH            469
    -> CSC.CF00090            JOHN ALEXANDER                469
  I HAVE RETESTED THE HUIP TRANSACTION AND IT IS WORKING FINE NOW.
  I HAVE ALSO PROCESSED AN ADJUSTMENT AND CANCEL AND THEY ARE ALSO
  WORKING. PLEASE START THE CYCLE WHEN YOU ARE READY SO THE BA'S
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 178
____________________________________________________________________________

 CAN REVIEW THE CYCLE RESULTS.

 THANKS!
 MEREDITH
 --- RECEIVED FROM CSC.CF00090 443-436-6751           06-09-29 09.59
   -> CSC.CSCBA             BUSINESS ANALYSTS
   -> CSC.CF00051           JERRY WEAVER                    CSC
   -> CSC.CF00072           JOSEPH SHANABROUGH              469
   -> CSC.RCSTAFF           RELEASE COORDINATORS
 ALL,

 JOE IS WORKING UP THE LAST TWO ELEMENT CHANGES AND WE'LL BE
 PROMOTING THEM SOON. ANASTASIYA IS RUNNING TODAY'S CYCLE AND
 IS READY ONCE JOE GIVES US THE WORD.

 --- RECEIVED FROM CSC.CF00113 443-436-6859           06-09-29 10.24
   -> CSC.RCSTAFF           RELEASE COORDINATORS
   -> CSC.CSCPRG            PROGRAMMERS
   -> CSC.CSCBA             BUSINESS ANALYSTS

  I WILL START CYCLE IN 15 MINUTES.PLEASE STOP WORKING IN
  CMYACT, CMYTEST AND CMXTEST UNTIL FURTHER NOTICE.


  THANKS, ANASTASIA
 --- RECEIVED FROM CSC.CF00090 443-436-6751          06-09-29 11.39
   -> CSC.CSCBA             BUSINESS ANALYSTS
   -> CSC.RCSTAFF           RELEASE COORDINATORS
   -> CSC.CF00072           JOSEPH SHANABROUGH             469
   -> CSC.CF00051           JERRY WEAVER                   CSC
   -> CSC.CF00113           ANASTASIYA NEPOMNYASHCHAYA     469
 ALL,

 JUST SPOKE WITH MEREDITH. SHE FEELS SHE'LL NEED ABOUT 2 HOURS FOR
 CONDUCTING HER REVIEW FOLLOWING COMPLETION OF THE CYCLE TODAY.

 JOHN
 --- RECEIVED FROM CSC.CF00113 443-436-6859           06-09-29 11.59
   -> CSC.RCSTAFF           RELEASE COORDINATORS
   -> CSC.CSCPRG            PROGRAMMERS
   -> CSC.CSCBA             BUSINESS ANALYSTS

 CMYACT REGION IS AVAILABLE NOW.

  THANKS, ANASTASIA

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 179
____________________________________________________________________________

  --- RECEIVED FROM CSC.CF00113 443-436-6859          06-09-29 12.35
    -> CSC.RCSTAFF           RELEASE COORDINATORS
    -> CSC.CSCPRG            PROGRAMMERS
    -> CSC.CSCBA             BUSINESS ANALYSTS

  CYCLE HAS COMPLETED WITHOUT CABPRINT ERRORS.
  PLEASE REVIEW THE FILES:

  CWM.TEST.R0701.D092906*

  THANKS, ANASTASIA

  --- RECEIVED FROM CWFSW.CF90213 (469) 372-1022      06-09-29 14.30
    -> CSC.CF00072           JOSEPH SHANABROUGH             469
    -> CSC.CF00051           JERRY WEAVER                   CSC
    -> CSC.CSCBA             BUSINESS ANALYSTS
    -> CSC.RCSTAFF           RELEASE COORDINATORS
    -> CSC.CF00090           JOHN ALEXANDER                 469

  HI JOHN,

  THA BA'S HAVE FINISHED THEIR REVIEW OF THE CYCLE AND OUTPUT.
  HICR REGRESSION AND PROVIDER INQUIRY REGRESSION BOTH LOOK GOOD.
  I SPOKE WITH KAREN AND HER REVIEW OF PART A AND PART B REGRESSION
  AS WELL AS THE HIAB SCREEN LOOKS GOOD. SO GOOD JOB! EVERYTHING IS
  READY TO TURN OVER TO THE JANUARY RELEASE TEAM. WE APPRECIATE YOU
  MEETING ALL OF THE DEADLINES NEEDED FOR US TO FINISH UP OUR
  REVIEW TODAY. HAVE A GOOD WEEKEND!

  THANKS!
  MEREDITH/KAREN
  --- RECEIVED FROM CSC.CF00090 443-436-6751          06-09-29 14.49
    -> CSC.CF00072           JOSEPH SHANABROUGH             469
    -> CSC.CF00041           CHRISTOPHER J SHERIDAN         CSC
    -> CSC.CF00051           JERRY WEAVER                   CSC
    -> CSC.RCSTAFF           RELEASE COORDINATORS
    -> CWFSW.CF90242         VICKI L SOMMERS                469
    -> CSC.CF91079           KAREN CHAFFIN                  469
    -> CWFSW.CF90213         MEREDITH L. REVIER             469
  ALL,
  A BIG THANK YOU TO MEREDITH AND KAREN FOR CWF TESTING. ALSO TO JOE
  AND CHRIS FOR ALL THE TESTING & MASS RE-COMPILE/ASSEMBLY EFFORTS.

  THIS WAS A FINE EXAMPLE OF GROUP EFFORT AND ATTENTION TO OUR SDLC
  STANDARDS AND CHECKPOINTS. IT WAS CRITICAL TO COMPLETE THIS CR IN
  ADVANCE OF ALL THE OTHERS IN THE RELEASE AND EVERYONE WORKED TO
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 180
____________________________________________________________________________

  ENSURE THAT HAPPENED. YOU GUYS KICK MAJOR DERRIERRE. CONGRATS!
  JOHN




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 181
____________________________________________________________________________


   14. 00025555    HICN 432XXXXXXA RECEIVING ERROR CODE 5248 IN ERROR.

  DATE ENTERED:    05/16/07

  TITLE:           HICN 432709317A RECEIVING ERROR CODE 5248 IN ERROR.

  PROJECT CODE:    CM01

  PRIORITY:        1

  RELEASE LEVEL: R2008100

  GROUP LEVEL:     2

  HOST SITE ID:    HCSC1000

  STATUS ON CR:    REQS

  DOC. REQUIRED: N

  HOST EVAL:       VALIDATE

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   2
  EST. HOURS:      0125
  ACT. HOURS:      0120
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  HICN 432XXXXXXA IS RECEIVING ERROR CODE 5248 ON
  ICN 681706220750020 IN ERROR. THE BOIA RECORD
  SHOWS DATES OF 03/30/06 THRU 03/31/06. THE DATES
  OF SERVICE ON THE CLAIM ARE 01/25/06, 02/25/06,
  03/25/06 AND 04/25/06. THIS IS A MI PRODUCTION
  CLAIM. I SPOKE TO KRISTY AKIN ABOUT THIS ISSUE
  AND SHE SUGGESTED THAT I WRITE A CHANGE REQUEST.

  REQUIREMENTS:
  -------------
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
    Common Working File                                                  R2008100
    Full Requirements Document                                    October 3, 2007
    Change Requests                                                      Page 182
    ____________________________________________________________________________

                   DEFINITION AND ANALYSIS PHASES

      CR:          ____25555________    WORK TYPE:   ___   Incidental
      SUBSYSTEM:   _________________                 _x_   Minor
      FUNCTION:    _________________                 ___   Major
      PROGRAM:     _________________                 ___   New Subsystem

      DEFINITION PHASE ORGANIZATION

      CMS Participants:
      1. Name:                 Cathy Pflaum
          Telephone:           410-786-3016
          FAX, CMS:            410-786-0271
          Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

      CWFM Participants:
      1. BUSINESS ANALYST:     Yvonne Anderson
          Telephone:           469-372-5420
          FAX,Richardson,TX:   469-372-0284
          Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

      2.   PROG ANALYST:       Liz Hayes
           Telephone:          443-436-6899
           FAX,Baltimore,MD:   443-436-3803
           Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                               TESTING


      *******************************************************************
      * PARAGRAPHS - Start in column 1. The paragraph will end when a *
N       *              blank line is found.                               *
      * HEADINGS   - Start in column 2.                                 *
      * FREE-FORMAT- Start in column 3.                                 *
      * Use upper and Lower case.                                       *
      *                                                                 *
      * EDITING    - Please allow 2 spaces after a period and 2 spaces *
      *               after a colon. Try to format as it should appear *
      *               in the Release Document.                          *
      *******************************************************************
          IMPACT:
      (x) Host
      ( ) Satellite Part A Inpatient
      ( ) Satellite Part A Outpatient
      (x) Satellite Part B
      ( ) Hospice
      ( ) Home Health
    ______________________________________________________________________________
    Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 183
____________________________________________________________________________

  ( ) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  Error code '5248' is setting in error when an HUBC record
  that contains an assignment indicator equal to 'N' is
  received for a Beneficiary's whose BOI File contains a
  Medicaid COBA ID (700000-79999). The incoming claim
  contains multiple detail lines and none of the dates of
  service on the claim are equal to, or within any of the
  open occurrences on the BOI File.

  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
  Error code '5248' is a utilization edit and sets in the
  header of the claim.

  CWF must modify the logic to read each of the 13 detail
  lines of an incoming non-assigned HUBC record to determine
  if the line item date of service is equal to, or within an
  open Medicaid COBA ID range (70000-79999).

  If the non-assigned HUBC claim contains multiple detail
  line items, and any of the detail line item Dates of
  Service are equal to, or within the Medicaid COBA ID
  date range error code '5248' will continue to set.

  If the non-assigned HUBC claim contains multiple detail
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 184
____________________________________________________________________________

 line items, and all of the detail line items Dates of
 Service are prior to the Medicaid COBA ID Effective Date,
 error code '5248' will be bypassed.

 If the non-assigned HUBC claim contains multiple detail
 line items, and all of the detail line items Dates of
 Service are after the Medicaid COBA ID Termination Date,
 error code '5248' will be bypassed.

 ***Note-If the edit is bypassed, the claim will cross over
 and Trailer '29' will be generated.***

 ***.......This is the width of the Release Document.......***


 The Event-Response List provides a description of the way
 that the system should function AFTER the change.

 *******************************************************************
 * If you want the EVENT-RESPONSES printed in the release document *
 * remove the word "None" and delete the delimiter line. Number    *
 * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
 * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
 *******************************************************************
   EVENT-RESPONSE LIST:
 ***.......This is the width of the Release Document.......***

 Event 1.1
 Submit an HUBC record that is non-assigned. The BOI File for
 the Beneficiary contains a Medicaid COBA ID (70000-79999). The
 earliest From Date and the latest Thru Date overlap an
 occurrence on the BOI Auxiliary file. The individual dates
 on the detail lines are not equal to, or within the dates for
 the Medicaid occurrence. The Dates of Service on the incoming
 are equal to, or within occurrence dates on the COIF File for
 the other COBA IDs. The other IDs do not contain any inclusions
 or exclusions.

 Example-   COBA 72241
            BOI Date Effective 3/30/2006 Term 3/31/2006
            Claim From/Thru Date-1/25/2006 thru 4/25/2006)
            Detail Dates-1/25/06, 3/25/06, 4/25/06

            COBA 42311
            BOI Date Effective 1/30/2006 Term 3/31/2006
            Claim From/Thru Date-1/25/2006 thru 4/25/2006)
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 185
____________________________________________________________________________

           Detail Dates-1/25/06, 3/25/06, 4/25/06


  Response
  The record is processed, error code '5248' is not set. The
  claim does not cross for the Medicaid, but crosses for the
  other COBA ID. Trailer '29' is generated for the other COBA
  IDs. The claim displays a Disposition Indicator 'A' for the
  other IDs.

  Event 1.2
  Submit an HUBC record that is non-assigned. The BOI File for
  the Beneficiary contains a Medicaid COBA ID (70000-79999). The
  earliest From Date and the latest Thru Date overlap an
  occurrence on the BOI Auxiliary file. The individual dates
  on the detail lines are not equal to, or within the dates for
  the Medicaid occurrence. The Dates of Service on the incoming
  claim are not equal to, or within occurrence dates on the COIF
  File for the other COBA IDs. The other IDs do not contain any
  inclusions or exclusions.

  Response
  The record is accepted, error code '5248' is not set. The claim
  does not cross for Medicaid or the other COBA IDs. Trailer '29' is
  not generated.

  Event 1.3
  Submit an HUBC record that is non-assigned. The BOI File for
  the Beneficiary contains a Medicaid COBA ID (70000-79999). All
  the Dates of Service on the incoming record are prior to the
  Effective Date of the Medicaid COBA ID. There are other COBA
  IDs on the COIF File Auxiliary that do not have any inclusions/
  exclusions. The dates on the incoming claim are prior to the
  Effective Dates of the other COBA IDs.

  Response
  The record is accepted, error code '5248' is not set. The claim
  does not cross for Medicaid or the other COBA IDs. Trailer
  '29' is not generated.

  Event 1.4
  Submit an HUBC record that is non-assigned. The BOI File for
  the Beneficiary contains a Medicaid COBA ID (70000-79999). All
  the Dates of Service on the incoming record are after the
  Termination Date of the Medicaid COBA ID. There are other COBA
  IDs on the COIF File Auxiliary that do not have any inclusions/
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 186
____________________________________________________________________________

  exclusions. The dates on the incoming claim are after the
  Effective Dates of the other COBA IDs.

  Response
  The record is accepted, error code '5248' is not set. The claim
  does not cross for Medicaid or the other COBA IDs. Trailer
  '29' is not generated.

  Event 1.5
  Submit an HUBC record that   is non-assigned. The BOI File for
  the Beneficiary contains a   Medicaid COBA ID (70000-79999). One
  of the Dates of Service on   the incoming record is equal to,
  or within the date span of   the Medicaid COBA ID.

  Response
  The record is rejected, error code '5248' is set. The claim
  does not cross to Medicaid. Trailer '29' is not generated.

  Event 1.6
  Submit an HUBC record that is non-assigned. The BOI File for
  the Beneficiary contains a Medicaid COBA ID (70000-79999). One
  of the Dates of Service on the incoming record is equal to,
  or within the date span of the Medicaid COBA ID. There are
  other COBA IDs on the COIF File Auxiliary that do not have any
  inclusions/exclusions, the dates are equal to, or within the
  Effective Dates of the other COBA IDs.


  Response
  The record is rejected, error code '5248' is set. The claim
  does not cross for Medicaid or the other COBA Ids. Trailer
  '29' is not generated.



  ***.......This is the width of the Release Document.......***

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

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 187
____________________________________________________________________________


  Solution Criteria: N/A

    EDITS AFFECTED:
  ***.......This is the width of the Release Document......***

  THIS IS A PROGRAMMING CHANGE ONLY-DOCUMENTATION DOES NOT
  NEED UPDATE


  a. Error Code:    5248   ( )New (x)Modified ( )Deleted
  Disposition:      UR

  Type of Record:   Part B Carrier/DMEPOS

  Error Message:    Beneficiary has Medicaid, and the claim
                    is non-assigned.

  Set Condition for edit '5248': Under Development

  Trailer Information: '08'


  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************



______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 188
____________________________________________________________________________


   15. 00025559    UR 538E SETTING IN ERROR ON HHA WHEN SUBSEQUENT EPISODE

  DATE ENTERED:    05/21/07

  TITLE:           UR 538E SETTING IN ERROR ON HHA WHEN SUBSEQUENT EPISODE

  PROJECT CODE:    CM01

  PRIORITY:        1

  RELEASE LEVEL: R2008100

  GROUP LEVEL:     2

  HOST SITE ID:    CWFM2000

  STATUS ON CR:    REQS

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   3
  EST. HOURS:      0300
  ACT. HOURS:      0135
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  RHHI (CAHABA) reported a problem where UR 538E is setting
  in error when a subequent episode is present and does
  not overlap the dates on the incoming adjustment for
  first episode to change the patient status to be 01.
  Example:
  First Episode is 11/3/04-12/29/04 Patient Status 06
  Second Episode is 6/10/05- 08/08/05 Different Provider

  Changing Patient Status on first episode to be '01' and
  returns UR 538E and should be allowed since no
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 189
____________________________________________________________________________

  overlap to subsequent episode.

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:          ______25559______    WORK TYPE:   ___   Incidental
  SUBSYSTEM:   _________________                 _x_   Minor
  FUNCTION:    _________________                 ___   Major
  PROGRAM:     _________________                 ___   New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                 Cathy Pflaum
      Telephone:           410-786-3016
      FAX, CMS:            410-786-0271
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     Ofelia Castillo
      Telephone:           469-372-6492
      FAX,Richardson,TX:   469-372-0284
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       Sai Batchu
       Telephone:          443-436-6739
       FAX,Baltimore,MD:   443-436-3803
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *              blank line is found.                               *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *              after a colon. Try to format as it should appear *
  *              in the Release Document.                           *
  *******************************************************************
    IMPACT:
  (x) Host
  ( ) Satellite Part A Inpatient
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 190
____________________________________________________________________________

  ( ) Satellite Part A Outpatient
  ( ) Satellite Part B
  ( ) Hospice
  (x) Home Health
  ( ) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  Currently, CWF is rejecting a Home Health adjustment claim
  incorrectly with utilization edit '538E' when a subsequent
  episode is present and does not overlap the dates of service.

  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
  CWF should not set utilization edit '538E' when a subsequent
  episode is present and does not overlap the dates of service
  (more than 60 days have elapse) of the incoming Home Health
  adjustment for the first episode. The adjustment being done
  will change the patient status from '06' to '01' on the
  first episode.

  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  *******************************************************************
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 191
____________________________________________________________________________

  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
  * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
  *******************************************************************
    EVENT-RESPONSE LIST: None
  ***.......This is the width of the Release Document.......***

  Event 1.1
  Enter a Home Health adjustment claim with Patient Status '01'.
  The From and Thru Date does not overlap a Home Health episode
  (more than 60 days have elapse) on the HHEH Aux file.

  Response
  Error code '538E' does not set.

  Event 1.2
  Enter a Home Health Final claim with a Patient Status other
  than '06'. The From and Thru Date are during a shortened
  (less than 60 days) Home Health episode on the HHEH Aux file.

  Response
  Error code '538E' does set.


  ***.......This is the width of the Release Document.......***

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

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1. Home Health PPS

  Solution Criteria: N/A

    EDITS AFFECTED: None
  ***.......This is the width of the Release Document......***

  a. Error Code:   XXXX    ( )New ( )Modified ( )Deleted
  Disposition:

  Type of Record:
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 192
____________________________________________________________________________


  Error Message:

  Set Condition for edit '####':

  Trailer Information:


  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 193
____________________________________________________________________________


   16. 00025562    5648-IMPLEMENT NEW CONTRACTOR ID FOR STC

  DATE ENTERED:    05/23/07

  TITLE:           5648-IMPLEMENT NEW CONTRACTOR ID FOR STC

  PROJECT CODE:    CM01

  PRIORITY:        1

  RELEASE LEVEL: R2008100

  GROUP LEVEL:     1

  HOST SITE ID:    CWFM2000

  STATUS ON CR:    REQS

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   1
  EST. HOURS:      0075
  ACT. HOURS:      0047
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  This request implements a new DMEMAC contractor number for use
  by the Single-Testing Contractor (STC) in Medicare fee-for-
  service integrated systems testing.

  CWF REQS
  1)Add new Contractor number '44410' for DMEMAC Systems integrated
  testing.

  PALMETTO GBA
  SINGLE TESTING CONTRACTOR
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 194
____________________________________________________________________________

  2300 SPRINGDALE DRIVE
  CAMDEN, SC 29020 - 7004


  2)Add all state code for locality codes and use same Effective
    Date that is currently used for 18003.

  3) Enter 'Y' to the CWF Site ID field on the Contractor file.

  4) Enter 'D' for Type of Service on the Contractor file.

  5) Enter 'H' for Primary HOST ID on the Contractor file.

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:          _25562___________    WORK TYPE:   ___   Incidental
  SUBSYSTEM:   _________________                 _X_   Minor
  FUNCTION:    _________________                 ___   Major
  PROGRAM:     _________________                 ___   New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                 Kathy Woytan
      Telephone:           410-786-4982
      FAX, CMS:            410-786-0271
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     Karen Chaffin
      Telephone:           469-372-0645
      FAX,Richardson,TX:   469-372-0284
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       Gopal Kumar
       Telephone:          443-436-6733
       FAX,Baltimore,MD:   443-436-3803
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *              blank line is found.                               *
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 195
____________________________________________________________________________

  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (X) Host
  ( ) Satellite Part A Inpatient
  ( ) Satellite Part A Outpatient
  ( ) Satellite Part B
  ( ) Hospice
  ( ) Home Health
  (X) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  This is a request to implement a new DMEMAC contractor number
  for use by the Single-Testing Contractor (STC) in Medicare
  fee-for-service integrated systems testing.

  CWF shall add new Contractor number '44410' for DMEMAC Systems
  integrated testing with the following name and address:

  Palmetto GBA
  Single Testing Contractor
  2300 Springdale Drive
  Camden, SC 29020-7004

  All state code for locality codes and Effective Date currently
  used for Contractor '18003' shall be added to Contractor '44410'.

  CWF Site ID on the contractor file shall be 'Y'(Contractor is a
  CWF Processor).

  Type of Service on the contractor file shall be 'D' (DME).

  Primary Host ID on the contractor file shall be 'H' (Southeast).

  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 196
____________________________________________________________________________


  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

    NEW BUSINESS REQUIREMENTS:

  Requirement 1
  CWF must add new Contractor number '44410' to the CONT table
  in HIMR with the following name and address:

  Palmetto GBA
  Single Testing Contractor
  2300 Springdale Drive
  Camden, SC 29020-7004

  Requirement 2
  CWF must add the state code for locality codes and Effective
  Date currently used for Contractor '18003' to the new Contractor
  '44410'. The Effective From Date shall be 01/01/2000 through
  Present. The state codes for locality codes shall be as below:

  'AK'   'AL'   'AR'   'AS'   'AZ'   'CA'   'CO'   'CT'   'DC'   'DE'   'FL'   'FM'
  'GA'   'GU'   'HI'   'IA'   'ID'   'IL'   'IN'   'KS'   'KY'   'LA'   'MA'   'MD'
  'ME'   'MH'   'MI'   'MN'   'MO'   'MP'   'MS'   'MT'   'NC'   'ND'   'NE'   'NH'
  'NJ'   'NM'   'NV'   'NY'   'OH'   'OK'   'OR'   'PA'   'PR'   'PW'   'RI'   'SC'
  'SD'   'TN'   'TX'   'UT'   'VA'   'VI'   'VT'   'WA'   'WI'   'WV'   'WY'

  Requirement 3
  The CWF Site ID field on the Contractor file shall be 'Y'
  (Contractor is a CWF processor).

  Requirement 4
  The Type of Service on the Contractor file shall be 'D' (DME).

  Requirement 5
  The Primary Host ID on the Contractor file shall be 'H'(Southeast).


______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 197
____________________________________________________________________________

 ***.......This is the width of the Release Document.......***


 The Event-Response List provides a description of the way
 that the system should function AFTER the change.

 *******************************************************************
 * If you want the EVENT-RESPONSES printed in the release document *
 * remove the word "None" and delete the delimiter line. Number    *
 * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
 * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
 *******************************************************************
   EVENT-RESPONSE LIST:
 ***.......This is the width of the Release Document.......***

 Event 1.1
 Access the CONT file in HIMR for new Contractor '44410'.

 Response
 The new contractor number '44410' has been added with the
 following name and address:

 Palmetto GBA
 Single Testing Contractor
 2300 Springdale Drive
 Camden, SC 29020-7004

 Event 1.2
 Submit an HUDC record using Contractor number '44410'.

 Response
 The record is accepted.

 Event 2.1
 Access the CONT file in HIMR for new Contractor '44410'.

 Response
 The Effective Date and state code for locality codes have
 been copied from contractor '18003'. The Effective From
 Date is 01/01/2000 through Present. The state code for
 locality codes are as below:

  'AK' 'AL' 'AR' 'AS' 'AZ' 'CA' 'CO' 'CT' 'DC' 'DE' 'FL' 'FM'
  'GA' 'GU' 'HI' 'IA' 'ID' 'IL' 'IN' 'KS' 'KY' 'LA' 'MA' 'MD'
  'ME' 'MH' 'MI' 'MN' 'MO' 'MP' 'MS' 'MT' 'NC' 'ND' 'NE' 'NH'
  'NJ' 'NM' 'NV' 'NY' 'OH' 'OK' 'OR' 'PA' 'PR' 'PW' 'RI' 'SC'
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 198
____________________________________________________________________________

  'SD' 'TN' 'TX' 'UT' 'VA' 'VI' 'VT' 'WA' 'WI' 'WV' 'WY'

  Event 3.1
  Access the CONT file in HIMR for new Contractor '44410'.

  Response
  The CWF Site ID field on the Contractor file is correctly
  displaying 'Y'(Contractor is a CWF processor).

  Event 4.1
  Access the CONT file in HIMR for new Contractor '44410'.

  Response
  The Type of Service on the Contractor file is correctly
  displaying 'D'(DME).

  Event 5.1
  Access the CONT file in HIMR for new Contractor '44410'.

  Response
  The Primary Host ID on the Contractor file is correctly
  displaying 'H'(Southeast).


  ***.......This is the width of the Release Document.......***

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

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1. Contractor Table

  Solution Criteria: N/A

    EDITS AFFECTED: None
  ***.......This is the width of the Release Document......***

  a. Error Code:    XXXX   ( )New ( )Modified ( )Deleted
  Disposition:

  Type of Record:

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 199
____________________________________________________________________________

  Error Message:

  Set Condition for edit '####':

  Trailer Information:


  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  Contractor:
    Author: DIAZ, HENRY
   Date: 06/11/2007
   Subject: Re: CWF Comments

     The first 750 characters of the comment are the following:
  That is the correct address.


  Contractor:
    Author: DIAZ, HENRY
   Date: 06/11/2007
   Subject: Re: CWF Comments

     The first 750 characters of the comment are the following:
  Yes all the state codes should be added for Locality codes on the contra
  Also the effective date for the 44410 contractor number should be the sa
  is currently being used for 18003.

  -----



  Contractor:
    Author: SOMMERS, VICKI
   Date: 05/23/2007
   Subject: CWF Comments

     The first 750 characters of the comment are the following:
  Please verify the following to update CWF:
   1) Is the correct name and address for 44410:
    PALMETTO GBA
   SINGLE TESTING CONTRACTOR
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 200
____________________________________________________________________________

   2300 SPRINGDALE DRIVE
   CAMDEN, SC 29020 - 7004

    2) Should all the state codes be added for Locality Codes on the Contr
  file and what should be the effective date?



  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 201
____________________________________________________________________________


  17. 00025564     5653-CLARIFICATION OF SNF BILLING REQS FOR BENE ON MA PLANS

  DATE ENTERED:    05/29/07

  TITLE:           5653-CLARIFICATION OF SNF BILLING REQS FOR BENE ON MA PLANS

  PROJECT CODE:    CM01

  PRIORITY:        1

  RELEASE LEVEL: R2008100

  GROUP LEVEL:     1

  HOST SITE ID:    CWFM2000

  STATUS ON CR:    REQS

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   2
  EST. HOURS:      0125
  ACT. HOURS:      0101
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
    This instruction manualizes SNF billing requirements for
    beneficiaries that are enrolled in MA plans. Previous
    billing instructions were provided in the Prospective Payment
    System and Consolidated Billing Update for SNFs manual
    originally created in 2001.   SNF and Swing Bed (SB) providers
    must submit covered claims with the condition code 04
    (information only bill) for beneficiaries enrolled in MA
    plans and receiving skilled care in order to take benefit
    days from the beneficiary and/or update the beneficiary's
    spell of illness in the Common Working File (CWF).
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 202
____________________________________________________________________________


       In addition, system changes are being made to allow the Fiscal
       Intermediary Standard System (FISS) hospital qualifying stay
       edits to be overridden by contractors. This change is necessary
       in case of a disaster or emergency-related situation, or some
       other circumstance indicated by CMS, which requires special
       processing instructions.

       CWF REQS:

       1) Medicare systems shall disable the SNF prior hospital qualifying
       stay edits for 18x or 21x bill type.
       The edits are 33#3 and 9904.

       2) CWF will also bypass Utilization edits '5233' and '5234' to
       no longer set for TOB '18x' or '21x' if Condition Code '04'
       (Information Only Bill) is present. This will include logic
       when HHMO overlay is received for a Beneficiary to no longer
       generate an IUR for TOB '18x' or '21x' when Condition Code
       '04' is present.

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:              _25564___________   WORK TYPE:   ___ Incidental
  SUBSYSTEM:       _________________                ___ Minor
  FUNCTION:        _________________                _X__Major
  PROGRAM:         _________________                ___ New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                    Kathy Woytan
      Telephone:              410-786-4982
      FAX, CMS:               410-786-0271
      Responsibilities:       REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:        Karen Chaffin
      Telephone:              469-372-0645
      FAX,Richardson,TX:      469-372-0284
      Responsibilities:       DEFINITION, ANALYSIS, SYSTEM TESTING

  2.  PROG ANALYST:      Liz Hayes
      Telephone:         443-436-6899
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 203
____________________________________________________________________________

     FAX,Baltimore,MD:   443-436-3803
     Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                         TESTING


 *******************************************************************
 * PARAGRAPHS - Start in column 1. The paragraph will end when a *
 *               blank line is found.                              *
 * HEADINGS   - Start in column 2.                                 *
 * FREE-FORMAT- Start in column 3.                                 *
 * Use upper and Lower case.                                       *
 *                                                                 *
 * EDITING    - Please allow 2 spaces after a period and 2 spaces *
 *               after a colon. Try to format as it should appear *
 *               in the Release Document.                          *
 *******************************************************************
   IMPACT:
 (X) Host
 (X) Satellite Part A Inpatient
 ( ) Satellite Part A Outpatient
 ( ) Satellite Part B
 ( ) Hospice
 ( ) Home Health
 ( ) DMERC
 ***.......This is the width of the Release Document.......***

   REASON FOR CHANGE:
 System changes are being made to allow hospital qualifying
 stay edits to be overridden by contractors. This change is
 necessary in case of a disaster or emergency-related
 situation, or some other circumstance indicated by CMS,
 which requires special processing instructions.

 CWF shall disable the SNF prior hospital qualifying stay edits
 for Type of Bill '18X' or '21X'. The edits are '33#3' (the qualifying
 stay requirement is not met) and '9904' (qualifying stay dates
 not present on an initial SNF claim, or Condition Code '16'
 used incorrectly.)

  CWF will also bypass Utilization edits '5233' and '5234' to
  no longer set for TOB '18x' or '21x' if Condition Code '04'
  (information only bill) is present.
  This will include logic when an HHMO overlay
  is received for a Beneficiary to no longer generate a IUR
  for TOB '18x' or '21x' when Condition Code '04'(information only
  bill) is present.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 204
____________________________________________________________________________


  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
  CWF must disable consistency edit '33#3' (the qualifying stay
  requirement is not met) for Type of Bill '18x' and '21x'.

  Requirement 2
  CWF must disable consistency edit '9904' (qualifying stay dates
  not present on an initial SNF claim, or Condition Code '16'
  used incorrectly) for Type of Bill '18x' and '21x'.

  Requirement 3
  CWF will modify Utilization edit '5233' (DOS during risk
  HMO period) to no longer set for TOB '18x' or '21x'
  if Condition Code '04' (information only bill) is present.
  The edit will continue to set for other TOBs and also
  set for TOB '18x' or '21x' if Condition Code '04' (information
  only bill) is not present.

  Requirement 4
  CWF will modify Utilization edit '5234' (DOS during risk
  HMO period) to no longer set for TOB '18x' or '21x'
  if Condition Code '04' (information only bill) is present.
  The edit will continue to set for other TOBs and also
  set for TOB '18x' or '21x' if Condition Code '04' (information
  only bill) is not present.

  Requirement 5
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 205
____________________________________________________________________________

  CWF will modify the IUR (Informational Unsolicited
  Response) logic for '5233' to no longer generate
  for TOB '18x' or '21x' if Condition Code '04' (information only bill)
  is present due to HHMO overlay.

  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  *******************************************************************
  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
  * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
  *******************************************************************
    EVENT-RESPONSE LIST:
  ***.......This is the width of the Release Document.......***

  Event 1.1
  An HUIP claim is entered with Type of Bill '18X' or '21X' with an
  Occurrence Span From/Thru date less than three (3) days or Span
  Code '70' is not present.

  Response
  The claim does not set error code '33#3'.

  Event 2.1
  An HUIP claim is entered with Type of Bill '18X' or '21X' without
  an Occurrence Span Code '70'.

  Response
  The claim does not set error code '9904'.

  Event 3.1
  Submit an HUIP (TOB 18x or 21x) record and the Dates of
  Service are within a MA Plan. The record has
  Condition Code '04' present. The Beneficiary has a risk
  HMO period and the Option Code is 'A', 'B', or 'C'.

  Response
  The record does not set UR '5233' edit.

  Event 3.2
  Submit an HUIP (TOB 18x or 21x) record and the Dates of
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 206
____________________________________________________________________________

  Service are within a MA Plan. The record does not have
  Condition Code '04' present. The Beneficiary has a risk
  HMO period and the Option Code is 'A', 'B', or 'C'.

  Response
  The record does set UR '5233' edit.

  Event 4.1
  Submit an HUIP (TOB 18x or 21x) record and the Dates of
  Service are within a MA Plan. The record has
  Condition Code '04' present. The Beneficiary has a risk
  HMO period and the Option Code is 'A', 'B', or 'C'.

  Response
  The record does not set UR '5234' edit.

  Event 4.2
  Submit an HUIP (TOB 18x or 21x) record and the Dates of
  Service are within a MA Plan. The record does not have
  Condition Code '04' present. The HMO Pay Code on the
  HUIP is a '1'. The Beneficiary has a risk HMO period
  and the Option Code is 'A', 'B', or 'C'.

  Response
  The record does set UR '5234' edit.

  Event 5.1
  Submit an HHMO overlay with a MA Plan and the
  Beneficiary has in history a Fee for Service claim
  for TOB '18x' or '21x' with Condition Code '04'
  present.

  Response
  The IUR (Informational Unsolicited Response for '5233'
  is not generated.

  Event 5.2
  Submit an HHMO overlay with a MA Plan and the
  Beneficiary has in history a Fee for Service claim
  for TOB '18x' or '21x' with no Condition Code '04'
  present.

  Response
  The IUR (Informational Unsolicited Response) for '5233'
  is generated.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 207
____________________________________________________________________________

  ***.......This is the width of the Release Document.......***

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

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1. Part A Consistency Module    HUIPCED
    2. Part A Utilization Module    HUIPCUT
    3. HABBHHMO Module

  Solution Criteria: N/A

    EDITS AFFECTED:
  ***.......This is the width of the Release Document......***

  a. Error Code:    33#3   ( )New (X)Modified ( )Deleted
  Disposition: ER

  Type of Record: SNF

  Error Message:
  The qualifying stay requirement is not met (two-day stay
  requirement when the prior stay was in the RPCH; three-day
  stay requirement for all other prior stays).

  Set Condition for edit '33#3': Under Development
  When the qualifying stay requirement is not met (two-day
  stay requirement when the prior stay was in an RPHC; three
  day stay requirement for all other prior stays), set '33#3'
  error code.

  When the bill type '18x', '21x', '28x', or '51x' and
  Condition Code 'W0' is present, bypass this edit.

  When the Dates of Service are between 01/01/1989 and
  12/31/1989, and the From Date is greater than the Admit
  Date, bypass this edit.
  When the No-Pay Code is present, bypass this edit.

  When Condition Code '58' is present, bypass this edit

  When the Action Code is '4', bypass this edit.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 208
____________________________________________________________________________


  When the Occurrence Span Code is not equal to '70', bypass
  this edit.

  When the Inpatient span Thru Date is not greater than the
  Inpatient span From Date, and the Inpatient stay From Date
  is greater than the Admission Date, bypass this edit.

  When   the Inpatient Source of Admission Code is equal to an
  'A',   and the total qualifying span Thru Date is greater
  than   the total qualifying span From Date plus one, bypass
  this   edit.

  When the total qualifying span Thru Date is not greater
  than the total qualifying span From Date plus two, and the
  Inpatient stay From Date is greater than the Inpatient
  Admission Date, bypass this edit.

  When Span Code '70' is present, the total qualifying stay
  is less than 3 days and the Beneficiary has a Condition
  Code '58' present, bypass this edit.

  When the bill type '18x', '21x', bypass this edit.

  Trailer Information: 08


  b. Error Code: 9904     ( )New (X)Modified ( )Deleted
  Disposition: ER

  Type of Record: SNF

  Error Message:
  Qualifying Stay Dates not present on an initial SNF claim,
  or Condition Code '16' used incorrectly.

  Set Condition for edit '9904': Under Development
  When the initial SNF claim's span From Date is equal to
  zeros, and the span Thru Date is equal to zeros, set the
  '9904' error code.

  When the Type of Bill is '185', '215', or '285', bypass
  this edit.

  When the bill type is equal to '18x, '21x', '28x', or '51x',
  and Condition Code 'W0' is present, bypass this edit.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 209
____________________________________________________________________________


  When Condition Code '58' is present, bypass this edit.

  When positions 3-6 of the Medicare Provider Number are
  greater than '6989' and less than '7000', bypass this edit.

  When the Inpatient Hospital Transfer Code is greater than
  '0' and less than '4', bypass this edit.

  When the Stay From year is greater than 1989, and the Stay
  Thru year is greater than 1989, and if the Inpatient
  Admission Date is greater than 12/31/1989, and if the
  Inpatient Stay From Date is greater than the Inpatient
  Admission Date, bypass this edit.

  When   the Stay From year is less than 1989, and the Stay
  Thru   year is less than 1989, and the Inpatient Stay From
  Date   is greater than the Inpatient Admission Date, bypass
  this   edit.

  When the Inpatient Non-payment Code is equal to 'B', 'C',
  'N', 'P', or 'R', bypass this edit.

  When the Stay From year is equal to 1989, bypass this edit.

  When the bill type '18x', '21x', bypass this edit.

  Trailer Information: 08

  c. Error Code:     5233   ( )New (X)Modified ( )Deleted
  Disposition: UR

  Type of Record: SNF

  Error Message:
   For PPS claims, and claims with Provider Numbers beginning
   with '210', the Admission Date falls within a risk GHO Paid
   period, but no GHO Paid Code or Condition Code '69', is
   indicated on the claim.

   OR

   For Non-PPS claims, and SNF claims, the Statement Dates fall
   within, or overlap a risk GHO period, but no GHO Paid Code or
   Condition code '69' is indicated on the claim.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 210
____________________________________________________________________________

  Set Condition for edit '5233': Under Development
   For Inpatient claims that have the following criteria:

        The claim falls within a risk GHO period,

        The GHO Pay Code equals zero with no Condition Code '69'
        present,

        The Admission Date and Service Dates are all equal.

        The utilized days equals zero.

        A No-Pay Code is absent.

   Services fall within, or overlap, a risk GHO period, but no
   GHO Paid Code is indicated on the claim.

   A RNHCO Notice of Election (41A), and the Admission Date falls
   within, or overlaps, a risk GHO period.

  A MCCD Notice of Election (89A), and the From Date falls
  within, or overlaps, a risk GHO period.

  Hospital, SNF, OUTP
  For PPS Claims, Non-PPS Inpatient claims, SNF claims, and
  claims with Provider Numbers beginning with '210', the
  Admission Dates fall within, or overlap, a risk GHO period,
  but no GHO Paid Code, or Condition Code '69', is indicated on
  the claim, set the '5233' error code.

  If a claim's Dates of Service are within a GHO period, and the
  Beneficiary Hospice Indicator equals zero, and the claim GHO
  Paid Code equals '0', and the Bene is not a SNF CHOICES Bene,
  set the '5233' error code.

  When Outpatient claim Dates of Service fall within a GHO
  Period with option code 'C', set the '5233' error code.
  When the claim's Dates of Service fall within or overlap a GHO
  period, and the claim Thru Date is less than the Hospice Start
  Date, the claim GHO Paid Code equals zero, the Bene is not a
  SNF CHOICES Bene, and the Claim is not an IME/GME (Condition
  Code '69' present), set the '5233' error code.

  When the claim's Dates of Service fall within or overlap a GHO
  period, and the claim Thru Date equals the Hospice Start Date,
  the Patient status is not equal to '30', the claim GHO Paid
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 211
____________________________________________________________________________

  Code equals zero, and the Bene is not a SNF CHOICES Bene, and
  the claim is not an IME/GME (Condition Code '69' present), set
  the '5233' error code.

  When the claim's Dates of Service fall within or overlap a GHO
  period, and the claim is not an IME/GME (Condition Code '69'
  present), and the claim From Date is equal to the current
  Hospice Term Date, and the Hospice Revocation Indicator is
  other than zero, and if the claim From Date is greater than,
  or equal to, the Hospice term month plus one, the claim GHO
  Paid Code equals zero, and the Bene is not a SNF CHOICES Bene,
  set the '5233' error code.

  When the claim's Dates of Service fall within or overlap a GHO
  period, and the claim is not an IME/GME (Condition Code '69'
  present), and the claim From Date is greater than the current
  Hospice Term Date, the next Hospice Start Date is greater than
  zero, and the claim Thru Date is less than the next Hospice
  Start Date, and if the claim Thru Date is greater than, or
  equal to, the Hospice term month plus one, the claim GHO Paid
  Code equals zero, and the Bene is not a SNF CHOICES Bene, set
  the '5233' error code.

   When the claim's Dates of Service fall within or overlap a GHO
   period, and the claim is not an IME/GME (Condition Code '69'
   present), the claim From Date is greater than the current
   Hospice Term Date, and the Hospice Revocation Indicator is
   other than zero, and if the claim From Date is greater than,
   or equal to, the Hospice term month plus one, the claim GHO
   Paid Code equals zero, and the Bene is not a SNF CHOICES Bene
   is not true, set the '5233' error code.

   When the Demonstration Project Number is equal to '30', bypass
   this edit.

   When the GHO option equals '1' or '2', bypass this edit.

   When the Detail Override Edit Table is '5233', bypass this
   edit.
   When the GHO option is not equal to 'C', and bytes two through
   five of the GHO ID equal '2603' or '5001', or the claim From
   Date is less than '88092', bypass this edit.

  When claim Util. days are equal to zero, and any of the
  following are true, bypass this edit:

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 212
____________________________________________________________________________

          Claim Admit Date is not equal to the claim From Date,

          Claim Admit Date is not equal to the claim Thru Date,

          Claim No-Pay Code is not equal to spaces.

  When the claim DRG equals '103' or '495', and the claim Admit
  Date is less than, or equal to, '95365', bypass this edit.

  When the Type of Bill '11x', if the DRG equals '380', or if
  Procedure Codes '6901', '6951', or '7491' are present for DRG
  '381'. When Condition Code 'A7' or 'A8' is present, for a PP
  Provider with Admit Date 10/01/1998, or later, and a Non-PPS
  Provider with Date of Service 10/01/1998, or later, bypass
  this edit.

  When the Beneficiary Hospice Indicator equals '0' or '2', and
  claim GHO Paid Code does not equal zero, bypass this edit.

  When the Clinical Trial claim has a Condition Code '30' with
  Dates of Service 09/19/2000 and after for Outpatient and Date
  of Discharge 09/19/2000 and after for Inpatient, bypass this
  edit.

  When the claim has a Pat Stat '30', a Condition Code '78',
  Condition Code '65' is not present, and the claim STA-THU-DATE
  is greater or equal to 10012003, bypass this edit.

  NOTE:    For a Clinical Trial Inpatient claim with Pat Stat '30'
           STA-FRM-DATE needs to be used for the Discharge Date.

  When the claim has a Condition Code '78' with Dates of Service
  are between 10/01/2003 and 12/31/2004 for Outpatient and Date
  of Discharge are between 10/01/2003 and 12/31/2004 for
  Inpatient, bypass this edit.

  Hospital, SNF, OUTP
  For PPS Claims, Non-PPS Inpatient claims, SNF claims, and
  claims with Provider Numbers beginning with '210', the
  Admission Dates fall within, or overlap, a risk GHO period,
  but no GHO Paid Code, or Condition Code '69', is indicated on
  the claim, set the '5233' error code.

  If a claim's Dates of Service are within a GHO period, and the
  Beneficiary Hospice Indicator equals zero, and the claim GHO
  Paid Code equals '0', and the Bene is not a SNF CHOICES Bene,
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 213
____________________________________________________________________________

  set the '5233' error code.

  When Outpatient claim Dates of Service fall within a GHO
  Period with option code 'C', set '5233' error code.

  When the claim's Dates of Service fall within or overlap a GHO
  period, and the claim is not an IME/GME (Condition Code '69'
  present), and the claim From Date is equal to the current
  Hospice Term Date, and the Hospice Revocation Indicator is
  other than zero, and if the claim From Date is greater than,
  or equal to, the Hospice term month plus one, the claim GHO
  Paid Code equals zero, and the Bene is not a SNF CHOICES Bene,
  set the '5233' error code.
  When the claim's Dates of Service fall within or overlap a GHO
  period, and the claim is not an IME/GME (Condition Code '69'
  present), the claim From Date is greater than the current
  Hospice Term Date, and the Hospice Revocation Indicator is
  other than zero, and if the claim From Date is greater than,
  or equal to, the Hospice term month plus one, the claim GHO
  Paid Code equals zero, and the Bene is not a SNF CHOICES Bene
  is not true, set the '5233' error code.

  When the Demonstration Project Number is equal to '30', bypass
  this edit.

  When the GHO option equals '1' or '2', bypass this edit.

  When the HMO Overrode Code is '1', bypass this edit.

  When the GHO option is not equal to 'C', and bytes two through
  five of the GHO ID equal '2603' or '5001', or the claim From
  Date is less than '88092', bypass this edit.

  When claim Util. days are equal to zero, and any of the
  following are true, bypass this edit:

        Claim Admit Date is not equal to the claim From Date,

        Claim Admit Date is not equal to the claim Thru Date,

        Claim No-Pay Code is not equal to spaces.

  When the claim DRG equals '103' or '495', and the claim Admit
  Date is less than, or equal to, '95365', bypass this edit.

  When the Type of Bill '11x', if the DRG equals '380', or if
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 214
____________________________________________________________________________

  Procedure Codes '6901', '6951', or '7491' are present for DRG
  '381'. When Condition Code 'A7' or 'A8' is present, for a PPS
  Provider with Admit Date 10/01/1998, or later, and a Non-PPS
  Provider with Date of Service 10/01/1998, or later, bypass
  this edit.

  When the Beneficiary Hospice Indicator equals '0' or '2', and
  claim GHO Paid Code does not equal zero, bypass this edit.

  When the Clinical Trial claim has a Condition Code '30' with
  Dates of Service 09/19/2000 and after for Outpatient and Date
  of Discharge 09/19/2000 and after for Inpatient, bypass this
  edit.

  NOTE: For a Clinical Trial Inpatient claim with Pat Stat '30'
        STA-FRM-DATE needs to be used for the Discharge Date.

  When the claim has a Condition Code '78' with Dates of Service
  on or after 10/01/2003 for Outpatient and Date of Discharge on
  or after 10/01/2003 for Inpatient, bypass this edit.

  When the HMO Option Code is '4', bypass this edit.

  When an Inpatient claim for a Beneficiary that is in a Risk
  Management Plan has a Condition Code of '78' and
  the Dates of Service are on or after 01/01/2006 and the
  ICD-9 code is '37.94', set the '5233' error code.

  When an Inpatient claim has a Condition Code of '78' and
  the Dates of Service are on or after 01/01/2005 and the
  ICD-9 codes are '37.66' or '32.22', set the '5233' error code.

  When an Inpatient claim has a Condition Code '78' and the
  Dates of Service are between 10/01/2003 and 12/31/2004,
  bypass this edit.

  When an Inpatient claim has a Condition Code '78' and
  either of the ICD-9 codes of '37.66' or '32.22' are not
  present, bypass this edit.

  HHA, OUTP
  Services fall within, or overlap, a risk GHO period, but no
  GHO Paid Code is indicated on the claim, set the '5233' error
  code.

  When the Beneficiary Hospice Indicator is equal to '0' or '2',
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 215
____________________________________________________________________________

  and the GHO Paid Indicator is equal to zero, set the '5233'
  error code.

  When the GHO Paid Indicator is equal to zero, the GHO Option
  Code of the first GHO period is equal to 'C', the claim
  service Thru Date is greater than, or equal to, the Start Date
  of the first GHO period, and the claim service Thru Date is
  less than, or equal to, the Termination Date of the first GHO
  period, set the '5233' error code.

  When the GHO Paid Indicator is equal to zero, the GHO Option
  Code of the first GHO period is equal to 'C', the Termination
  Date of the first GHO period is equal to zero, and the claim
  Service Thru Date is greater than, or equal to, the Start Date
  of the first GHO period, set the '5233' error code.

  When the GHO Paid Indicator is equal to zero, the GHO Option
  Code of the second GHO period is equal to 'C', the claim
  service Thru Date is greater than, or equal to, the Start Date
  of the second GHO period, and the claim service Thru Date is
  less than, or equal to, the Termination Date of the second GHO
  period, set the '5233' error code.

  When the GHO Paid Indicator is equal to zero, the GHO Option
  Code of the second GHO period is equal to 'C', the claim
  service From Date is less than, or equal to, the Termination
  Date of the second GHO period, and the claim service Thru Date
  is greater than, or equal to, the Termination Date of the
  second GHO period, set the '5233' error code.

  When incoming Home Health PPS is a RAP '3x2', bypass this
  edit.

  When Lung Volume Reduction Demonstration number (Demonstration
  Number '30') is present, bypass this edit.

  When Outpatient Encounter Claims (Demonstration Number '38')
  is present, bypass this edit.

  When Type of Bill '13x', '83x', or '85x', or if one of the
  following CPT codes are present with a 'G7' Modifier: '59840',
  '59841', '59850', '59851', '59852', '59855', '59856', '59857',
  or '59866', with Date of Service 10/01/1998, or later, bypass
  this edit.

  When Non-Payment Code 'B' or 'N' is present on an incoming
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 216
____________________________________________________________________________

  Part A claim, bypass this edit.

  When the claim is a Hospice claim, bypass this edit.
  When the Outpatient claim is not within a GHO period, bypass
  this edit.

  When the header Override Code Table has '5233' present,
  bypass this edit.

  When the Non-Payment Code 'N', bypass this edit.

  When the GHO Paid Code is equal to '1', and the service From
  Date is greater than '86000', and the Group Health
  Organization (GHO) Option Code from the first period is not
  equal to 'A', 'B', or 'C', bypass this edit.

  When the GHO Paid Code is equal to '1' and the service From
  Date is not greater than '86000', and the GHO Option Code from
  the first period is not equal to 'C', bypass this edit.
  When the GHO Paid Code is equal to '1' and the GHO Option Code
  from the first period is not equal to 'A', 'B', or 'C', bypass
  this edit.


  When the GHO Paid Code is equal to '1', the GHO Option Code
  from the first period is not equal to 'C', and positions two
  through five of the GHO plan number are equal to '2603' or
  '5001', bypass this edit.

  When the GHO Paid Code is equal to '1', the GHO Code from the
  first period is not equal to 'C', positions two through five
  of the GHO plan number are not equal to '2603' or '5001', and
  the service From Date is less than '88092', bypass this edit.

  When the GHO Paid Code is equal to '1', and the service From
  Date is greater than '86000', and the GHO Option Code from the
  second period is not equal to 'A', 'B', or 'C', bypass this
  edit.

  When the GHO Paid Code is equal to '2' and the GHO Option Code
  from the second period is not equal to 'A', 'B', or 'C',
  bypass this edit.

  When the GHO Paid Code is equal to '2' and the service From
  Date is not greater than '86000', and the GHO Option Code from
  the second period is not equal to 'C', bypass this edit.
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 217
____________________________________________________________________________


  When the GHO Paid Code is equal to '2', the GHO Option Code
  from the second period is not equal to 'C', and position two
  through five of the GHO plan number are equal to '2603' or
  '5001', bypass this edit.

  When the GHO Paid Code is equal to '2', the GHO Option Code
  from the second period is not equal to 'C', position two
  through five of the GHO plan number are not equal to '2603' or
  '5001', bypass this edit.


  When the GHO Paid Code is equal to '2', the GHO Option Code
  from the second period is not equal to 'C', position two
  through five of the GHO plan number are not equal to '2603' or
  '5001', and the service From Date is less than '88092', bypass
  this edit.

  When the GHO is CHOICES and the Beneficiary Hospice Indicator
  is equal to '0' or '2', bypass this edit.

  OUTP
  When the Outpatient stay Thru Date is less than, or equal to,
  Indicator is equal to zero, set the '5233' error code.

  When the Outpatient stay From Date is equal to the Termination
  Date for the first, second, third, or fourth Hospice period,
  the Hospice Revocation Indicator for the Hospice period is
  other than zero, the service From Date is greater than, or
  equal to, the date of the first day of the month following the
  Termination Date for the Hospice period, and the GHO Paid
  Indicator is equal to zero, set the '5233' error code.

  When the Outpatient service From Date is greater than the
  Termination Date for the first, second, or third Hospice
  period, the Start Date for the first, second or third Hospice
  period is greater than zeros, the Outpatient service Thru Date
  is less than the Start Date for the first, second or third
  Hospice period, the Outpatient service Thru Date is not less
  than the date of the first day of the month after the
  Termination Date for the first, second or third Hospice
  period, and the GHO Paid Indicator equals zero, set the '5233'
  error code.


  When the Outpatient service From Date is greater than the
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 218
____________________________________________________________________________

  Termination Date for the first, second or third Hospice
  period, the Start Date for the second or third or fourth
  Hospice period is greater than zeros, the Outpatient service
  Thru Date is less than the Start Date for the second, third or
  fourth Hospice period, the Outpatient service Thru Date is not
  less than the date of the first day of the month following the
  Termination Date for the first, second or third Hospice
  period, and the GHO Paid Indicator is equal to zero, set the
  '5233' error code.

  When the Outpatient service From Date is greater than the
  Termination Date for the first, second or third Hospice
  period, the Hospice Revocation Indicator for the first, second
  or third Hospice period is other than zero the service From
  Date is greater than, or equal to, the first day of the month
  following the Termination Date for the first, second or third
  Hospice period, and the GHO Paid Indicator is equal to zero,
  set the '5233' error code.


  FOURTH HOSPICE PERIOD ONLY:
  When the Outpatient service Thru Date is greater than the
  Start Date for the fourth Hospice period, the Outpatient
  service From Date is greater than, or equal to, the
  Termination Date for the fourth Hospice period, the Hospice
  Revocation Indicator for the fourth Hospice period is other
  than zero, the stay From Date is greater than, or equal to,
  the first day of the month following the Termination Date for
  the fourth Hospice period, and the GHO Paid Indicator is equal
  to zero, set the '5233' error code.

  When an Outpatient claim for a Beneficiary that is in a Risk
  Management Plan has a Condition Code '78' and the Dates
  of Service are on or after 01/01/2006 and the HCPCS codes are
  'G0297', 'G0298', 'G0299', or 'G0300', set the '5233' error
  code.

  When Outpatient claim has a Condition Code '78' and the Dates
  of Service are on or after 01/01/2005 and the HCPCS codes are
  'G0302', 'G0303', 'G0304', or 'G0305', set the '5233' error
  code.

  When an Outpatient claim has a Condition Code '78' and one
  of the HCPCS codes are not 'G0302', 'G0303', 'G0304', or
  'G0305', bypass this edit.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 219
____________________________________________________________________________

  When an Outpatient claim has TOB '73' and the Revenue Code is
  '0519' and Dates of Service on or after 01/01/2006 but will
  apply to a claim that processes on or after 04/03/2006, bypass
  this edit.

  Trailer Information: 05, 08

  d. Error Code:    5234   ( )New (X)Modified ( )Deleted
  Disposition: UR

  Type of Record: SNF

  Error Message:
  Beneficiary Master Record with GHO data and incoming claim
  record is missing GHO Identification Number. (Error does not
  apply to GHO option one.)

  Set Condition for edit '5234': Under Development

  When the claim Dates of Service are within or overlapping a
  GHO period and the claim DRG equals '103' or '495', the claim

  Admit Date is greater than '95365', and the claim GHO ID
  equals spaces, set the '5234' error code.

  When the claim Dates of Service are within or overlapping a
  GHO period, and the claim GHO ID equals spaces, set the '5234'
  error code.

  When an Inpatient claim for a Beneficiary that is in a Risk
  Management Plan has a Condition Code of '78' and
  the Dates of Service are on or after 01/01/2006 and the
  ICD-9 code is '37.94', set the '5234' error code.

  When an Inpatient claim has a Condition Code of '78' and
  the Dates of Service are on or after 10/01/2005 and the
  ICD-9 codes are '37.66' or '32.22', set the '5234' error code.

  When the Claim Condition Code is equal to '07', bypass this
  edit.

  When claim UTIL days are equal to zero and any of the
  following are true, bypass this edit.

        The claim Admit Date is not equal to the claim From
        Date.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 220
____________________________________________________________________________


       The claim Admit Date is not equal to the claim Thru
       Date.

       The claim No-Pay Code is not equal to spaces.

  When the claim DRG equals '103' or '495' and claim Admit Date
  is less than, or equal to, '95365', bypass this edit.

  When the Type of Bill '11x', if the DRG equals '380', or if
  Procedure Codes '6901', '6951', or '7491' are present for DRG
  '381'. When Condition Code 'A7' or 'A8' is present for a PPS
  Provider with Admit Date 10/01/1998, or later, or a Non-PPS
  Provider with Dates of Service 10/01/1998, or later, bypass
  this edit.

  When Clinical Trial claim has Condition Code '30' with Dates
  of Service 09/19/2000 and after for Outpatient and Date of
  Discharge 09/19/2000 and after for Inpatient, bypass this
  edit.

  NOTE: For a Clinical Trial Inpatient claim with Pat Stat '30'
        STA-FRM-DATE needs to be used for the Discharge Date.

  For CHOICES Demonstration Project, ESRD Managed Care
  Demonstration claims, and Lung Volume Reduction Demonstration
  claims (Demonstration Number '30'), bypass this edit.

  When the Type of Bill '11x', if the DRG equals '380', or if
  Procedure Codes '6901', 6951', or '7491' are present for DRG
  '381'and when Condition Code 'A7' or 'A8' is present for a PPS
  Provider with Admit Date 10/01/1998, or later, and a Non-PPS
  Provider with Dates of Service 10/01/1998, or later, bypass
  this edit.

  When the Type of Bill '13x', '83x', or '85x', if Procedure
  Codes '59840', '59841', '59850', '59851', '59852', '59855',
  '59856', '59857', or '59866' are present with a 'G7' Modifier
  with Dates of Service 10/01/1998, or later, bypass this edit.

  When the claim has a Pet Stat '30', a Condition Code '78',
  Condition Code '65' is not present, and the claim STA-THRU-
  DATE is greater or equal to 10/01/2003, bypass this edit.

  When the claim has a Condition Code '78' with Dates of Service
  are between 10/01/2003 and 12/31/2004 for Outpatient and Date
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 221
____________________________________________________________________________

  of Discharge are between 10/01/2003 and 12/31/2004 for
  Inpatient, bypass this edit.

  When an Inpatient claim has a Condition Code '78' and
  either of the ICD-9 codes are '37.66' or '32.22' are not
  present, bypass this edit.

  When COND-CDE-30-PRESENT for a Clinical Trial claim, bypass
  this edit.

  Note: For a Clinical Trial Inpatient claim with Pat Stat '30'
         STA-FRM-DATE needs to be used for the Discharge Date.

  When the header Edit Override Table has '5233' or '5234'
  present, bypass this edit.

  When the HMO Option Code is '4', bypass this edit.

  HHA, OUTP
  When Condition Code '07' does not exist, and the claim GHO
  plan number for the Beneficiary is equal to spaces, set the
  '5234' error code.

  When an Outpatient claim is submitted without a GHO
  Identification Number, and there is GHO data on the
  Beneficiary's eligibility file record, set the '5234' error
  code.

  When an Outpatient claim for a Beneficiary that is in a Risk
  Management Plan has a Condition Code '78' and the
  Dates of Service are on or after 01/01/2006 and the HCPCS
  codes are 'G0297', 'G0298', 'G0299', or 'G0300', set the
  '5234' error code.

  When an Outpatient claim has a Condition Code '78' and the
  Dates of Service are on or after 01/01/2005 and the HCPCS
  codes are 'G0302', 'G0303', 'G0304', or 'G0305',
  set the '5234' error code.

  When the Non-Payment Code is equal to 'B' or 'N' on an
  incoming Outpatient claim, bypass this edit.

  If the incoming claim is a Hospice claim, bypass this edit.

  When the Demonstration Project Number is equal to '30', bypass
  this edit.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 222
____________________________________________________________________________


  When the header Edit Override Table has '5233' or '5234'
  present, bypass this edit.

  When the Outpatient claim has Non-Payment Code 'N' and the
  header Edit Override Table has '5233' or '5234' present,
  bypass this edit.

  When the Outpatient service From Date is greater than '86000',
  and greater than, or equal to, the Beneficiary GHO first
  period Effective Date, the Beneficiary GHO first period
  Termination Date is not equal to zero, the service From Date
  is greater than the GHO first period Termination Date, and the
  GHO Paid Indicator is not equal to one, bypass this edit.

  When the Outpatient service From Date is greater than '86000',
  and less than the Beneficiary GHO first period Effective Date,
  the service From Date is less than the GHO second period
  Effective Date, or greater than the GHO second period
  Termination Date, and the GHO Paid Indicator is not equal to
  one, bypass this edit.

  When the Outpatient service From Date is greater than the GHO
  first period Termination Date, and the GHO Paid Indicator is
  not equal to one, bypass this edit.

  When the Beneficiary's total number of GHO periods is equal to
  one, and the GHO Paid Indicator is not equal to one, bypass
  this edit.

  When the Type of Bill '13x', '83x', or '85x' if Procedure
  Codes '59840', '59841','59850', '59851', '59852', '59855',
  '59856', '59857', or '59866' are present with a 'G7' Modifier
  with Dates of Service 10/01/1998, or later, bypass this edit.
  When the Outpatient service From Date is equal to the
  Termination Date for the first, second or third Hospice
  period, the Revocation Indicator for the first, second or
  third Hospice period is equal to one, and the service From
  Date is not greater than, or equal to, the date of the first
  day of the month following the Termination Date for the first,
  second or third Hospice period, bypass this edit.

  When the Outpatient service From Date is greater than the
  Termination Date for the first, second or third Hospice
  period, the Start Date for the second, third or fourth Hospice
  period is greater than zeros, and the Outpatient service Thru
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 223
____________________________________________________________________________

 Date is less than the Start Date for the second, third or
 fourth Hospice period and less than the date of the first day
 than zero, and the service From Date is less than the
 Termination Date for the fourth Hospice period, bypass this
 edit.

 When incoming Home Health PPS is a RAP '3x2', bypass this
 edit.

 When the GHO Paid Code is equal to two, and the Beneficiary's
 GHO Option Code for this period is equal to one, bypass this
 edit.

 When Clinical Trial claim has Condition Code '30' with Dates
 of Service 09/19/2000 and after for Outpatient and Date of
 Discharge 09/19/2000 and after for Inpatient, bypass this
 edit.
 NOTE: For a Clinical Trial Inpatient claim with Pat Stat '30'
       STA-FRM-DATE needs to be used for the Discharge Date.

 When the GHO Paid Indicator is not equal to zero, bypass this
 edit.

 When the HMO Option Code is '4', bypass this edit.

 When an Outpatient claim has a Condition Code '78' and one
 of the HCPC codes are not 'G0302', 'G0303', 'G0304', or
 'G0305', bypass this edit.

 When an Outpatient claim has TOB '73' and the Revenue Code is
 '0519' and Dates of Service on or after 01/01/2006 but will
 apply to a claim that processes on or after 04/03/2006, bypass
 this edit.

 Trailer Information: 05, 08

 ***.......This is the width of the Release Document......***

 ISSUE/ANSWERS:
 --------------
   RISK/DESIGN ISSUE:

  -----Original Message-----
  From: Kerr.Jason.D.CMS/CMMjason.kerr@cms.hhs.gov.TBHE
  Sent: Tuesday, October 02, 2007 8:54 AM
  To: Woytan.Kathryn.A.CMS/OISKathryn.Woytan@cms.hhs.gov.TBHE; VICKI.SOMME
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 224
____________________________________________________________________________

 Cc: Tucker.Wendy.S.CMS/CMMWendy.Tucker@cms.hhs.gov.TBHE; Gehne.Wilfried.
 Subject: Clarification for CR 5653 - BR 5653.4

 Good Morning,

 Thank you very much Vicki and Kathy for speaking with me this morning.
 I do apologize for any inconvenience this misunderstanding has caused.

 This message is to clarify the intent of BR 5653.4 "Medicare systems
 (CWF indicated) shall ensure benefit days are deducted and/or the
 beneficiary's spell of illness is updated upon receipt of a covered 21x
 or 18x bill type when a condition code 04 is present"

 CMS would like to clarify requirement 5653.4 by stating CWF should be
 bypassing any MA/HMO edits for 21x and 18x bill types that have
 condition code 04 present on these claims.

 Please let me know if you need further information.

 Thanks again for all your help.

 Jason Kerr
 CMS Division of Institutional Claims Processing
 Phone: (410) 786-2123
 Fax: (410) 786-0330 (shared, send w/ cover)




  Contractor:
   Author: Kerr, Jason
  Date: 05/24/2007
  Subject: Re: CWF Comments

    The first 750 characters of the comment are the following:
 Thank you for commenting.

   Per your comments the following business requirement changes were made

   5653.1 - CWF has been added to this req
  5653.3 - included additional lanaguage 'when a condition code 04 is pre
 to the end of the req.
  5653.4 - CWF has been added to this req.

    Should CWF ensure when condition code 04 is present that the bene is r
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 225
____________________________________________________________________________

  in an MA Plan??

  CMS RESPONSE: The condition code 04(information only bill indicator) may
  used in other circumstances in the future and i do not see the need to v
  the MA plan exists. No reimbursement will be made on the claim by FISS
  the 04 is present.

  I certainly agree with the early involvement call.

  Thanks
  ----

  Contractor:
    Author: SOMMERS, VICKI
   Date: 05/23/2007
   Subject: CWF Comments

     The first 750 characters of the comment are the following:
  CWF currently has two edits to not allow an initial SNF claim for
  TOB 18x and 21x without the qualifying stay. There is no CWF Requirement
   to address this. Also if CWF is to be included in the
  reqs should CWF ensure when Condition Code 04 is present that the
  Beneficiary is enrolled in a MA Plan?
   Should CWF allow the edits being addressed in 5653.4 also be overridden
  CWF is going to request an Early Involvement Call for this CMS CR.



  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 226
____________________________________________________________________________


   18. 00025566     5663-PHASEII IMPLEMENTATION OF CASE MIX REFINEMENT FOR HHPPS

  DATE ENTERED:     06/04/07

  TITLE:            5663-PHASEII IMPLEMENTATION OF CASE MIX REFINEMENT FOR HHPPS

  PROJECT CODE:     CM01

  PRIORITY:         1

  RELEASE LEVEL: R2008100

  GROUP LEVEL:      1

  HOST SITE ID:     CWFM2000

  STATUS ON CR:     WORK

  DOC. REQUIRED: N

  HOST EVAL:        N/A

  DOC RECEIVED:     N

  ADDENDUM INFO: NONE

  EST. CATEGORY:    4
  EST. HOURS:       0750
  ACT. HOURS:       0370
  CAT/CR EVAL:      N

  COMMENT:          N/A

  DESCRIPTION:
  ------------
  Effective Date:       Episodes beginning on or after January 1, 2008

  Final policies will be published in the HH PPS case mix refinement
  final rule in the summer of 2007. However, it is necessary to issue
  this change request to implement the necessary changes as required
  by the HH PPS case mix refinement rule as part of the January 2008
  systems release. The requirements below reflect policies expected
  in the final rule, as nearly as they can be anticipated at this
  time. The proposed changes below apply only to HH PPS claim
  types (types of bill 32x and 33x).
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 227
____________________________________________________________________________


  CMS Requirements are stated below:

  Medicare systems shall accept the new HIPPS codes described
  in attachment one.

  Medicare systems shall ensure that the provider submitted
  HIPPS code on a claim, adjustment accurately reflects the
  position of the episode within a sequence of adjacent HH
  episodes.

  Medicare systems shall define a sequence of adjacent episodes
  as episodes with no more than 60 days between each episode
  end date and the next episode start date.

  Medicare systems shall ensure that claims and adjustments
  submitted with HIPPS containing 1 or 2 in the 1st position
  represent the first or second episode in a sequence.

  Medicare systems shall identify claims and adjustments with
  HIPPS codes misrepresenting first or second episodes for re-coding.

  Medicare systems shall ensure that claims and adjustments
  submitted with HIPPS containing 3 or 4 in the 1st position
  represent the third or later episode in a sequence.

  Medicare systems shall identify claims with HIPPS codes
  misrepresenting third or later episodes for re-coding.

  Medicare systems shall adjust previously paid episodes when
  the receipt of earlier dated episodes changes their position in
  a sequence of episodes.

  Medicare systems shall read the HH episode history when a
  new episode is received and identify any HIPPS codes that
  represent an incorrect position in the sequence.

  Medicare systems shall initiate an automatic adjustment of any
  previously paid episodes identified in requirement 5663.71.

  Medicare systems shall disable any edits and unsolicited response
  processes that validate inpatient stays in the 14 days prior to an
  episode, for episodes beginning on or after January 1, 2008.

  CWF REQS:
  Create two new Utilization edits to ensure the correct
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 228
____________________________________________________________________________

  HIPPS Code is present for the Early and Late Episodes.

  CWF will need to read the HIPPS Code on the Final or
  LUPA Final to determine if correct based on Early (1st
  or 2nd) or the Later (3rd and later) episode.

  This will include creating logic for the two new codes
  for the IUR process also.

  CWF will modify A/B Crossover edits 7273 and 7274 for
  episodes beginning 1/1/2008 and after to no longer set.

  REQUIREMENTS:
  -------------
  10          DEFINITION AND ANALYSIS PHASES

  CR:          _______25566_____     WORK TYPE:   ___   Incidental
  SUBSYSTEM:   _________________                  ___   Minor
  FUNCTION:    _________________                  _X_   Major
  PROGRAM:     _________________                  ___   New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                  Kathy Woytan
      Telephone:            410-786-4982
      FAX, CMS:             410-786-0271
      Responsibilities:     REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:      Vicki Sommers
      Telephone:            469-372-7642
      FAX,Richardson,TX:    469-372-0284
      Responsibilities:     DEFINITION, ANALYSIS, SYSTEM TESTING

       BUSINESS ANALYST:    Ofelia Castillo
       Telephone:           469-372-6492
       FAX,Richardson,TX:   469-372-0284
       Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:        Shailan Mandayam
       Telephone:           443-436-6720
       FAX,Baltimore,MD:    443-436-3803
       Responsibilities:    ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                            TESTING

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 229
____________________________________________________________________________


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *               blank line is found.                              *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (X) Host
  ( ) Satellite Part A Inpatient
  ( ) Satellite Part A Outpatient
  ( ) Satellite Part B
  ( ) Hospice
  (X) Home Health
  ( ) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  Final policies will be published in the HHPPS case mix
  refinement final rule in the summer of 2007. However, it is
  necessary to issue this change request to implement the
  necessary changes as required by the HHPPS case mix refinement
  rule as part of the January 2008 systems release.

  The requirements will reflect policies expected in the final
  rule, as nearly as they can be anticipated at this time and
  are further subject to issuance of the final rule. The
  proposed changes apply only to HHPPS claim types (Type of
  Bill 32x and 33x).

  CWF will be required to create two new utilization edits
  to ensure that the provider submitted HIPPS code on a
  claim reflects the position of the episode within a
  sequence of adjacent episode. CWF will create
  Informational Unsolicited Response for the two codes
  when the receipt of earlier dated episodes changes their
  position in a sequence of episodes.

  CWF will also modify A/B crossover edits '7273' (incorrect
  HIPPS code for RAP) and '7274' (incorrect HIPPS code
  for Final or LUPA) to no longer set for episode beginning
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 230
____________________________________________________________________________

  on or after 01/01/2008.


  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
  CWF will create a new utilization edit '524P' on a Home
  Health Final or LUPA record (Type of Bill 32x or 33x) to
  reject when the first position of the HIPPS codes is
  a '1' or '2' that represents an early HH episode but
  should be a '3' or '4' for a late HH episode.

  The first position of the HIPPS code will be '1', '2', or '5'
  in the early episode.

  The first position of the HIPPS code will be '3', '4', or '5'
  in the late episode.

  (Note: '5' can be in the early or late episode.)

  CWF will read the Beneficiary's Home Health Episodes (HHEH)
  when an incoming HUHH (Final or LUPA) record is received
  to determine if the HIPPS code in the HCPCS field for
  the earliest Revenue Code '0023' is for an early or a
  late Home Health episode.

  If there is a change in the HRG code the HIPPS code can
  be obtained in the HIPPS code field in the detail line
  for Revenue Code '0023'.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 231
____________________________________________________________________________


  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.

  CWF will only apply the new utilization edit '524P' to
  HH episodes beginning on or after 01/01/2008.

  The edit should not apply to RAPS (Type of Bill 322 or 332).

  CWF will return Trailer '08' with the new error code.

  The new edit will be bypassed when:
  - DOS are prior to 01/01/2008.
  - The Non-Payment Denial Code 'B' or 'N' is present.
  - The Action Code is '4' (Cancel Only).
  - If the first position of the HIPPS code equals '5'

  Requirement 2
  CWF will create a new utilization edit '524Q' on a Home
  Health Final or LUPA record (Type of Bill 32x or 33x) to
  reject when the first position of the HIPPS codes is
  a '3' or '4' that represents a late HH episode but
  should be a '1' or '2' for an early HH episode.

  The first position of the HIPPS code will be a '1', '2', or '5'
  in the early episode.

  The first position of the HIPPS code will be a '3', '4', or '5'
  in the late episode.

  (Note: '5' can be in the early or late episode.)

  CWF will read the Beneficiary's Home Health Episodes (HHEH)
  when an incoming HUHH (Final or LUPA) record is received
  to determine if the HIPPS code in the HCPCS field for
  the earliest Revenue Code '0023' is for an early or a
  late Home Health episode.

  If there is a change in the HRG code the HIPPS code can
  be obtained in the HIPPS code field in the detail line
  for Revenue Code '0023'.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 232
____________________________________________________________________________

  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.

  CWF will only apply the new utilization edit '524Q' to
  HH episodes beginning on or after 01/01/2008.

  The edit should not apply to RAPS (Type of Bill 322 or 332).

  CWF will return Trailer '08' with the new error code.

  The new edit will be bypassed when:
  - DOS are prior to 01/01/2008.
  - The Non-Payment Denial Code 'B' or 'N' is present.
  - The Action Code is '4' (Cancel Only).
  - If the first position of the HIPPS code equals '5'

  Requirement 3
  CWF will create a new Informational Unsolicited Response
  (IUR) process for code '524P' on a Home Health claim
  in history for the following:

  If an incoming Home Health record (HUHH) creates or
  updates a HH episode that would change the position in
  a sequence of already posted episodes.

  CWF will determine if the episode that was processed
  as an early episode but now should be for a late HH
  episode and has the DOEBA and DOLBA present.

  This will require an IUR (Informational Unsolicited
  Response) to be generated if the HIPPS code on the
  HH claim has a '1' or '2' in the first position and
  now should represent a late episode.

  The HIPPS code is in the HCPCS field for the earliest
  Revenue Code '0023'. If there is a change in the HRG
  code the HIPPS code can be obtained in the HIPPS code
  field in the detail line for Revenue Code '0023'.

  CWF will read the Home Health Claim History to find
  the applicable dates related to the changed episode
  and generate the IUR '524P' on the Final or LUPA
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 233
____________________________________________________________________________

  Final.

  If the DOEBA and DOLBA are not present, CWF will not
  be required to read claim history.

  The IUR will apply to a Final or LUPA Final (Type of Bill
  32x or 33x).

  An early episode is the 1st and 2nd episode and the late
  episode is the 3rd and later. If no more than 60 days
  between each HH episode's End and Start Date will define
  a sequence of adjacent episodes. If more than 60 days
  between each HH episode will start a new early episode.

  If the first position of the HIPPS code is a '1', '2', or '5'
  this is considered an early episode.

  If the first position of the HIPPS code is a '3', '4', or '5'
  this is considered late episode.

  CWF will only apply the new IUR process for '524P' to
  HH episodes beginning on or after 01/01/2008.

  The IUR generated should not apply to RAPS (Type of Bill
  322 or 332).

  The new IUR will return '01' in the Disposition Code.
  The Trailer 24 Mask will be a 'Y'.
  The following existing Trailers will be returned:
  Trailer 24 with the new code '524P' and the claim
  information.

  The UNSOL IND in HIMR in the claim history for HHAH
  will be a 'Y'.

  The new IUR will not generate when:
  - DOS are prior to 01/01/2008
  - The Non-Payment Denial Code 'B' or 'N' is present.
  - The Home Health claim in history has a cancel
    date greater than zero.
  - If the first position of the HIPPS code equals '5'

  Requirement 4
  CWF will create a new Informational Unsolicited Response
  (IUR) process for code '524Q' on a Home Health claim
  in history for the following:
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 234
____________________________________________________________________________


  If an incoming Home Health record (HUHH) creates or
  updates a HH episode that would change the position in
  a sequence of already posted episodes.

  CWF will determine if the episode that was processed
  as a late episode but now should be for an early episode
  and has the DOEBA and DOLBA present.

  This will require an IUR (Informational Unsolicited
  Response) to be generated if the HIPPS code on the
  claim has a '3' or '4' in the first position and now
  should represent an early episode.

  The HIPPS code is in the HCPCS field for the earliest
  Revenue Code '0023'. If there is a change in the HRG code
  the HIPPS code can be obtained in the HIPPS code field
  in the detail line for Revenue Code '0023'.

  CWF will read the Home Health Claim History to find
  the applicable dates related to the changed episode
  and generate the IUR '524Q' on the Final or LUPA Final.

  If the DOEBA and DOLBA are not present, CWF will not be
  required to read claim history.

  The IUR will apply to a Final or LUPA Final (Type of Bill
  32x or 33x).

  An early episode is the 1st and 2nd episode and the late
  episode is the 3rd and later. If no more than 60 days
  between each HH episode's end and start date will define
  a sequence of adjacent episodes. If more than 60 days
  between each HH episode will start a new early episode.

  If the first position of the HIPPS code is a '1', '2', or '5'
  this is considered an early episode.

  If the first position of the HIPPS code is a '3', '4', or '5'
  this is considered late episode.

  CWF will only apply the new IUR process to '524Q' for
  HH episodes beginning on or after 01/01/2008.

  The IUR generated should not apply to RAPS (Type of Bill
  322 or 332).
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 235
____________________________________________________________________________


  The new IUR will return '01' in the Disposition Code.
  The Trailer '24' Mask will be a 'Z'.
  The following existing Trailers will be returned:
  Trailer '24' with the new code '524Q' and the claim
  information.

  The UNSOL IND in HIMR in the claim history for HHAH
  will be a 'Z'.

  The new IUR will not generate when:
  - DOS are prior to 01/01/2008.
  - The Non-Payment Denial Code 'B' or 'N' is present.
  - The Home Health claim in history has a cancel
    date greater than zero.
  - If the first position of the HIPPS code equals '5'

  Requirement 5
  Modify A/B Crossover edit '7273' (incorrect HIPPS code
  for RAP) to no longer set for an episode beginning on or
  after 01/01/2008.

  Requirement 6
  Modify A/B Crossover edit '7274' (incorrect HIPPS code
  for Final or LUPA) to no longer set for an episode
  beginning on or after 01/01/2008.

  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  *******************************************************************
  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
  * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
  *******************************************************************
    EVENT-RESPONSE LIST:
  ***.......This is the width of the Release Document.......***

  Event 1.1
  Submit a HUHH (Final or LUPA) record where the first position
  of the HIPPS code is a '1' or '2' for Revenue Code '0023'.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 236
____________________________________________________________________________

  The HH 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 HH episode is on or after 01/01/2008 and is within
  60 days of the prior or subsequent episodes.

  Response
  The record does set UR '524P' and returns Trailer '08'.

  Event 1.2
  Submit a HUHH (Final or LUPA) record where the first position
  of the HIPPS code is a '1', '2', or '5' for Revenue Code '0023'.

  The HH episode that applies to the earliest line item
  date for the Revenue Code '0023' will be an early episode
  on the Beneficiary's HHEH Aux File.

  The HH episode is on or after 01/01/2008 and is not
  within 60 days of the prior or subsequent episodes.

  Response
  The record does not set UR '524P' edit.

  Event 2.1
  Submit a HUHH (Final or LUPA) record where the first position
  of the HIPPS code is a '3' or '4' for Revenue Code '0023'.

  The HH episode that applies to the earliest line item
  date for the Revenue Code '0023' will be an early episode
  on the Beneficiary's HHEH Aux File.

  The HH episode is on or after 01/01/2008 and is not
  within 60 days of the prior or subsequent episodes.

  Response
  The record does set UR '524Q' and returns Trailer '08'.

  Event 2.2
  Submit a HUHH (Final or LUPA) record where the first position
  of the HIPPS code is a '3', '4', or '5' for Revenue Code '0023'.

  The HH 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.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 237
____________________________________________________________________________

  The HH episode is on or after 01/01/2008 and is
  within 60 days of the prior or subsequent episodes.

  Response
  The record does not set UR '524Q' edit.

  Event 3.1
  Submit a new RAP or Final LUPA or adjustment to a
  Final or LUPA that will cause a posted early HH episode
  to now be a late HH episode (within 60 days of the
  prior or subsequent episodes).

  The posted early HH episode is on or after 01/01/2008
  and the DOEBA and DOLBA is present which means a Home
  Health Final or LUPA is in history.

  Response
  An IUR response is generated on the Home Heath Final or
  LUPA claim where the HIPPS code is a '1' or '2' in the
  first position and now should be a '3' or '4'.

  The IUR will return a '24' Trailer Mask with a 'Y'.

  The IUR will return Trailer '24' with the code '524P'
  and the claim information.

  The UNSOL IND in HIMR will indicate a 'Y' on the
  HH claim in history.

  Event 4.1
  Submit an adjustment/cancel on a Final or LUPA that
  will cause a prior or subsequent HH episode to now
  be an early HH episode (not within 60 days of
  the prior or subsequent episodes).

  The posted late episode is on or after 01/01/2008
  and the DOEBA and DOLBA is present which means a Home
  Health Final or LUPA is in history with a HIPPS
  code of '3' or '4'.

  Response
  An IUR response is generated on the Home Health Final or
  LUPA claim where the HIPPS code is for a late episode
  and now should be for an early episode.

  The IUR will return a '24' Trailer Mask with a 'Z'.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 238
____________________________________________________________________________


 The IUR will return Trailer '24' with the code '524Q'
 and the claim information.

 The UNSOL IND in HIMR will indicate a 'Z' on the
 HH claim in history.

 Event 5.1
 Submit a RAP (HUHH) and the HIPPS code has a 'K' or 'M' in
 the fourth position for Revenue Code '0023'. The Beneficiary
 has an Inpatient Hospital stay in history and the Thru
 Date is within 14 days of the earliest line item date
 for Revenue Code '0023' of the incoming RAP.

 The HH episode is on or after 01/01/2008.

 Response
 The record does not set CR '7273' edit.

 Event 5.2
 Submit a RAP (HUHH) and the HIPPS code has a 'K' or 'M' in
 the fourth position for Revenue Code '0023'. The Beneficiary
 has an Inpatient Hospital stay in history and the Thru
 Date is within 14 days of the earliest line item date
 for Revenue Code '0023' of the incoming RAP.

 The HH episode is prior to 01/01/2008.

 Response
 The record does set CR '7273' edit.

 Event 6.1
 Submit a Final or LUPA (HUHH) and the HIPPS code has a 'K'
 or 'M' in the fourth position for Revenue Code '0023'.

 The Beneficiary has an Inpatient Hospital stay in history
 and the Thru Date is within 14 days of the earliest line
 item data for Revenue Code '0023' of the incoming Final or
 LUPA claim.

 The HH episode is on or after 01/01/2008.

 Response
 The record does not set CR '7274' edit.

  Event 6.2
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 239
____________________________________________________________________________

  Submit a Final or LUPA (HUHH) and the HIPPS code has a 'K'
  or 'M' in the fourth position for Revenue Code '0023'.

  The Beneficiary has an Inpatient Hospital stay in history
  and the Thru Date is within 14 days of the earliest line
  item data for Revenue Code '0023' of the incoming Final or
  LUPA claim.

  The HH episode is prior to 01/01/2008.

  Response
  The record sets the CR '7274' edit.


  ***.......This is the width of the Release Document.......***

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

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1. Home Health Utilization Module HUOPCUT
    2. IUR Module HHEHUSPL
    3. A/B Crossover Module HIABCCR2

  Solution Criteria: N/A

    EDITS AFFECTED:
  ***.......This is the width of the Release Document......***

  a. Error Code:    524P   (X)New ( )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': Under Development
  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
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 240
____________________________________________________________________________

  to a late episode, set the '524P' error code.

  Note: 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 the HH episode begins prior to 01/01/2008,
  bypass the edit.

  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    (X)New ( )Modified ( )Deleted
  Disposition: UR

  Type of Record: Home Health

  Error Message:
  A Home Health Final or LUPA Final has a HIPPS code that is
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 241
____________________________________________________________________________

  for a late HH episode and should be an early HH episode.

  Set Condition for edit '524Q': Under Development
  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: 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 the HH episode begins prior to 01/01/2008,
  bypass the edit.

  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


  c. Error Code: 7273 ( )New (X)Modified ( )Deleted
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 242
____________________________________________________________________________

  Disposition: CR

  Type of Record: Home Health

  Error Message:
  A RAP has the incorrect HIPPS code and an Inpatient claim is
  in history within '14' days of the start of Home Health
  care.

  Set Condition for edit '7273': Under Development
  When a RAP (3x2) is received and the HIPPS code has a 'K' or
  'M' in the fourth position, CWF is to search for an
  Inpatient claim in history with a through date within '14'
  days of the start of Home Health Care (From Date on the
  RAP). Count '14' days using the day prior to the Home
  Health RAP 'From' date as day one. If the Inpatient claim
  is found and the RAP has a HIPPS code with a 'K' or 'M' in
  the fourth position, set the '7273' error code.

  Note: 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 No-pay code is equal to 'N', bypass this edit.

  When the Inpatient claim (11x) in history is a Rehab where
  the third position of the Provider Number is an 'R' or 'T',
  bypass this edit.

  When the history Inpatient Provider number range is equal to
  '3025-3099', bypass this edit.

  Trailer Information: 08, 13


  d. Error Code:    7274   ( )New (X)Modified ( )Deleted
  Disposition: CR

  Type of Record: Home Health

  Error Message:
  A Home Health Final or LUPA Final has incorrect HIPPS code
  and an Inpatient claim is in history within '14' days of the
  start of Home Health care.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 243
____________________________________________________________________________

  Set Condition for edit '7274': Under Development
  When a HH Final or LUPA is received and the earliest date of
  HIPPS code has a 'K' or 'M' in the fourth position, CWF is
  to search for an Inpatient claim in history with a
  Thru Date within '14' days of the start of Home
  Health Care (From Date on the Final or LUPA) Count '14'
  days using the day prior to the Home Health Final or
  LUPA From Date as day one. If the Inpatient claim
  is found and the Final or LUPA earliest date has a HIPPS
  code with a 'K' or 'M' in the fourth position,
  set the '7274' error code.

  Note: 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 No-pay code is equal to 'N', bypass this edit.

  When the Inpatient claim (11x) in history is a Rehab where
  the third position of the Provider Number is an 'R' or 'T',
  bypass this edit.

  When the history Inpatient Provider Number range is equal to
  '3025-3099', bypass this edit.

  When the detail Edit Override Table has '7274' present,
  bypass this edit.

  Trailer Information: 08, 13


  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

   -----Original Message-----
  From: Gehne.Wilfried.K.CMS/CMMWilfried.Gehne@cms.hhs.gov.TBHE
  Sent: Wednesday, August 15, 2007 9:33 AM
  To: VICKI.SOMMERS; Woytan.Kathryn.A.CMS/OISKathryn.Woytan@cms.hhs.gov.TB
  YOUNG.YVONNE.D.CMS/CMMYVONNE.YOUNG@cms.hhs.gov.TBHE
  Subject: RE: CMS CR 5663 comment for CWF

  Ok, now I understand (I think).   I don't expect this scenario to
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 244
____________________________________________________________________________

 happen.   CWF will reject the claim for the wrong HIPPS code, and then
 FISS will automatically send it back to the HH Pricer to recode it and
 then it will come back to CWF with the right HIPPS code.    I don't see
 any reason why the claim would ever be denied following the CWF reject.



 Wil Gehne
 CMS Division of Institutional Claims Processing
 Phone: (410) 786-6148
 Fax: (410) 786-0330 (Shared, send w/cover)

 From: VICKI.SOMMERS@trailblazerhealth.com
 mailto:VICKI.SOMMERS@trailblazerhealth.com
 Sent: Friday, August 10, 2007 3:34 PM
 To: Gehne, Wilfried K. (CMS/CMM); VICKI.SOMMERS@trailblazerhealth.com;
 Woytan, Kathryn A. (CMS/OIS); YOUNG, YVONNE D. (CMS/CMM)
 Subject: RE: CMS CR 5663 comment for CWF


 I was concerned when CWF creates a HH episodes when Final or LUPA Final
 is denied...
 The issue I have is that if the Final or LUPA FINAL claim rejected
 previously due to an incorrect HIPPS code (submitted as early and should
 be late or submitted as late and should be early) and the RHHI resends
 as denied to CWF. CWF then created the HH episode and the denied claim
 is posted with an incorrect HIPPS Code..
 I wanted to ensure that everyone understood what would occur and not be
 surprised.
 Also that the next claim submitted would read the above denied episode
 to determine the incoming claim's early or late period.

 Vicki

 --------------------------



 From: Gehne.Wilfried.K.CMS/CMMWilfried.Gehne@cms.hhs.gov.TBHE
 Sent: Friday, August 10, 2007 1:13 PM
 To: VICKI.SOMMERS; Woytan.Kathryn.A.CMS/OISKathryn.Woytan@cms.hhs.gov.TB
 YOUNG.YVONNE.D.CMS/CMMYVONNE.YOUNG@cms.hhs.gov.TBHE
 Cc: OFELIA.CASTILLO
 Subject: RE: Question for CMS CR 5663 Phase II Implementation of Case Mi

  Vicki,
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 245
____________________________________________________________________________

  I'm very sorry for the delayed response on this.
  I don't see any need for the Tr 23 information with
  these rejects.   FISS will have a simple process based
  on the reject code itself -- send the record back through
  the Pricer with one or the other
  recoding indicator based on which reject code CWF sends.
  There will no need for the FISS system or staff at the
  satellite to read the Tr 23 information so you don't need
  to send it.

  Wil


  Wil, Yvonne, and Kathy,
  We need assistance on the following when returning the two new
  Utilization edits in a CWF reply.
  Currently if a Final claim is received in CWF, a HH episode is
  already created from the RAP however,
  if a Final LUPA is received no HH episode is created until the
  Final LUPA is accepted.
  For the two new rejects if submitting HIPPS Code for early but
  the HH episode would be late or the other reject
  is where submitting HIPPS Code for late but the HH episode would
  be early, should we send back Trailer 23 (episode information from RAP)
  for Final Claim but not send back Trailer 23 for LUPA since no HH
  episode created?
  There would be no HH episode that applies to the LUPA but would be a HH
  episode that applies to the Final Claim due to previously posted RAP.
  Do we want inconsistent information on the rejects depending on the type
  of Home Health claim?
  How will the information from the Trailer 23 assist the RHHI's in the
  rejects?
  We may need to discuss what information to send back in the two new
  rejects and IURs involving episodes.

  Vicki




  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 246
____________________________________________________________________________

  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 247
____________________________________________________________________________


   19. 00025580    DELETING CORRUPT BENE RECORDS

  DATE ENTERED:    06/20/07

  TITLE:           DELETING CORRUPT BENE RECORDS

  PROJECT CODE:    CM01

  PRIORITY:        3

  RELEASE LEVEL: R2008100

  GROUP LEVEL:     2

  HOST SITE ID:    CWFM1000

  STATUS ON CR:    INIT

  DOC. REQUIRED: N

  HOST EVAL:       VALIDATE

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   4
  EST. HOURS:      0750
  ACT. HOURS:      0350
  CAT/CR EVAL:     N/A

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  CWF HOSTS RECEIVE REQUESTS FROM CMS TO OCCASIONALLY DELETE
  CORRUPT BENE'S & ALL ASSOCIATED RECORDS FROM OUR DATABASES.

  CWF HOSTS HAVE A PROCESS TO DO THIS. IT'S NOT, HOWEVER, A CSC
  PROVIDED PROCESS AND, AS SUCH, IS VULNERABLE TO BECOMING
  OUTDATED AS THE SOFTWARE EVOLVES FROM RELEASE TO RELEASE.

  WITHIN THE SOFTWARE, WE HAVE A UTLJMOVE AND A UTLJLOAD.
  COULD A CR BE CREATED FOR A NEW UTILITY NAMED, PERHAPS,
  UTLJDELE ?
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 248
____________________________________________________________________________

       UTLJDELE COULD PERHAPS HAVE TWO JOB STEPS:
             JS10 FIRST DO A UTLMOVE OF THE BENE INCASE IT
                  IS DECIDED THAT THE ONE GETTING DELETED
                  NEEDS TO BE RESTORED. TO FACILITATE THIS,
                  A NEW PROC COULD BE CREATED THAT UTLJMOVE &
                  UTLJDELE COULD BOTH MAKE USE OF.
             JS20 A NEW PROC TO DELETE THE BENE (AND ASSOCIATED
                  RECORDS) FROM THE DATABASE.


          THANKS,
             GREG CENOVA


  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:            _________________    WORK TYPE:   ___   Incidental
  SUBSYSTEM:     _________________                 _X_   Minor
  FUNCTION:      _________________                 ___   Major
  PROGRAM:       _________________                 ___   New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                   Cathy Pflaum
      Telephone:             410-786-3016
      FAX, CMS:              410-786-0271
      Responsibilities:      REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:       Vicki Sommers
      Telephone:             469-372-7642
      FAX,Richardson,TX:     469-372-0284
      Responsibilities:      DEFINITION, ANALYSIS, SYSTEM TESTING

  2.     PROG ANALYST:       Mike Ulman/Joe Shanabrough
         Telephone:          301-855-8182
         FAX,Baltimore,MD:   443-436-3803
         Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                             TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 249
____________________________________________________________________________

  *               blank line is found.                              *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (X) Host
  ( ) Satellite Part A Inpatient
  ( ) Satellite Part A Outpatient
  ( ) Satellite Part B
  ( ) Hospice
  ( ) Home Health
  ( ) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  When CMS requests the HOST to remove HICs from CWF files this
  change will reduce the effort on the HOST part.

  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
  This process should copy the requested HIC to a backup, and then
  remove the HIC from the CWF files.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 250
____________________________________________________________________________

  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  *******************************************************************
  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
  * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
  *******************************************************************
    EVENT-RESPONSE LIST:
  ***.......This is the width of the Release Document.......***

  Event 1.1
  Select a HIC from the test files and run the process.

  Response
  Check the backup file for the HIC and then check the CWF
  files to ensure that the HIC is no longer on these files.

  ***.......This is the width of the Release Document.......***

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

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1.

  Solution Criteria: N/A

    EDITS AFFECTED: None
  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 251
____________________________________________________________________________

  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************
  REQUIREMENTS WAIVED 07/12/2007
  REFER TO BETA PLOG 25621-ISSUES WITH UTLDELT UTILITY
  FOR FURTHER REVIEW AND COMMENTS




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 252
____________________________________________________________________________


   20. 00025582    5679-PRESENT ON ADMISSION INDICATOR SYSTEMS IMPLEMENTATION

  DATE ENTERED:    06/20/07

  TITLE:           5679-PRESENT ON ADMISSION INDICATOR SYSTEMS IMPLEMENTATION

  PROJECT CODE:    CM01

  PRIORITY:        1

  RELEASE LEVEL: R2008100

  GROUP LEVEL:     1

  HOST SITE ID:    CWFM2000

  STATUS ON CR:    REQS

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   4
  EST. HOURS:      0750
  ACT. HOURS:      0322
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  In order to group diagnoses into the proper DRG, CMS needs to
  capture a POA indicator for all claims involving inpatient admissions
  to general acute care hospitals.   Use the UB-04 Data Specifications
  Manual and the ICD-9-CM Official Guidelines for Coding and Reporting
  to facilitate the assignment of the POA indicator for each "principal"
  diagnosis and "other" diagnoses codes reported on claim forms UB-04
  and 837 Institutional. The law requires that these POA indicators be
  reported on all claims for inpatient admissions to general acute care
  hospitals with discharge dates on or after October 1, 2007. Critical
  Access Hospitals, Maryland Waiver Hospitals, LTCH, Cancer Hospitals
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 253
____________________________________________________________________________

  and Children's Inpatient Facilities are exempt from this requirement as
  are all hospitals paid under any other type of PPS system than the acute
  care hospital PPS system.

  These guidelines are not intended to replace any guidelines in the main
  body of the ICD-9-CM Official Guidelines for Coding and Reporting.
  The POA guidelines are not intended to provide guidance on when a
  condition should be coded, but rather, how to apply the POA indicator
  to the final set of diagnosis codes that have been assigned in accordanc
  with Sections I, II, and III of the official coding guidelines. Subseque
  to the assignment of the ICD-9-CM codes, the POA indicator should then
  be assigned to those conditions that have been coded.

  General Reporting Requirements
  - All claims involving inpatient admissions to general
    acute care hospitals or other facilities that are subject
    to a law or regulation mandating collection of present
    on admission information.
  - Present on admission is defined as present at the time
    the order for inpatient admission occurs -- conditions
    that develop during an outpatient encounter, including
    emergency department, observation, or outpatient surgery,
     are considered as present on admission.
  - POA indicator is assigned to principal and secondary
    diagnoses (as defined in Section II of the Official
    Guidelines for Coding and Reporting) and the external
    cause of injury codes.
  - Issues related to inconsistent, missing, conflicting or
    unclear documentation must still be resolved by the
    provider.
  - If a condition would not be coded and reported based on
    Uniform Hospital Discharge Data Set definitions and
    current official coding guidelines, then the POA indicator
    would not be reported.
  - CMS does not require a POA indicator for the external
    cause of injury code unless it is being reported as an
    "other diagnosis".

  CMS Reporting Options and Definitions
  - Y = Yes = present at the time of inpatient admission
  - N = No = not present at the time of inpatient admission
  - U = Unknown = the documentation is insufficient to
        determine if the condition was present at the time of
        inpatient admission
  - W = Clinically Undetermined = the provider is unable
        to clinically determine whether the condition was present
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 254
____________________________________________________________________________

        at the time of inpatient admission or not
  - 1 = Unreported/Not used - Exempt from POA reporting
    This code is the equivalent code of a blank on the UB-04,
    however, it was determined that blanks were undesirable when
    submitting this data via the 4010A1.


  CMS REQs for CWF:
  This CR contains all relevant information on POA claims
  processing so that all appropriate systems modifications can
  be made with a complete understanding of the total project
  requirements. The purpose of this CR is to implement the
  following business requirements on January 1, 2008.

  Effective for discharges on or after October 1, 2007, on UB-04
  paper claims the POA is the eighth digit of FL 67, Principal
  Diagnosis and the eighth digit of each of the Secondary Diagnosis
  fields FL 67 A-Q.

  Effective for discharges on or after January 1, 2008, claims submitted
  electronically via 837, 4010A1 format shall use segment K3 in the
  2300 loop, data element K301. The data element shall contain the
  letters "POA", followed by a single POA indicator for every diagnosis
   reported on the claim. The POA indicator for the principal diagnosis
  should be Effective for discharges on or after January 1, 2008, claims
  submitted electronically via 837, 4010A1 format shall use segment
  K3 in the 2300 loop, data element K301. The data element shall
  contain the letters "POA", followed by a single POA indicator for
  every diagnosis reported on the claim. The POA indicator for the
  principal diagnosis should be the first indicator after "POA". POA
  indicators for secondary diagnoses would follow next, if applicable.
  The last POA indicator for principal and, if applicable, other diagnoses
  shall be followed by the letter "Z" to indicate the end of POA
  indicators for principal and, if applicable, other diagnoses or the
  letter "X" to indicate the end of POA indicators for principal and,
  if applicable, other diagnoses in special data processing situations
  that may be identified by CMS in the future.

  Effective for discharges on or after January 1, 2008, CWF/NCH shall
  create a new field to capture and store at least nine POAs and one
  end of POA indicator.
  -----------

  CWF REQS based on Analysis in CMS CR 5499 in CR 25378.
  Analysis:
  CWF will need to make the following modifications
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 255
____________________________________________________________________________

 to accept, transmit and display the new 10, one byte
 Present on Admission indicator fields on inpatient
 acute care hospital claims.

 1. CWF will add the 10, one byte, Present on Admission (POA)
    indicator fields to the header portion of the inpatient claim
    transmit record (HUIP) submitted by Acute Care Hospitals
    (XX0001-XX0999) starting 01/01/2008 and after.


     The fields will stand for the following:

     POA1   for principle diagnosis
     POA2   for secondary diagnosis
     POA3   thru POA9 other diagnoses
     POAE   for Exemption

     This field will be added to CABEHUIN copybook.


 2. CWF will add the 10, one byte, new Present on Admission
    (POA) indicator fields to the NCH record for inpatient
    claims (HUIP) starting 01/01/2008 and after.

     This field will be added to CABEHUIP copybook.

 3. CWF will add the 10, one byte, new Present on Admission
    (POA) indicator fields to the ITF screens for inpatient claims
    (HIIP) starting 01/01/02008 and after.

    This field will be added to CICSMAP HIIPM04.

 4. CWF will add the 10, one byte, new Present on Admission
    (POA) indicator fields to the INPH HIMR screen for inpatient
    claims (HUIP) starting 01/01/02008 and after.

    This field will be added to CICSMAP HMRMIP4.


 5. CWF will add the 10, one byte, new Present on Admission
    (POA) indicator fields to the inpatient claim history on the
    beneficiary record starting 01/01/2008 and after.

    This field will be added to CIOCINP copybook.

  REQUIREMENTS:
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 256
____________________________________________________________________________

  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:          __25582__________    WORK TYPE:   ___   Incidental
  SUBSYSTEM:   _________________                 ___   Minor
  FUNCTION:    _________________                 XXX   Major
  PROGRAM:     _________________                 ___   New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                 Kathy Woytan
      Telephone:           410-786-4982
      FAX, CMS:            410-786-0271
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     Janice Maxwell
      Telephone:           773-252-1327
      FAX,Richardson,TX:   773-252-1319
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       Heather Byram
       Telephone:          717-909-5122
       FAX,Baltimore,MD:   443-436-3803
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *              blank line is found.                               *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *              after a colon. Try to format as it should appear *
  *              in the Release Document.                           *
  *******************************************************************
    IMPACT:
  (X) Host
  (X) Satellite Part A Inpatient
  ( ) Satellite Part A Outpatient
  ( ) Satellite Part B
  ( ) Hospice
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 257
____________________________________________________________________________

  ( ) Home Health
  ( ) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  CWF will need to make modifications to accept, transmit and
  display the new Present on Admission indicator field on
  inpatient acute care hospital claims.

  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
  CWF will add ten one byte Present on Admission indicator
  fields to the header portion of the inpatient claim
  records when submitted by Acute Care Hospitals (CABEHUIN).
  Acute Care Hospitals are identified by provider range XX0001-
  XX0999. This requirement is in effect for claims submitted
  01/01/2008 and after.

  Following are the field definitions:
  POA1 for principle diagnosis
  POA2 for secondary diagnosis
  POA3 thru POA9 other diagnosis
  POAE for Exemption

  Requirement 2
  CWF will add the ten one byte new Present on Admission
  (POA) indicator fields to the NCH record (CABEHUIP) for
  inpatient claims starting 01/01/2008 and after.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 258
____________________________________________________________________________


  Requirement 3
  CWF will add the ten one byte new Present on Admission
  (POA) indicator fields to the ITF screens (CICSMAP HIIPM04)
  inpatient claims starting 01/01/2008 and after.

  Requirement 4
  CWF will add the ten one byte new Present on Admission
  (POA) indicator fields to the INPH HIMR screen (CICSMAP HMRMIP4)
  for inpatient claims starting 01/01/2008 and after.

  Requirement 5
  CWF will add the ten one byte new Present on Admission
  (POA) indicator fields to the inpatient claim history on the
  beneficiary record (CIOCINP) starting 01/01/2008 and after.

  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  *******************************************************************
  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
  * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
  *******************************************************************
    EVENT-RESPONSE LIST:
  ***.......This is the width of the Release Document.......***

  Event 1.1
  An HUIP Acute Care Hospital record (provider range XX0001 -
  XX0999) is submitted on or after 01/01/2008 is submitted with
  one of the new Present on Admission indicators.

  Response
  The HUIP record is accepted.

  Event 2.1
  An HUIP Acute Care Hospital record (provider range XX0001 -
  XX0999) submitted on or after 01/01/2008 is submitted with
  one of the new Present on Admission indicators.

  Response
  The HUIP record is accepted and the NCH record (CABEHUIP)
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 259
____________________________________________________________________________

  is populated with the Present on Admission (POA)
  indicator.

  Event 3.1
  An HUIP Acute Care Hospital record (provider range XX0001 -
  XX0999) with a Present on Admission indicator is entered
  into the Internal Testing Facility (ITF) on or after
  01/01/2008.

  Response
  The HUIP record is accepted.

  Event 4.1
  An HUIP Acute Care Hospital record (provider range XX0001 -
  XX0999) with a Present on Admission indicator is submitted
  on or after 01/01/2008 and accepted.

  Response
  The Present on Admission Indicator (POA) is shown on the
  INPH HIMR screen.

  Event 5.1
  An HUIP Acute Care Hospital record (provider range XX0001 -
  XX0999) with a Present on Admission indicator is submitted
  on or after 01/01/2008 and accepted.

  Response
  The Present on Admission Indicator (POA) is present on the
  inpatient claim history beneficiary record.

  ***.......This is the width of the Release Document.......***

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

  Entity List: N/A
    1. Entity:
        Description:

  Areas   Affected by the Problem.
    1.    Transmit records
    2.    ITF
    3.    Claim History
    4.    HIMR
    5.    NCH

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 260
____________________________________________________________________________


  Solution Criteria: N/A

    EDITS AFFECTED: None
  ***.......This is the width of the Release Document......***

  a. Error Code:    XXXX   ( )New ( )Modified ( )Deleted
  Disposition:

  Type of Record:

  Error Message:

  Set Condition for edit '####':

  Trailer Information:


  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************
  --- Received from CSC.CF00015 717-909-2228          07-06-21 14.15
    -> CSC.RCSTAFF           Release coordinators
  All - in the event that we are still here, I would appreciate
  being assigned to this CR for Jan, because, I had all of the
  screen changes done before we knew the original CR for Oct. was
  analysis only.
  H

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 261
____________________________________________________________________________


   21. 00025594    DOCUMENTATION CHANGES FOR RELEASE R2008100

  DATE ENTERED:    07/03/07

  TITLE:           DOCUMENTATION CHANGES FOR RELEASE R2008100

  PROJECT CODE:    CM01

  PRIORITY:        2

  RELEASE LEVEL: R2008100

  GROUP LEVEL:     2

  HOST SITE ID:    CWFM1000

  STATUS ON CR:    REQS

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   0
  EST. HOURS:      0025
  ACT. HOURS:      0000
  CAT/CR EVAL:     N

  COMMENT:         3

  DESCRIPTION:
  ------------
  THIS CR DESCRIBES CHANGES TO DOCUMENTATION RESULTING FROM THE
  CWFM RELEASE.

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:         25594____________   WORK TYPE: ___ Incidental
  SUBSYSTEM: _________________                ___ Minor
  FUNCTION:   _________________               _X_ Major
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 262
____________________________________________________________________________

  PROGRAM:     _________________                ___ New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                 Kathy Woytan
      Telephone:           410-786-4982
      FAX, CMS:            410-786-0271
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     Rita Crane
      Telephone:           469-372-0645
      FAX,Richardson,TX:   469-372-2199
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       John Alexander
       Telephone:          443-436-6751
       FAX,Baltimore,MD:   443-436-3803
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *               blank line is found.                              *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (X) Host
  (X) Satellite Part A Inpatient
  (X) Satellite Part A Outpatient
  (X) Satellite Part B
  (X) RHHI
  (X) Home Health
  (X) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  Make documentation updates that are not associated with a CR in the
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 263
____________________________________________________________________________

  R2008100 release and communicate them to the users.

    NEW BUSINESS REQUIREMENTS:
  The documentation updates that are not associated with a CR in the
  R2008100 release are listed below:

  1.   DOCUMENTATION UPDATE REQUESTED:
       ASSOCIATED CR:
       ASSOCIATED DOC ONLY:
       ASSOCIATED RELEASE:
       REQUESTED DATE: 10/01/2007
       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: 09/26/2007
       REQUESTED BY: Ofelia Castillo
       PHONE NUMBER: 469-372-6492
       LOCATION OF CHANGE(S): EDITABX

       DESCRIPTION OF CHANGE(S):
       Make the following correction to the Set Condition
       of edit '7245':

       Typo error under set condition: HCPCS code
       'J8497' should be 'J8597' and 'J8598' should be 'J8498'.


  3.   DOCUMENTATION UPDATE REQUESTED:
       ASSOCIATED CR:
       ASSOCIATED DOC ONLY:
       ASSOCIATED RELEASE:
       REQUESTED DATE: 09/28/2007
       REQUESTED BY: Rita Crane
       PHONE NUMBER: 469-372-2199
       LOCATION OF CHANGE(S): EDITUTIL

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 264
____________________________________________________________________________

       DESCRIPTION OF CHANGE(S):
       Add the following to '5232' Part B and DMEPOS: Set Condition

       When the Plan ID is for Choices or ESRD, and
       override code is present continue to set the edit.


  4.   DOCUMENTATION UPDATE REQUESTED:
       ASSOCIATED PR:
       ASSOCIATED DOC ONLY:
       ASSOCIATED RELEASE:
       REQUESTED DATE:
       REQUESTED BY:
       PHONE NUMBER:
       LOCATION OF CHANGE(S):

       DESCRIPTION OF CHANGE(S):




  5.   DOCUMENTATION UPDATE REQUESTED:
       ASSOCIATED CR:
       ASSOCIATED DOC ONLY:
       ASSOCIATED RELEASE:
       REQUESTED DATE:
       REQUESTED BY:
       PHONE NUMBER:
       LOCATION OF CHANGE(S):

       DESCRIPTION OF CHANGE(S):




  6.   DOCUMENTATION UPDATE REQUESTED:
       ASSOCIATED PROB:
       ASSOCIATED DOC ONLY:
       ASSOCIATED RELEASE:
       REQUESTED DATE:
       REQUESTED BY:
       PHONE NUMBER:
       LOCATION OF CHANGE(S):

       DESCRIPTION OF CHANGE(S):

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 265
____________________________________________________________________________




  7.   DOCUMENTATION UPDATE REQUESTED:
       ASSOCIATED CR:
       ASSOCIATED DOC ONLY:
       ASSOCIATED RELEASE:
       REQUESTED DATE:
       REQUESTED BY:
       PHONE NUMBER:
       LOCATION OF CHANGE(S):

       DESCRIPTION OF CHANGE(S):


  8.   DOCUMENTATION UPDATE REQUESTED:
       ASSOCIATED CR:
       ASSOCIATED DOC ONLY:
       ASSOCIATED RELEASE:
       REQUESTED DATE:
       REQUESTED BY:
       PHONE NUMBER:
       LOCATION OF CHANGE(S):

       DESCRIPTION OF CHANGE(S):



  9.   DOCUMENTATION UPDATE REQUESTED:
       ASSOCIATED CR:
       ASSOCIATED DOC ONLY:
       ASSOCIATED RELEASE:
       REQUESTED DATE:
       REQUESTED BY:
       PHONE NUMBER:
       LOCATION OF CHANGE(S):

       DESCRIPTION OF CHANGE(S):


  10. DOCUMENTATION UPDATE REQUESTED:
      ASSOCIATED CR:
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 266
____________________________________________________________________________

     ASSOCIATED DOC ONLY:
     ASSOCIATED RELEASE:
     REQUESTED DATE:
     REQUESTED BY:
     PHONE NUMBER:
     LOCATION OF CHANGE(S):

     DESCRIPTION OF CHANGE(S):




  11. DOCUMENTATION UPDATE REQUESTED:
      ASSOCIATED PROB:
      ASSOCIATED DOC ONLY:
      ASSOCIATED RELEASE:
      REQUESTED DATE:
      REQUESTED BY:
      PHONE NUMBER:
      LOCATION OF CHANGE(S):

     DESCRIPTION OF CHANGE(S):


  12. DOCUMENTATION UPDATE REQUESTED:
      ASSOCIATED CR:
      ASSOCIATED DOC ONLY:
      ASSOCIATED RELEASE:
      REQUESTED DATE:
      REQUESTED BY:
      PHONE NUMBER:
      LOCATION OF CHANGE(S):

     DESCRIPTION OF CHANGE(S):




  13. DOCUMENTATION UPDATE REQUESTED:
      ASSOCIATED CR:
      ASSOCIATED DOC ONLY:
      ASSOCIATED RELEASE:
      REQUESTED DATE:
      REQUESTED BY:
      PHONE NUMBER:
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 267
____________________________________________________________________________

      LOCATION OF CHANGE(S):

      DESCRIPTION OF CHANGE(S):




  14. DOCUMENTATION UPDATE REQUESTED:
      ASSOCIATED CR:
      ASSOCIATED DOC ONLY:
      ASSOCIATED RELEASE:
      REQUESTED DATE:
      REQUESTED BY:
      PHONE NUMBER:
      LOCATION OF CHANGE(S):

      DESCRIPTION OF CHANGE(S):



  ***.......This is the width of the Release Document......***
    EVENT-RESPONSE LIST:
  ***.......This is the width of the Release Document.......***

   EDITS AFFECTED:

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 268
____________________________________________________________________________


   22. 00025595    EXTERNAL COPYBOOK CHANGES FOR R2008100

  DATE ENTERED:    07/03/07

  TITLE:           EXTERNAL COPYBOOK CHANGES FOR R2008100

  PROJECT CODE:    CM01

  PRIORITY:        2

  RELEASE LEVEL: R2008100

  GROUP LEVEL:     2

  HOST SITE ID:    CWFM1000

  STATUS ON CR:    REQS

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   0
  EST. HOURS:      0025
  ACT. HOURS:      0000
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  This CR will serve as the repository for all copybook changes that are
  made as a result of Release R2008100.

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:         25595____________   WORK TYPE: ___ Incidental
  SUBSYSTEM: _________________                _x_ Minor
  FUNCTION:   _________________               ___ Major
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 269
____________________________________________________________________________

  PROGRAM:     _________________                ___ New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                 Kathy Woytan
      Telephone:           410-786-4982
      FAX, CMS:            410-786-0271
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     Rita Crane
      Telephone:           469-372-0645
      FAX,Richardson,TX:   469-372-2199
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       John Alexander
       Telephone:          443-436-6751
       FAX,Baltimore,MD:   443-436-3803
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *              blank line is found.                               *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *              after a colon. Try to format as it should appear *
  *              in the Release Document.                           *
  *******************************************************************
    IMPACT:
  (X) Host
  (X) Satellite Part A Inpatient
  (X) Satellite Part A Outpatient
  (X) Satellite Part B
  (X) RHHI
  (X) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  Make external copybook updates that are associated with the
  CRs contained in the R2008100 Release, and communicate them
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 270
____________________________________________________________________________

  to the Standard System Maintainers.
  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

   Requirement 1

   Copybook Name: xxxxxxxx

  These changes are associated with CRs 000xxxxx, 000xxxxx:


   Requirement 2

   Copybook Name: xxxxxxxx

  These changes are associated with CRs 000xxxxx, 000xxxxx:



  Requirement 3

  Copybook Name: xxxxxxxx

  These changes are associated with CR 000xxxxx:



  Requirement 4

  Copybook Name: xxxxxxxx
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 271
____________________________________________________________________________


  These changes are associated with CR 000xxxxx:



  Requirement 6

  Copybook Name: xxxxxxxx

  These changes are associated with CR 000xxxxx:


  Requirement 7

  Copybook Name: xxxxxxxx

  These changes are associated with CR 000xxxxx:


  Requirement 8

  Copybook Name: xxxxxxxx

  These changes are associated with CR 000xxxxx:



  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  ******************************************************************
  * If you want the EVENT-RESPONSEs printed in the release document*
  * remove the word "None" and delete the delimiter line. Number *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.        *
  * NBR 1, Event would be 1.1, NBR 2,Events would be 2.1, 2.2, etc.*
  ******************************************************************
    EVENT-RESPONSE LIST: None
  ***.......This is the width of the Release Document.......***

  Event 1.1

  Response
  ***.......This is the width of the Release Document.......***
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 272
____________________________________________________________________________


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

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1.

  Solution Criteria: N/A

    EDITS AFFECTED: None
  ***.......This is the width of the Release Document......***

  a. Error Code:    XXXX   ( )New ( )Modified ( )Deleted
  Disposition:

  Type of Record:

  Error Message:

  Set Condition for edit '####':

  Trailer Information:
  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 273
____________________________________________________________________________


   23. 00025596    R2008100 INSTALLATION INSTRUCTION - ONE-TIMER CONTROL CR

  DATE ENTERED:    07/03/07

  TITLE:           R2008100 INSTALLATION INSTRUCTION - ONE-TIMER CONTROL CR

  PROJECT CODE:    CM01

  PRIORITY:        2

  RELEASE LEVEL: R2008100

  GROUP LEVEL:     2

  HOST SITE ID:    CWFM1000

  STATUS ON CR:    REQS

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   0
  EST. HOURS:      0025
  ACT. HOURS:      0000
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  THIS CR WILL CONTAIN THE INSTALLATION INSTRUCTIONS FOR EACH INDIVIDUAL
  CR WITHIN RELEASE R2008100 THAT REQUIRES ANY SPECIAL INSTALLATION
  PROCEDURES. THE INDIVIDUAL CRS WILL REFERENCE THIS CR AS THE REPOSITORY
  FOR THE INSTRUCTIONS.

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:         25596____________   WORK TYPE: ___ Incidental
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 274
____________________________________________________________________________

 SUBSYSTEM:   _________________                _x_ Minor
 FUNCTION:    _________________                ___ Major
 PROGRAM:     _________________                ___ New Subsystem

 DEFINITION PHASE ORGANIZATION

 CMS Participants:
 1. Name:                 Kathy Woytan
     Telephone:           410-786-4982
     FAX, CMS:            410-786-0271
     Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

 CWFM Participants:
 1. BUSINESS ANALYST:     Rita Crane
     Telephone:           469-372-0645
     FAX,Richardson,TX:   469-372-2199
     Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

 2.   PROG ANALYST:       John Alexander
      Telephone:          443-436-6751
      FAX,Baltimore,MD:   443-436-3803
      Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                          TESTING


 *******************************************************************
 * PARAGRAPHS - Start in column 1. The paragraph will end when a *
 *               blank line is found.                              *
 * HEADINGS   - Start in column 2.                                 *
 * FREE-FORMAT- Start in column 3.                                 *
 * Use upper and Lower case.                                       *
 *                                                                 *
 * EDITING    - Please allow 2 spaces after a period and 2 spaces *
 *               after a colon. Try to format as it should appear *
 *               in the Release Document.                          *
 *******************************************************************
   IMPACT:
 (X) Host
 (X) Satellite Part A Inpatient
 (X) Satellite Part A Outpatient
 (X) Satellite Part B
 (X) RHHI
 (X) Home Health
 (X) DMERC
 ***.......This is the width of the Release Document.......***

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 275
____________________________________________________________________________

    REASON FOR CHANGE:
  This CR will track one-timers and Installation Instructions for
  the R2008100 Release. Host and Satellites should refer to the
  R2008100 Release Documentation Appendix A for information
  concerning interdependencies and timing of these jobs.

  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
  One-Timer Job Name:
  Originating CR:     000xxxxx
  Run by Host/Satl:
  Files Prod/Test:
  Purpose of Job:




  Requirement 2
  One-Timer Job Name:
  Originating CR:
  Run by Host/Satl:
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 276
____________________________________________________________________________

 Files Prod/Test:
 Purpose of Job:


 Requirement 3
 One-Timer Job Name:
 Originating CR:
 Run by Host/Satl:
 Files Prod/Test:
 Purpose of Job:



 Requirement 4
 One-Timer Job Name:
 Originating CR:
 Run by Host/Satl:
 Files Prod/Test:
 Purpose of Job:


 Requirement 5
 One-Timer Job Name:
 Originating CR:
 Run by Host/Satl:
 Files Prod/Test:
 Purpose of Job:


 Requirement 6
 One-Timer Job Name:
 Originating CR:
 Run by Host/Satl:
 Files Prod/Test:
 Purpose of Job:


 Requirement 7
 One-Timer Job Name:
 Originating CR:
 Run by Host/Satl:
 Files Prod/Test:
 Purpose of Job:


  Requirement 8
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 277
____________________________________________________________________________

  One-Timer Job Name:
  Originating CR:
  Run by Host/Satl:
  Files Prod/Test:
  Purpose of Job:


  Requirement 9
  One-Timer Job Name:
  Originating CR:
  Run by Host/Satl:
  Files Prod/Test:
  Purpose of Job:


  Requirement 10
  One-Timer Job Name:
  Originating CR:
  Run by Host/Satl:
  Files Prod/Test:
  Purpose of Job:


  ***.......This is the width of the Release Document.......***
  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  ******************************************************************
  * If you want the EVENT-RESPONSEs printed in the release document*
  * remove the word "None" and delete the delimiter line. Number *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.        *
  * NBR 1, Event would be 1.1, NBR 2,Events would be 2.1, 2.2, etc.*
  ******************************************************************
    EVENT-RESPONSE LIST: None
  ***.......This is the width of the Release Document.......***

  Event 1.1

  Response
  ***.......This is the width of the Release Document.......***

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

  Entity List: N/A
    1. Entity:
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 278
____________________________________________________________________________

        Description:

  Areas Affected by the Problem.
    1.

  Solution Criteria: N/A

    EDITS AFFECTED: None
  ***.......This is the width of the Release Document......***

  a. Error Code:    XXXX   ( )New ( )Modified ( )Deleted
  Disposition:

  Type of Record:

  Error Message:

  Set Condition for edit '####':

  Trailer Information:


  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 279
____________________________________________________________________________


  24. 00025597    ARCHIVE MAINTENANCE FOR RELEASE R2008100

 DATE ENTERED:    07/03/07

 TITLE:           ARCHIVE MAINTENANCE FOR RELEASE R2008100

 PROJECT CODE:    CM01

 PRIORITY:        2

 RELEASE LEVEL: R2008100

 GROUP LEVEL:     2

 HOST SITE ID:    CWFM1000

 STATUS ON CR:    REQS

 DOC. REQUIRED: N

 HOST EVAL:       N/A

 DOC RECEIVED:    N

 ADDENDUM INFO: NONE

 EST. CATEGORY:   0
 EST. HOURS:      0025
 ACT. HOURS:      0000
 CAT/CR EVAL:     N

 COMMENT:         N/A

 DESCRIPTION:
 ------------
 ARCHIVE OBSOLETE CWF SOFTWARE CHANGES DUE TO MAINTENANCE CHANGES
 FOR RELEASE R2008100.

 REQUIREMENTS:
 -------------
             DEFINITION AND ANALYSIS PHASES

  CR:         _25597____      __  WORK TYPE: ___ Incidental
  SUBSYSTEM: _________________                _X_ Minor
  FUNCTION:   _________________               ___ Major
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 280
____________________________________________________________________________

  PROGRAM:     _________________                ___ New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                 Kathy Woytan
      Telephone:           410-786-4982
      FAX, CMS:            410-786-0271
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     Rita Crane
      Telephone:           469-372-0645
      FAX,Richardson,TX:   469-372-2199
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       John Alexander
       Telephone:          443-436-6751
       FAX,Baltimore,MD:   443-436-3803
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *               blank line is found.                              *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (X) Host
  (X) Satellite Part A Inpatient
  (X) Satellite Part A Outpatient
  (X) Satellite Part B
  ( ) RHHI
  ( ) Home Health
  ( ) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  This CR will record those CWFM configuration items that are
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 281
____________________________________________________________________________

  to be archived and/or restored with the R2008100 Release.

  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
  Archive the following SOURCE modules:

   HOST:
   -----

      CR 000xxxxx (R200xx00 Release)
         xxxxxxxx
         xxxxxxxx
         xxxxxxxx
         xxxxxxxx


      PR 000xxxxx (R200xx00 Release)
         xxxxxxxx
         xxxxxxxx

   SATL:
   -----

      CR 000xxxxx (R200xx00 Release)
         xxxxxxx
         xxxxxxx


______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 282
____________________________________________________________________________


     PR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx


  Archive the following COPYBOOKS modules:

   HOST:
   -----

     CR 000xxxxx (R200xx00 Release)
        xxxxxxxx

     PR 000xxxxx (R200xx00 Release)
        xxxxxxxx

   SATL:
   -----

     CR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx


     PR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx


  Archive the following CICSMAP modules:

   HOST:
   -----

     CR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx


   SATL:
   -----

      CR 000xxxxx (R200xx00 Release)
         xxxxxxxx
         xxxxxxxx
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 283
____________________________________________________________________________



  Archive the following UTILITY modules:

   HOST:
   -----

     CR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx



     PR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx

   SATL:
   -----

     CR 000xxxxx (R200xx00 Release)-
        xxxxxxxx
        xxxxxxxx



     PR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx


  Archive the following JCL modules:

   HOST:
   -----

     CR 000xxxxx (R200xx00 Release)
        xxxxxxxx

     CR 000xxxxx (R200XX00 Release)
        xxxxxxxx
        xxxxxxxx

      PR 000xxxxx (R200xx00 Release)
         xxxxxxxx
         xxxxxxxx
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 284
____________________________________________________________________________


   SATL:
   -----

     CR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx

     PR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx


 Archive the following PROC modules:

   HOST:
   -----

     CR 000xxxxx (R200xx00 Release)
        xxxxxxxx

     CR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx


     PR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx

   SATL:
   -----

     CR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx

     PR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx


 Archive the following IDCMCARD modules:

    HOST:
    -----
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 285
____________________________________________________________________________


     CR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx

     PR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx

   SATL:
   -----

     CR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx

     PR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx


  Archive the following CONTROL CARD modules:

   HOST:
   -----

     CR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx


     PR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx

   SATL:
   -----

     CR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx

     PR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 286
____________________________________________________________________________


  Archive the following CICS RDO Entries:

   HOST:
   -----

     CR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx

     PR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx

   SATL:
   -----

     CR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx


     PR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx

  ******************************************************
  **    Do not include this section in the Release    **
  **    letters. This pertains only to CSC Internal **
  ******************************************************



  Archive the following CSCINT Entries:

   CSCINT:
   -------

     CR 00025551 (R200xx00 Release)
        HIDLCIP (L1COB2C)
        HIDLM01 (cicsmap)

     PR 000xxxxx (R200xx00 Release)
        xxxxxxxx
        xxxxxxxx

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 287
____________________________________________________________________________

    SATL:
    -----

      CR 000xxxxx (R200xx00 Release)
         xxxxxxxx
         xxxxxxxx


      PR 000xxxxx (R200xx00 Release)
         xxxxxxxx
         xxxxxxxx




  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  ******************************************************************
  * If you want the EVENT-RESPONSEs printed in the release document*
  * remove the word "None" and delete the delimiter line. Number *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.        *
  * NBR 1, Event would be 1.1, NBR 2,Events would be 2.1, 2.2, etc.*
  ******************************************************************
    EVENT-RESPONSE LIST: None
  ***.......This is the width of the Release Document.......***

  Event 1.1

  Response
  ***.......This is the width of the Release Document.......***

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

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 288
____________________________________________________________________________

  Solution Criteria: N/A

    EDITS AFFECTED: None
  ***.......This is the width of the Release Document......***

  a. Error Code:    XXXX   ( )New ( )Modified ( )Deleted
  Disposition:

  Type of Record:

  Error Message:

  Set Condition for edit '####':

  Trailer Information:


  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************

  --- Received from CSC.CF00083 443-436-6732               07-06-18 12.07
    -> CSC.RCSTAFF           Release coordinators
    -> CWFSE.CF91081         LIZ JONES                          469
    -> CWFSE.CF90144         JANET JOHNSON                      0469
    -> CSC.CF00051           JERRY WEAVER                       CSC

  Hi Liz,

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 289
____________________________________________________________________________

  Thanks for catching this issue. We will be archiving
  one proc and associated JCL with 2007400 (CR25478) Release.
  *.HOST.PROC ----> CAB$WC89
  *.HOST.JCL ----> CABMWC89

  Please let us know if you have any other questions/Concerns.

  Thanks
  Raju
  ------------------------------------------------------------------
  --- Received from CWFSE.CF91081 205-220-3696        06-08-24 14.41
    -> CWFSE.CF90144         JANET JOHNSON                  0469
    -> CWFSE.CF91081         LIZ JONES                      469
    -> CSC.CF00051           JERRY WEAVER                   CSC

  Jerry,

      In cleaning up some old JCL I noticed that CAB$WC89 is still
   listed as a current proc and is in the documentation. I do
   not believe Trailblazers nor Cahaba uses this PROC anymore.
   The program it executes CABPOMN is not even sent to us anymore.
   Can you look at archiving this process.
                                           Thanks,
                                           Liz Jones




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 290
____________________________________________________________________________


   25. 00025599    5696-2008 ANNUAL UPDATE TO HCPCS FOR SNF CB FOR CWF

  DATE ENTERED:    07/05/07

  TITLE:           5696-2008 ANNUAL UPDATE TO HCPCS FOR SNF CB FOR CWF

  PROJECT CODE:    CM01

  PRIORITY:        1

  RELEASE LEVEL: R2008100

  GROUP LEVEL:     1

  HOST SITE ID:    CWFM1000

  STATUS ON CR:    CMS

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   3
  EST. HOURS:      0300
  ACT. HOURS:      0204
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  7/5/2007
  Currently CWF has edits in place for claims received for
  beneficiaries in a Part A covered SNF stay as well as for
  beneficiaries in a non-covered stay. These edits only allow
  services that are excluded from consolidated billing to be
  separately paid by the carrier and/or FI. Barring any delay
  in the MPFS, the new code files will be provided to CWF by
  11/01/2007.

  1) CWF shall accept new carrier SNF coding files and process
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 291
____________________________________________________________________________

       SNF CB claims for Dates of Service on, or after 01/01/2008-
       12/31/2008 using these files.


  2) CWF shall compare the new Fi code list for Major Categories
     I-V to the codes in the current edit.

  3) Codes that appear on the new list, but are not in the
     current edit, shall be added to the edit by CWF.

  4) After the comparison is made, cWF shall provide CMS with a
     list of codes by edit that were formerly on the edit, but
     no longer appear on the new code lists.

  5) CWF shall delete codes from the edits per CMS' determination.

  Yvonne Anderson
  CWFM Support Team

  469 372-5420

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:            ______25599______   WORK TYPE:   ___   Incidental
  SUBSYSTEM:     _________________                _x_   Minor
  FUNCTION:      _________________                ___   Major
  PROGRAM:       _________________                ___   New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                  Kathy Woytan
      Telephone:            410-786-4982
      FAX, CMS:             410-786-0271
      Responsibilities:     REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:      Ofelia Castillo
      Telephone:            469-372-6492
      FAX,Richardson,TX:    469-372-0284
      Responsibilities:     DEFINITION, ANALYSIS, SYSTEM TESTING

  2.  PROG ANALYST:      Jackie Dolphus
      Telephone:         443-436-6721
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 292
____________________________________________________________________________

     FAX,Baltimore,MD:   443-436-3803
     Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                         TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *               blank line is found.                              *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (X) Host
  (X) Satellite Part A Inpatient
  (X) Satellite Part A Outpatient
  (X) Satellite Part B
  ( ) Hospice
  ( ) Home Health
  (X) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  The SNF Consolidated Billing (CB) HCPCS code(s) have been
  revised for fiscal year 2008. CWF must accept the new Carrier
  SNF CB coding files (Physician Services (category 75),
  Physician Services submitted with the '26' Modifier, ambulance
  services, and therapy services) for both the rejects and the
  informational unsolicited process for A/B Crossover edits
  '7258', '7259', '7260', and '7261'. Also, CWF must modify the
  reject and the informational unsolicited process for A/B
  Crossover edits '7251' and '7252' to add or terminate the
  new SNF CB HCPCS code(s) for therapy and non-therapy services.

  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 293
____________________________________________________________________________

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

    NEW BUSINESS REQUIREMENTS:

  Requirement 1

  Requirement 2


  Requirement 3
  CWF must modify CABCHCCB copybook to accept the four new
  SNF CB Coding files:
       Physician Services (Category 75),
       Physician Services submitted with the '26' Modifier,
       Ambulance Services, and
       Therapy Services
  for calendar year 2008 for Carrier processing beginning
  with Dates of Service on or after 01/01/2008.

  Category '75' HCPCS code(s)

  Modifier '26' Table

  Ambulance

  Therapy

  Note:
  CWF will ensure that Part B/DMERC claims process correctly
  for A/B Crossover edits '7258', '7259', '7260', and '7261'.

  Also, CWF will ensure that an informational unsolicited
  response is generated correctly for A/B Crossover edit
  '7258', '7259', '7260', and '7261'.

  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 294
____________________________________________________________________________

  that the system should function AFTER the change.

  *******************************************************************
  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
  * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
  *******************************************************************
    EVENT-RESPONSE LIST:
  ***.......This is the width of the Release Document.......***

  Event 1.1

  Response

  Event 1.1

  Response

  Event 3.1
  Submit a 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 claim with therapy services and the
  detail From or Thru Date overlaps the posted SNF Inpatient
  Part A claim in history.

  Response
  The Part B claim set A/B Crossover edit '7258'.

  Event 3.2
  Submit a SNF Inpatient Part A claim (21x) with Dates of
  Service on or after 01/01/2008 that posted to history.

  Submit a Part B claim with therapy services and the
  detail From and Thru Date is within the posted SNF Inpatient
  Part A claim in history.

  Response
  The Part B claim set A/B Crossover edit '7259'.

  Event 3.3
  Submit a SNF Inpatient Part A claim (21x) with Dates of
  Service on or after 01/01/2008 that posted to history.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 295
____________________________________________________________________________

  Submit a Part B/DMERC claim with physician service (category
  75) and the detail From or Thru Date overlaps the SNF Inpatient
  Part A claim in history.

  Response
  The Part B/DMERC does not set A/B Crossover edit '7260'.

  Event 3.4
  Submit a SNF Inpatient Part A claim (21x) with Dates of
  Service on or after 01/01/2008 that posted to history.

  Submit a Part B/DMERC claim with physician service with
  Modifier '26' and the detail From or Thru Date overlaps the
  SNF Inpatient Part A claim in history.

  Response
  The Part B/DMERC does not set A/B Crossover edit '7260'.

  Event 3.5
  Submit a SNF Inpatient Part A claim (21x) with Dates of
  Service on or after 01/01/2008 that posted to history.

  Submit a Part B/DMERC claim with ambulance service with
  Modifier other than 'NN' and the detail From or Thru Date
  overlaps the SNF Inpatient Part A claim in history.

  Response
  The Part B/DMERC does not set A/B Crossover edit '7260'.

  Event 3.6
  Submit a SNF Inpatient Part A claim (21x) with Dates of
  Service on or after 01/01/2008 that posted to history.

  Submit a Part B/DMERC claim with physician service (category
  75) and the detail From and Thru Date is within the SNF
  Inpatient Part A claim in history.

  Response
  The Part B/DMERC does not set A/B Crossover edit '7261'.

  Event 3.7
  Submit a SNF Inpatient Part A claim (21x) with Dates of
  Service on or after 01/01/2008 that posted to history.

  Submit a Part B/DMERC claim with physician service with
  Modifier '26' and the detail From and Thru Date is within
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 296
____________________________________________________________________________

  the SNF Inpatient Part A claim in history.

  Response
  The Part B/DMERC does not set A/B Crossover edit '7261'.

  Event 3.8
  Submit a SNF Inpatient Part A claim (21x) with Dates of
  Service on or after 01/01/2008 that posted to history.

  Submit a Part B/DMERC claim with ambulance service with
  Modifier other than 'NN' and the detail From and Thru Date
  is within the SNF Inpatient Part A claim in history.

  Response
  The Part B/DMERC does not set A/B Crossover edit '7261'.

  Event 3.9
  Submit a Part B claim that is accepted and posted to
  history. The Part B claim Date of Service is on or after
  01/01/2008 with a therapy HCPCS code(s). The Part B
  From or Thru Date overlaps the incoming SNF claim.

  Submit an SNF Inpatient Part A claim (21x).

  Response
  The SNF Inpatient Part A claim (21x) is accepted. An
  informational unsolicited response is generated for the
  Part B claim for A/B Crossover edit '7258'.

  Event 3.10
  Submit a Part B claim that is accepted and posted to
  history. The Part B claim Date of Service is on or after
  01/01/2008 with a therapy HCPCS code(s). The Part B
  From and Thru Date is within the incoming SNF claim.

  Submit an SNF Inpatient Part A claim (21x).

  Response
  The SNF Inpatient Part A claim (21x) is accepted. An
  informational unsolicited response is generated for the
  Part B claim for A/B Crossover edit '7259'.

  Event 3.11
  Submit a Part B/DMERC claim that is accepted and posted
  to history. The Part B/DMERC claim Date of Service is on
  or after 01/01/2008 with a physician service (category
______________________________________________________________________________
Computer Sciences Corporation                              Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 297
____________________________________________________________________________

 75). The Part B/DMERC From or Thru Date overlaps the
 incoming SNF claim.

 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 claim for A/B Crossover edit '7260'.

 Event 3.12
 Submit a Part B/DMERC claim that is accepted and posted
 to history. The Part B/DMERC claim Date of Service is on
 or after 01/01/2008 with a physician service with Modifier
 '26'. The Part B/DMERC From or Thru Date overlaps the
 incoming SNF claim.

 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 claim for A/B Crossover edit '7260'.

 Event 3.13
 Submit a Part B/DMERC claim that is accepted and posted
 to history. The Part B/DMERC claim Date of Service is on
 or after 01/01/2008 with ambulance service with Modifier
 other than 'NN'. The Part B/DMERC From or Thru Date
 overlaps the incoming SNF claim.

 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 claim for A/B Crossover edit '7260'.

 Event 3.14
 Submit a Part B/DMERC claim that is accepted and posted
 to history. The Part B/DMERC claim Date of Service is on
 or after 01/01/2008 with a physician service (category
 75). The Part B/DMERC From and Thru Date is within the
 incoming SNF claim.

  Submit an SNF Inpatient Part A claim (21x).
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 298
____________________________________________________________________________


  Response
  The SNF Inpatient Part A claim (21x) is accepted and no
  informational unsolicited response is generated for the
  Part B claim for A/B Crossover edit '7261'.

  Event 3.15
  Submit a Part B/DMERC claim that is accepted and posted
  to history. The Part B/DMERC claim Date of Service is on
  or after 01/01/2008 with a physician service with Modifier
  '26'. The Part B/DMERC From and Thru Date is within the
  incoming SNF claim.

  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 claim for A/B Crossover edit '7261'.

  Event 3.16
  Submit a Part B/DMERC claim that is accepted and posted
  to history. The Part B/DMERC claim Date of Service is on
  or after 01/01/2008 with ambulance service with Modifier
  other than 'NN'. The Part B/DMERC From and Thru Date is
  within the incoming SNF claim.

  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 claim for A/B Crossover edit '7261'.

  Event 3.17

  Response
  The SNF Inpatient Part A claim (21x) is accepted and no
  informational unsolicited response is generated for the
  Part B claim for A/B Crossover edit '7261'.

  ***.......This is the width of the Release Document.......***

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

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 299
____________________________________________________________________________

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1. A/B Crossover module
    2. Informational Unsolicited process

  Solution Criteria: N/A

    EDITS AFFECTED:
  ***.......This is the width of the Release Document......***

  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': Under Development
  Under Development

  Trailer Information: 08, 13, 31

  b. Error Code:    XXXX   ( )New ( )Modified ( )Deleted
  Disposition:

  Type of Record:

  Error Message:

  Set Condition for edit '####':

  Trailer Information:

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 300
____________________________________________________________________________

 c. Error Code:    XXXX   ( )New ( )Modified ( )Deleted
 Disposition:

 Type of Record:

 Error Message:

 Set Condition for edit '####':

 Trailer Information:

 ***.......This is the width of the Release Document......***

 ISSUE/ANSWERS:
 --------------
   RISK/DESIGN ISSUE:

 ***.......This is the width of the Risk/Issue Memo.....***

 **********************************************************
 * Key the RISK/DESIGN ISSUE between the title and the end*
 * line. The CR # and title will appear on daily memo     *
 * with CR-relate information: CMS, BA, SE, SME and CAT. *
 * Example from CR 16871. "John: I keyed answers to your *
 * questions. Please review. Thanks, Joe" or Example      *
 * from CR 17062: "This CR is being placed in CMS status *
 * awaiting CMS's answer concerning TOS 53".              *
 * When keying, only place information that should appear *
 * on the memo between the header and *** width *** line. *
 * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
 **********************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 301
____________________________________________________________________________


   26. 00025627    5725-MEDICARE FRAUD EDIT MODULE

  DATE ENTERED:    08/06/07

  TITLE:           5725-MEDICARE FRAUD EDIT MODULE

  PROJECT CODE:    CM01

  PRIORITY:        1

  RELEASE LEVEL: R2008100

  GROUP LEVEL:     1

  HOST SITE ID:    CWFM2000

  STATUS ON CR:    CMS

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   5
  EST. HOURS:      2000
  ACT. HOURS:      1500
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  The concept for the Fraud Edit Module began as a result of the
  Infusion Therapy fraud in South Florida. First Coast Service
  Options (a Medicare Carrier in Florida) developed a series of
  edits to flag claims with potential improper payments associated
  with Infusion Therapy for further review and denials. The edits
  have helped to reduce improper payments in Florida , but with a
  considerable cost to FCSO operating budget. Recently, data suggested
  that Infusion Therapy fraud was moving to Michigan and NJ/NY. WPS,
  Empire, and NGS developed similar edits to address this same issue.
  In Michigan, these edits have been able to save close to $6.8 M in
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 302
____________________________________________________________________________

  improper payments and $3.1M in NJ and NY.

  Programming these edits, and associated reviews, requires a considerable
  operating expense for contractors. As the fraud moves from state to
  state, the need for a low-cost way to share and implement edits on the
  fly becomes clear. One option is to develop a shared system solution to
  meet this need. Another option would be to develop the edits to work in
  similar fashion as the SuperOps software module. SuperOps allows FISS
  users, and possibly some VIPS users, to meet the above business need.
  Unfortunately, a similar solution does not exist for MCS users, who are
  target of many of the fraudulent schemes in the Medicare FFS program.

  A Fraud Edit Module workgroup was convened consisting of representatives
  from OFM Program Integrity, CMM, OIS and the NY & LA Satellite Offices
  to develop requirements for a proactive Fraud Edit Module that MCS and
  VIPS users can implement on-the-fly edits when potentially fraudulent
  claims are found locally and nationally to prevent Medicare program
  fraud and abuse. This will ultimately provide these contractors with an
  improper fraud editing capability.


  Each Contractor shall have the capability to develop custom, plug
  and play edits to meet specific fraudulent activity.

  The plug and play edits shall incorporate a hierarchy that governs
  how and when edits will be run.

  The edits shall detect inconsistencies using specific claims data
  elements that include, but are not limited, to: CPT code, diagnosis
  code, dates of service, frequency of time, provider specialty, dollar
  amounts, units, place of service, duplicate claims.

  The Contractor shall develop edits that have the capability of
  comparing information against the claims history (up to 27 months
  of data). This shall require measurement of claim to claim and
  comparing other claims in process under the same batch.

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:          25627____________   WORK TYPE:   ___   Incidental
  SUBSYSTEM:   _________________                ___   Minor
  FUNCTION:    _________________                _X_   Major
  PROGRAM:     _________________                ___   New Subsystem

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 303
____________________________________________________________________________

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                   Kathy Woytan
      Telephone:             410-786-4982
      FAX, CMS:              410-786-0271
      Responsibilities:      REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:       Rita Crane
      Telephone:             469-372-2199
      FAX,Richardson,TX:     469-372-0284
      Responsibilities:      DEFINITION, ANALYSIS, SYSTEM TESTING

  2.     PROG ANALYST:
         Telephone:          443-436-____
         FAX,Baltimore,MD:   443-436-3803
         Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                             TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *               blank line is found.                              *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  ( ) Host
  ( ) Satellite Part A Inpatient
  ( ) Satellite Part A Outpatient
  ( ) Satellite Part B
  ( ) Hospice
  ( ) Home Health
  ( ) DMERC
  ***.......This is the width of the Release Document.......***

       REASON FOR CHANGE:

  ***.......This is the width of the Release Document.......***

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 304
____________________________________________________________________________

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

    NEW BUSINESS REQUIREMENTS:

  Requirement 1
  xxxx

  Requirement 2
  xxx

  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  *******************************************************************
  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
  * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
  *******************************************************************
    EVENT-RESPONSE LIST: None
  ***.......This is the width of the Release Document.......***

  Event 1.1

  Response
  ***.......This is the width of the Release Document.......***

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

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 305
____________________________________________________________________________

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1.

  Solution Criteria: N/A

    EDITS AFFECTED: None
  ***.......This is the width of the Release Document......***

  a. Error Code:    XXXX   ( )New ( )Modified ( )Deleted
  Disposition:

  Type of Record:

  Error Message:

  Set Condition for edit '####':

  Trailer Information:


  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************


______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 306
____________________________________________________________________________


  27. 00025629    5728 - MEDICARE FEE FOR SERVICE (FFS) NPI FINAL IMPLEMENTATI

 DATE ENTERED:    08/08/07

 TITLE:           5728 - MEDICARE FEE FOR SERVICE (FFS) NPI FINAL IMPLEMENTATI

 PROJECT CODE:    CM01

 PRIORITY:        N/A

 RELEASE LEVEL: R2008100

 GROUP LEVEL:     1

 HOST SITE ID:    CWFM1000

 STATUS ON CR:    CMSM

 DOC. REQUIRED: N

 HOST EVAL:       N/A

 DOC RECEIVED:    N

 ADDENDUM INFO: NONE

 EST. CATEGORY:   3
 EST. HOURS:      0300
 ACT. HOURS:      0214
 CAT/CR EVAL:     N

 COMMENT:         N/A

  DESCRIPTION:
  ------------
  8/8/07
  THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)
  OF 1996 REQUIRED ISSUANCE OF A UNIQUE PROVIDER IDENTIFIER (NPI
  TO EACH PHYSICIAN, SUPPLIER AND OTHER PROVIDER OF HEALTH CARE
  WHO CONDUCTS HIPAA STANDARD ELECTRONIC TRANSACTIONS. CMS BEGAN
  TO ISSUE NPIS ON MAY 23, 2005. CMS HAS BEEN ALLOWING TRANSACTIONS
  ADOPTED UNDER HIPAA TO BE SUBMITTED WITH A VARIETY OF IDENTIFIERS.
  THEY ARE: NPI ONLY
             MEDICARE LEGACY ONLY
             NPI AND LEGACY COMBINATION
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 307
____________________________________________________________________________


  ON APRIL 2, 2007 THE DEPARTMENT OF HEALTH AND HUMAN SERVICES
  (DHHS) PROVIDED GUIDANCE TO COVERED ENTITIES REGARDING CONTIN-
  GENCY PLANNING FOR THE IMPLEMENTATION OF THE NPI. AS LONG AS A
  HEALTH PLAN IS COMPLIANT (THEY ACCEPT AND SEND NPIS ON ELECTRONIC
  TRANSACTIONS) THEY MAY ESTABLIC CONTINGENCY PLANS TO FACILITATE
  THE COMPLIANCE OF THEIR TRADING PARTNERS. AS A COMPLIANT HEALTH
  PLAN, MEDICARE FEE FOR SERVICE (FFS) ESTABLISHED A CONTINGENCY
  PLAN ON APRIL 20, 2007 THAT FOLLOWED THIS GUIDANCE.
  THIS CR DIRECTS CONTRACTORS TO BEGIN REJECTING HIPAA INBOUND
  CLAIMS IF THEY CONTAIN LEGACY PROVIDER IDENTIFIERS.

  MEDICARE FFS REQUIRES TRANSACTIONS TO CONTAIN AN NPI; IT ALSO
  SURRENTLY ALLOWS BOTH NPI AND LEGACY IDENTIFIERS. ON, AND
  AFTER MAY 23, 2008 THE LEGACY NUMBER WILL NOT BE PERMITTED ON ANY
  INBOUND OR OUTBOUND TRANSACTIONS. CONTRACTORS ARE TO BEGIN REJECTING
  CLAIMS, BOTH ELECTRON, INCLUDING DIRECT DATA ENTRY (DDE) AND PAPER
  THAT CONTAIN A LEGACY PROVIDER IDENTIFER FOR ANY PRIMARY PROVIDER.
  THE NPI MUST BE SENT.
  CMS DOES NOT WISH FOR CWF TO CROSSOVER TO THE TRADING PARTNERS
  PART A OR PART B CLAIMS THAT HAVE BEEN SUBMTITED WITHOUT AN
  NPI.

  CWF CHANGES:
  For claims received on, or after MAY 23, 2008 CWF will bypass
  the cobs process when an NPI Number is not submitted in field
  084-093 for HUIP, HUOP, HUHH or HUHC records.

  If the NPI/Provider Number is not submitted CWF will not cross
  the claim over, and a Trailer '29' will not be generated.

  This CR has an implementation date of ????

  Yvonne Anderson
  CWFM Support Team

  469 372-5420

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:         _________________   WORK TYPE: ___ Incidental
  SUBSYSTEM: _________________                ___ Minor
  FUNCTION:   _________________               ___ Major
  PROGRAM:    _________________               ___ New Subsystem
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 308
____________________________________________________________________________


  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:
      Telephone:             410-786-____
      FAX, CMS:              410-786-0271
      Responsibilities:      REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:
      Telephone:         469-372-____
      FAX,Richardson,TX: 469-372-0284
      Responsibilities: DEFINITION, ANALYSIS, SYSTEM TESTING

  2.     PROG ANALYST:
         Telephone:          443-436-____
         FAX,Baltimore,MD:   443-436-3803
         Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                             TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *               blank line is found.                              *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  ( ) Host
  ( ) Satellite Part A Inpatient
  ( ) Satellite Part A Outpatient
  ( ) Satellite Part B
  ( ) Hospice
  ( ) Home Health
  ( ) DMERC
  ***.......This is the width of the Release Document.......***

       REASON FOR CHANGE:

  ***.......This is the width of the Release Document.......***
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 309
____________________________________________________________________________


 Analyze Current Situation:

 Alternative Solutions: N/A

 Evaluation of Alternative Solutions: N/A

 Recommendation: N/A


 *******************************************************************
 * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
 * the release document. Numerically list statements that reflect *
 * the NEW BUSINESS REQUIREMENTS.                                  *
 *******************************************************************

   NEW BUSINESS REQUIREMENTS:

 Requirement 1
 xxxx

 Requirement 2
 xxx

 ***.......This is the width of the Release Document.......***


 The Event-Response List provides a description of the way
 that the system should function AFTER the change.

 *******************************************************************
 * If you want the EVENT-RESPONSES printed in the release document *
 * remove the word "None" and delete the delimiter line. Number    *
 * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
 * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
 *******************************************************************
   EVENT-RESPONSE LIST: None
 ***.......This is the width of the Release Document.......***

 Event 1.1

 Response
 ***.......This is the width of the Release Document.......***

  The Entity List includes only NEW acronyms and terminology
  that is currently not in use in CWF.
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 310
____________________________________________________________________________


  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1.

  Solution Criteria: N/A

    EDITS AFFECTED: None
  ***.......This is the width of the Release Document......***

  a. Error Code:    XXXX   ( )New ( )Modified ( )Deleted
  Disposition:

  Type of Record:

  Error Message:

  Set Condition for edit '####':

  Trailer Information:


  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 311
____________________________________________________________________________


  From         "Woytan, Kathryn         08/09/2007 1:59PM

               A. (CMS/OIS)"

               <Kathryn.Woytan@c
  To
               ms.hhs.gov>
  YVONNE.ANDERSON@trailblazerhealth.com,
                                            "Pflaum, Cathy M. (CMS/OIS)"

                                            <Cathy.Pflaum@cms.hhs.gov>,

                                            "Wolfsheimer, Richard E.
                                            (CMS/OIS)"

                                           <Richard.Wolfsheimer@cms.hhs.gov>,
                                            "Rogers, Vivian A. (CMS/OIS)"

                                            <Vivian.Rogers@cms.hhs.gov>,


  VICKI.SOMMERS@trailblazerhealth.com
                                            , John P Alexander/CIV/CSC@CSC,
                                            Don Moon/CIV/CSC@CSC, Chet

                                            Powell/CIV/CSC@CSC,

                                            vvuyyuru@csccom, Jacqueline



   08/08/2007 11:36 AM              kwoytan@cms.hhs.gov,
                                    cpflaum@cms.hhs.gov,
                                    rwolfsheimer@cms.hhs.gov,
                                    vivian.rogers@cms.hhs.gov,
                                    VICKI.SOMMERS@trailblazerhealth.com,
                                    John P Alexander/CIV/CSC@CSC, Don
                                    Moon/CIV/CSC@CSC, Chet
                                    Powell/CIV/CSC@CSC, vvuyyuru@csccom,
                                    Jacqueline Dolphus/CIV/CSC@CSC, Ronald
                                    Dodson/CIV/CSC@CSC


                                                                     Subje
                                    RE: POC Review (2nd): CR #5728 Medicar
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 312
____________________________________________________________________________

                                    Fee For Service (FFS) Nationa


  Yvonne,

  One CR is fine with a April implementation date.

  Kathy Woytan
  Business Applications Management Group
  Division of Business Application Analysis
  Common Working File Group Team Lead
  Kathryn.Woytan@cms.hhs.gov
  410-786-4982

  --------------------------------------------------------
  -----Original Message-----
  From: Yvonne.Anderson
  To: Kwoytan@cms.hhs.gov.tbhe

  Sent: Wednesday, August 08, 2007 11:37 AM

  Kathy,
  CWF CR25629 has been created to address the issues in PM5728. 5728 has
  an implementation date of January 2008 and April 2008. In reviewing the
  comments for the PM the author of the CR, Joy Glass states the changes
  for this CR will span two releases. January will be the analysis and
  April will be the actual implementation.

  I have only created one CR for CWF because the changes necessary for
  CWF do not require analysis. We will bypass the COBC process as we have
  done in numerous other CRs.

  Do you agree a January CR is not necessary, or would you prefer two CRs
  opened. If you agree with only opening one CR, an implementation date of
  April 2008 would be assigned to 25629.

  Thanks,

  Yvonne J. Anderson
  IT Business Analyst II
  CWFM Support
  Trailblazer Health Enterprises Inc.
  8330 LBJ Freeway
  Executive Center III
  Dallas TX 75243

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 313
____________________________________________________________________________

  (469) 372-5420 Telephone
  (469) 372-0284 Fax

  -----Original Message-----
  From:                  echimp@cms.hhs.gov.TBHE




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 314
____________________________________________________________________________


   28. 00025636    ELIGIBILITY AUDIT PURGE

  DATE ENTERED:    08/20/07

  TITLE:           ELIGIBILITY AUDIT PURGE

  PROJECT CODE:    CM01

  PRIORITY:        1

  RELEASE LEVEL: R2008100

  GROUP LEVEL:     2

  HOST SITE ID:    CWFM1000

  STATUS ON CR:    INIT

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   3
  EST. HOURS:      0300
  ACT. HOURS:      0220
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  Create a job to purge the ELIGIBILITY AUDIT File by date;
  yearly or by request.

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:         _________________   WORK TYPE: ___ Incidental
  SUBSYSTEM: _________________                ___ Minor
  FUNCTION:   _________________               ___ Major
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 315
____________________________________________________________________________

  PROGRAM:       _________________                ___ New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:
      Telephone:             410-786-____
      FAX, CMS:              410-786-0271
      Responsibilities:      REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:
      Telephone:         469-372-____
      FAX,Richardson,TX: 469-372-0284
      Responsibilities: DEFINITION, ANALYSIS, SYSTEM TESTING

  2.     PROG ANALYST:
         Telephone:          443-436-____
         FAX,Baltimore,MD:   443-436-3803
         Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                             TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *               blank line is found.                              *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (x) Host
  ( ) Satellite Part A Inpatient
  ( ) Satellite Part A Outpatient
  ( ) Satellite Part B
  ( ) Hospice
  ( ) Home Health
  ( ) DMERC
  ***.......This is the width of the Release Document.......***

       REASON FOR CHANGE:

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 316
____________________________________________________________________________

  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A

  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
  Create a job to purge the ELIGIBILITY AUDIT File yearly or by
  request. The first step of the job will be to backup the
  Eligibility Audit file (ELGAUDIT). The next step will read the
  Eligibility Audit file to separate the data into two output
  files. The two output files will be determine by a date
  parameter(YYCCMMDD). Any data record's date is less or equal
  the date parameter will be written to the Purge file and
  the remaining data records will be written to the Load file.
  The following step will delete and define (IDCAMS) Eligibility
  Audit file to get the file ready for the next step to load the
  Required data. The finally step will take the output Load file
  from the previous step and load the data to Eligibility Audit
  file needed for Eligibility Report process.


  Note: When purging the Eligibility Audit file other than yearly
  And by request; the output Purge File will be added as input
  along with the Eligibility Audit file in Job CABMDC08 for the
  Eligibility reporting process.




  ***.......This is the width of the Release Document.......***
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 317
____________________________________________________________________________



  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  *******************************************************************
  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
  * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
  *******************************************************************
    EVENT-RESPONSE LIST: None
  ***.......This is the width of the Release Document.......***

  Event 1.1

  Response
  ***.......This is the width of the Release Document.......***

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

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1.

  Solution Criteria: N/A

    EDITS AFFECTED: None
  ***.......This is the width of the Release Document......***

  a. Error Code:    XXXX   ( )New ( )Modified ( )Deleted
  Disposition:

  Type of Record:

  Error Message:

  Set Condition for edit '####':

  Trailer Information:


______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 318
____________________________________________________________________________

 ***.......This is the width of the Release Document......***

 ISSUE/ANSWERS:
 --------------
   RISK/DESIGN ISSUE:

 ***.......This is the width of the Risk/Issue Memo.....***

 **********************************************************
 * Key the RISK/DESIGN ISSUE between the title and the end*
 * line. The CR # and title will appear on daily memo     *
 * with CR-relate information: CMS, BA, SE, SME and CAT. *
 * Example from CR 16871. "John: I keyed answers to your *
 * questions. Please review. Thanks, Joe" or Example      *
 * from CR 17062: "This CR is being placed in CMS status *
 * awaiting CMS's answer concerning TOS 53".              *
 * When keying, only place information that should appear *
 * on the memo between the header and *** width *** line. *
 * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
 **********************************************************




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 319
____________________________________________________________________________


   29. 00025653    5775 - ANNUAL 2008 HCPCS UPDATE

  DATE ENTERED:    09/05/07

  TITLE:           5775 - ANNUAL 2008 HCPCS UPDATE

  COMB:            00025667

  PROJECT CODE:    CM01

  PRIORITY:        1

  RELEASE LEVEL: R2008100

  GROUP LEVEL:     1

  HOST SITE ID:    CWFM1000

  STATUS ON CR:    CMS

  DOC. REQUIRED: N

  HOST EVAL:       N/A

  DOC RECEIVED:    N

  ADDENDUM INFO: NONE

  EST. CATEGORY:   4
  EST. HOURS:      0750
  ACT. HOURS:      0470
  CAT/CR EVAL:     N

  COMMENT:         N/A

  DESCRIPTION:
  ------------
  9/5/07

  Medicare contractors shall download the 2008 annual HCPCS
  update from the CMS mainframe. The file may be retrieved after
  8:00 p.m. Eastern time , on October 24, 2007.
  The Web site address is http://www.cms.hhs.gov/HCPCSRelease
  CodeSets/ANHCPCS/list.asp.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 320
____________________________________________________________________________


  This CR has an effective date of January 1, 2008 with an
  implementation date of January 7, 2008.

  Karen Chaffin
  CWFM Support Teams
  469-372-0645

  REQUIREMENTS:
  -------------
              DEFINITION AND ANALYSIS PHASES

  CR:          _25653___________    WORK TYPE:   ___   Incidental
  SUBSYSTEM:   _________________                 ___   Minor
  FUNCTION:    _________________                 _X_   Major
  PROGRAM:     _________________                 ___   New Subsystem

  DEFINITION PHASE ORGANIZATION

  CMS Participants:
  1. Name:                 Vivian Rogers
      Telephone:           410-786-8142
      FAX, CMS:            410-786-0271
      Responsibilities:    REVIEW TECH DESIGN, APPROVE MODS

  CWFM Participants:
  1. BUSINESS ANALYST:     Karen Chaffin
      Telephone:           469-372-0645
      FAX,Richardson,TX:   469-372-0284
      Responsibilities:    DEFINITION, ANALYSIS, SYSTEM TESTING

  2.   PROG ANALYST:       Gopal Kumar/ Margarita Podyachev
       Telephone:          443-436-6733/ 443-436-6608
       FAX,Baltimore,MD:   443-436-3803
       Responsibilities:   ANALYSIS, TECH DESIGN, CONSTRUCTION, UNIT
                           TESTING


  *******************************************************************
  * PARAGRAPHS - Start in column 1. The paragraph will end when a *
  *              blank line is found.                               *
  * HEADINGS   - Start in column 2.                                 *
  * FREE-FORMAT- Start in column 3.                                 *
  * Use upper and Lower case.                                       *
  *                                                                 *
  * EDITING    - Please allow 2 spaces after a period and 2 spaces *
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 321
____________________________________________________________________________

  *               after a colon. Try to format as it should appear *
  *               in the Release Document.                          *
  *******************************************************************
    IMPACT:
  (X) Host
  (X) Satellite Part A Inpatient
  (X) Satellite Part A Outpatient
  (X) Satellite Part B
  (X) Hospice
  (X) Home Health
  (X) DMERC
  ***.......This is the width of the Release Document.......***

    REASON FOR CHANGE:
  The year-end updates from the CMS HCPCS tape will be done with
  this CR.

  -The Type of Service codes are not carried over from the
   existing CWF file to the new file after the CMS Tape load
   is processed.

  -Any new HCPCS codes that require CLIA editing for Category
   '12' must be identified.

  -Any new HCPCS codes that require CLIA editing for Category
   '69' must be identified.

  -All CLIA classifications currently identified on the HCPCS
   Table must continue to be shown.

  -Any new surgical HCPCS codes with a global period must be
   identified, and the Follow-Up Days (FUD) for those surgeries
   must be updated on the HCPCS Inquiry Screen (HCPI) in HIMR.

  -HCPCS codes identified as surgical assistant must have a
   Type of Service '8'.

  -Add Type of Service 'F' to all the HCPCS codes in the annual
   update that have a 'YY' in the ASC Payment field.


  ***.......This is the width of the Release Document.......***

  Analyze Current Situation:

  Alternative Solutions: N/A
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 322
____________________________________________________________________________


  Evaluation of Alternative Solutions: N/A

  Recommendation: N/A


  *******************************************************************
  * The NEW BUSINESS REQUIREMENT will be extracted, as written, for *
  * the release document. Numerically list statements that reflect *
  * the NEW BUSINESS REQUIREMENTS.                                  *
  *******************************************************************

   NEW BUSINESS REQUIREMENTS:

  Requirement 1
  Load the CMS HCPCS tape for this release.

  Requirement 2
  Add checks to reinstate the original Type of Service (TOS)
  codes that are not on the CMS HCPCS tape.

  Requirement 3
  Identify any new HCPCS codes that require CLIA editing, and
  add them to Category '12'.

  Requirement 4
  Identify any new HCPCS codes that require CLIA editing, and
  add them to Category '69'.

  Requirement 5
  Ensure that all the CLIA classifications shown on the HCPCS
  Table are retained.

  Requirement 6
  Identify any new global surgery HCPCS codes being added, and
  update the Follow-Up Days (FUD) associated with those codes.

  Requirement 7
  Ensure that all HCPCS codes identified as surgical assistant
  have a Type of Service '8'.

  Requirement 8
  Add a Type of Service 'F' to all codes in the annual update
  that have a 'YY' in the ASC Payment Field.

  Requirement 9
______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 323
____________________________________________________________________________

  Modify HCPCAUPD to process as follows:

  - If Effective Dates on the HCPCS Table do not match the
    Effective Dates on the CMS tape, retain the dates from
    the HCPCS Table.

  - If a HCPCS code is new, add it to the HCPCS Table along
    with the appropriate HCPCS Categories where applicable.

  - If a HCPCS code has a delete status, terminate the record
    if it is not already terminated . Use the Termination Date
    12/31/2007.

    Note:     The HCPCS Table is cumulative; no records should
              be deleted.

  ***.......This is the width of the Release Document.......***


  The Event-Response List provides a description of the way
  that the system should function AFTER the change.

  *******************************************************************
  * If you want the EVENT-RESPONSES printed in the release document *
  * remove the word "None" and delete the delimiter line. Number    *
  * Events to correspond with the NEW BUSINESS REQUIRMENTS.         *
  * NBR 1, Event would be 1.1, NBR 2, Events would be 2.1, 2.2, etc.*
  *******************************************************************
    EVENT-RESPONSE LIST: None
  ***.......This is the width of the Release Document.......***

  Event 1.1

  Response
  ***.......This is the width of the Release Document.......***

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

  Entity List: N/A
    1. Entity:
        Description:

  Areas Affected by the Problem.
    1.

______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Change Requests                                                      Page 324
____________________________________________________________________________

  Solution Criteria: N/A

    EDITS AFFECTED: None
  ***.......This is the width of the Release Document......***

  a. Error Code:    XXXX   ( )New ( )Modified ( )Deleted
  Disposition:

  Type of Record:

  Error Message:

  Set Condition for edit '####':

  Trailer Information:


  ***.......This is the width of the Release Document......***

  ISSUE/ANSWERS:
  --------------
    RISK/DESIGN ISSUE:

  ***.......This is the width of the Risk/Issue Memo.....***

  **********************************************************
  * Key the RISK/DESIGN ISSUE between the title and the end*
  * line. The CR # and title will appear on daily memo     *
  * with CR-relate information: CMS, BA, SE, SME and CAT. *
  * Example from CR 16871. "John: I keyed answers to your *
  * questions. Please review. Thanks, Joe" or Example      *
  * from CR 17062: "This CR is being placed in CMS status *
  * awaiting CMS's answer concerning TOS 53".              *
  * When keying, only place information that should appear *
  * on the memo between the header and *** width *** line. *
  * DELETE THIS FLOWER BOX. RISK/DESIGN MUST BE TOP LINE. *
  **********************************************************
  TOTAL RECORDS: 29
  TOTAL RECORDS: 0




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland
Common Working File                                                  R2008100
Full Requirements Document                                    October 3, 2007
Analysis Change Requests                                             Page 325
____________________________________________________________________________


II.   ANALYSIS CHANGE REQUESTS


None to report




______________________________________________________________________________
Computer Sciences Corporation                             Baltimore, Maryland

				
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