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NHIC, Corp.

MEDICARE ADMINISTRATIVE CONTRACTOR


JURISDICTION 14 A/B MAC

Electronic Data Interchange


Testing Guide

NHIC, Corp.
75 Sgt. William Terry Drive
Hingham, MA 02044
www.medicarenhic.com
MAN-EDI-0007 V2.0 Release date: 12/08/2010
The controlled version of this document resides on the NHIC Quality Portal (SharePoint). Any other version or copy, either
electronic or paper, is uncontrolled and must be destroyed when it has served its purpose.
.
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TABLE OF CONTENTS

PREFACE……………………………………………………………………………………………………..3

CONTACT INFORMATION ………………………………………………………………………………..3

WELCOME TO EDI -------------------------------------------------------------------------------------------------------4

EDI ENROLLMENT ..………………………………………………………..…………………………5 thru 6

CARRIER BULLETIN BOARD SYSTEM………………………………………………………………..7 thru 8

EDI TESTING ………………...…………………………………………………………………….…………….8

EDI TESTING PHASE CHECKLIST………………………………………………………………………….……9 thru 10

EDI TESTING RESULTS……..…………………………………………………………………………...………… 10

CLAIM DATA FOR TESTING ..………………………………………………………………. ……………11 thru 13

THE CABBS ONLINE ERROR SUMMARY REPORT………………………………………………………… 14 thru 17

NHIC, Corp.
75 Sgt. William Terry Drive
Hingham, MA 02044
www.medicarenhic.com
MAN-EDI-0007 V2.0 Release date: 12/08/2010
The controlled version of this document resides on the NHIC Quality Portal (SharePoint). Any other version or copy, either electronic or
paper, is uncontrolled and must be destroyed when it has served its purpose.
.
Page 3
PREFACE

A primary responsibility of Medicare is to provide high quality, accessible, and cost effective
information to the Medicare community.

This manual is intended to serve as a resource showing the electronic services available to you.
The information provided herein does not represent a guarantee of payment. Coverage for services
is based on the patient’s eligibility, provisions of the Law and regulations, and instructions from
the Centers for Medicare & Medicaid Services (CMS).

NHIC, Corp. Medicare Administration makes every effort to ensure that the information contained in
this guide is accurate and current. The edition date appears on each page. However, because the
Medicare program is constantly changing, it is the responsibility of each provider or practitioner to keep
abreast of the Medicare program requirements.

For more detailed information about the products and services offered through the Medicare program,
please refer to the Medicare Part B Billing Manual. For continuing updates to Medicare policies, billing
guidelines, products and services are available to you, refer to the regularly published Your Medicare
Newsletter. Additionally, further information may be accessed on our website by visiting
www.medicarenhic.com.
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CONTACT INFORMATION NEW ENGLAND


New England (States of Maine, Massachusetts,
New Hampshire, and Vermont)

EDI Customer Service – All EDI Issues Our toll free number is: 1-877-386-1056
Facsimile (781) 741-3523
(781) 741-3032
Email: EDINHIC@HP.com

Mailing Address

NHIC, Corp.-Medicare NHIC, Corp.-Medicare


EDI Department EDI Department
PO Box 9104 75 Sgt. William Terry Drive
Hingham, MA 02044 Hingham, MA 02043
NHIC, Corp.
75 Sgt. William Terry Drive
Hingham, MA 02044
www.medicarenhic.com
MAN-EDI-0007 V2.0 Release date: 12/08/2010
The controlled version of this document resides on the NHIC Quality Portal (SharePoint). Any other version or copy, either electronic or
paper, is uncontrolled and must be destroyed when it has served its purpose.
.
Page 4

WELCOME TO EDI
We are pleased that you have chosen to join the majority of Medicare providers now billing claims
electronically. We are confident that Electronic Data Interchange (EDI) will result in accurate and
timely processing of your claims.

Your EDI Submitter Number (Code) is your permanent and unique identification number for all EDI
transactions. Please have it available when calling Medicare so we may assist you in a timely manner.

Enclosed is your “New EDI Submitter Starter Kit”. This kit was prepared to help ensure a smooth
transition from paper to electronic claim submission.

As an EDI Submitter, you can now take advantage of the following:


 Priority processing – Claims received electronically go directly into our system for processing,
ensuring faster turnaround. Paper claims are processed only after manual sorting and batching.
 Better Cash Flow – Electronically submitted claims are paid faster than paper claims. Clean
claims submitted with covered/payable services can be paid on the 14th day of receipt as compared
to the 28th day for paper claims.
 Edit Reports (Edit Status Report, 997 Acknowledgement Report, Error Summary Report) - You
receive electronic verification that your EDI claims have been received and are being processed by
Medicare’s claim system (see your software vendor for more information on how to receive
reports.) No verification is mailed out for paper claims; verification can only be made either
through a call to Medicare for confirmation or receipt of your Remittance Advice.
 Access to the Beneficiary Eligibility System (BES) – If you are a participating provider sending
claims via a computer modem, you can use your beneficiary eligibility module to check if your
patients are eligible for Medicare Part B, have met their deductible, or if they are locked into an
HMO. See your software vendor for details.
 Access to automatic posting of your remittance advice – If your software has an ERA retrieval and
posting module you could have your Medicare remittances automatically posted into your system.
Manual posting and reconciliation of your remittance advice are eliminated.
 EDI Technical Support Staff – Representatives are available to provide technical support to handle
your Medicare EDI needs.
Once you reviewed your EDI Starter Kit, if you have any questions, please call the EDI Technical
Support Staff for the Medicare office that processes your claims.

NHIC, Corp.
75 Sgt. William Terry Drive
Hingham, MA 02044
www.medicarenhic.com
MAN-EDI-0007 V2.0 Release date: 12/08/2010
The controlled version of this document resides on the NHIC Quality Portal (SharePoint). Any other version or copy, either electronic or
paper, is uncontrolled and must be destroyed when it has served its purpose.
.
Page 5
EDI ENROLLMENT
The following collection of tips will assist you in completing the Electronic Data Interchange (EDI)
enrollment process. Following these guidelines will ensure that your EDI enrollment application is
processed correctly in a timely manner. You will find EDI applications and information on enrollment
status on your regional Part B EDI website.

√ Both the EDI Profile Form and EDI Enrollment Form signature page are required for first-time
enrollment in EDI.

√ The application must be signed* by the Medicare Part B provider submitting the electronic
claims and not the billing service, clearing house, vendor etc., title requirements must be met.

√ First-time enrollments must be mailed to your regional EDI office, they may not be faxed.

√ The provider must have an NPI # and the NPI # must be on the application or it will not be
processed.

√ Incomplete EDI Profile / Enrollment Forms will not be processed, forms missing pages will not
be processed.

√ A separate EDI Enrollment must be completed for multiple providers or multiple groups.

*Signature & Title: Please follow the signature / title requirements below, or the enrollment
request may not be processed:
o EDI forms must be signed by the billing / pay-to provider and the title must be listed, per below.
o If a doing-business-as-name (DBA) appears on the professional letterhead the title must be:
• Owner, President or CEO
• Owner/Partner, if the entity is a partnership
• If the entity does not have an individual who holds one of the titles listed above, the
Signature Page may be signed by the Authorized / Delegated Official on file with
the Provider Enrollment Department
• If only the given name is used on the professional letterhead, MD, PhD, DO, etc.,
will be accepted

• No one else may sign

NHIC, Corp.
75 Sgt. William Terry Drive
Hingham, MA 02044
www.medicarenhic.com
MAN-EDI-0007 V2.0 Release date: 12/08/2010
The controlled version of this document resides on the NHIC Quality Portal (SharePoint). Any other version or copy, either electronic or
paper, is uncontrolled and must be destroyed when it has served its purpose.
.
Page 6

Please retain one copy for your files and return an original, completed copy to:

NHIC, Corp.
P.O. Box 9104
ATTN: EDI DEPARTMENT
HINGHAM, MA 02044

NHIC, Corp.
75 Sgt. William Terry Drive
Hingham, MA 02044
www.medicarenhic.com
MAN-EDI-0007 V2.0 Release date: 12/08/2010
The controlled version of this document resides on the NHIC Quality Portal (SharePoint). Any other version or copy, either electronic or
paper, is uncontrolled and must be destroyed when it has served its purpose.
.
Page 7

CARRIER BULLETIN BOARD SYSTEM


CABBS allows the provider to:
• Send Medicare claims electronically
• Receive abbreviated error summary reports of electronically transmitted files
• Receive Electronic Remittance Advice (ERA)

Equipment Required For Electronic Exchange

• Electronic claim submission requires a computer capable of running communication software


while connected to a modem.

• The modem should have the capacity to connect to your system and to communicate with a
remote system via a voice grade telephone line at either 9600, 14,400, 28,800, 33,600, 56,000
baud or higher.

• The Communication software must support one or more of the following transmission
protocols using CRC error checking:

1) X-MODEM 4) KERMIT
2) Y-MODEM 5) BLAST
3) Z-MODEM

• Voice grade telephone line, no DSL, no cable telephone connection, no Call Waiting, or Call
Waiting turned off while connected to CABBS.

Connecting to CABBS via Direct Access

Prior to connecting to CABBS via Direct Access you should have your unique SUBMITTER ID and
be prepared to select your Password.

Using your communications software, dial the CABBS Direct Access number (781) 741-1100 for New
England. When you are first connected, press <enter>. You should now scroll to a screen that looks
like this:

Connected to 00xx Electronic Data Systems


Authorized users only, please.
Submitter ID:

NHIC, Corp.
75 Sgt. William Terry Drive
Hingham, MA 02044
www.medicarenhic.com
MAN-EDI-0007 V2.0 Release date: 12/08/2010
The controlled version of this document resides on the NHIC Quality Portal (SharePoint). Any other version or copy, either electronic or
paper, is uncontrolled and must be destroyed when it has served its purpose.
.
Page 8
At the Submitter ID prompt, type in the Submitter ID and press <enter>.
The responses to the Submitter ID and Password prompts are not case sensitive.
You will now be prompted for a Password. Your temporary password is CABBS!99.

Password:
Type in your password. (You will not be able to see the password on the screen as it is entered.)
Password must be at least 8 characters in length and include at least one number and at least
one upper or lower case letter and one special character of “!” or “@” or “#”. You will be prompted
to re-enter the password for verification. Once you press <Enter> you should now be successfully
logged on to CABBS. The new password you entered will be your password for the next 30 days until
it expires and a new password is entered.

EDI TESTING
Once you have an EDI submitter number and have been trained on how to use your software, you must
successfully transmit test claims before you can transmit “live” or production claims to
NHIC, Corp. Testing your software will reduce the number of rejections or re-transmissions resulting
from insufficient or incorrect data. In addition, testing your software will ensure that your program is
capable of producing a valid claim file.
A test batch must be transmitted if you are:

A. A first time EDI user;


B. An existing EDI user converting to a new software system; or
C. An existing EDI user undergoing a major system update, e.g., format updates.

You must submit a test file within 10 days of being issued a submitter number. Failure to send a test
file will result in your Submitter Number being deactivated by Medicare. Remember, you must
continue to bill your production claims on paper while you go through the testing process.

Your electronic test must consist of 25 claims that are a representation of your practice. This 25-claim
minimum may be waived at Carrier discretion. We recommend you test using previously billed claim
information. Please use appropriate ICD9 diagnostic coding and the appropriate CPT and HCPCS
procedure codes in your test claims. Remember, the claims submitted for testing will not be
processed for payment.
NHIC, Corp.
75 Sgt. William Terry Drive
Hingham, MA 02044
www.medicarenhic.com
MAN-EDI-0007 V2.0 Release date: 12/08/2010
The controlled version of this document resides on the NHIC Quality Portal (SharePoint). Any other version or copy, either electronic or
paper, is uncontrolled and must be destroyed when it has served its purpose.
.
Page 9
To begin testing, make sure your software indicator is set to Test status. Enter your submitter number
and password, and then proceed with sending your test claims.

EDI TESTING PHASE CHECKLIST


Please check off each activity that you have completed.

 1. Billing software, computer and modem meet Medicare’s specifications.

 2. I/we completed two copies of the enclosed Electronic Data Interchange (EDI) Enrollment
Form completed, one returned to NHIC, Corp. (with original signature requested) and the
other on file for my records.

 3. I/we contacted the Medicare EDI Technical Team. My EDI


Submitter \ Number is confirmed.

 4. Billing personnel have been trained to use the software and a test file consisting of
25 claims ready to send . Test claim information is representative of our
practice’s service but does not have to be from new Medicare claims. (You may use old claim
information previously processed on paper.)

 5. I/we switched the indicator on our software to “Test” status.

 6. Test claims are submitted into a read only system in Medicare and are not processed for
payment. These claims are test claims and if they contain real claim data, the claims were
sent for processing as paper to Medicare

 7. I/we have transmitted out first test batch within 10 days of receiving our Submitter
Number.
 8. I/we have retrieved the Edit Status Report, 997 Acknowledgment Report, and Error Summary
Report from the CABBS electronic mailbox. This is not a confirmation of approval to
submit production EDI claims.

 9. I/we have received test results from Medicare (This should occur within 3-4 working days
from the date Medicare receives the test). Please Note: If you have not received a verbal
acknowledgment of the receipt of your claims after 3 working days; call your local EDI Tester.

NHIC, Corp.
75 Sgt. William Terry Drive
Hingham, MA 02044
www.medicarenhic.com
MAN-EDI-0007 V2.0 Release date: 12/08/2010
The controlled version of this document resides on the NHIC Quality Portal (SharePoint). Any other version or copy, either electronic or
paper, is uncontrolled and must be destroyed when it has served its purpose.
.
Page10

 10. I/we have received written or verbal confirmation to begin billing EDI in production. I/we
have switched our claims indicator from “Test” to “Production” mode. If I/we need
assistance, I/we will contact our programmer or software vendor.
 11. I/we have successfully passed the Testing Phase, if I/we have questions or inquiries related to
production transmission, invalid submitter number, or telecommunication difficulties
I/we should call the EDI Technical Team for the Medicare office that processes our claims.

If you have questions or inquiries related to claims, check status, denials, EOMB, new billing requirements,
coverage, you should call the Customer Service department for the Medicare office that processes your claims.

EDI TESTING RESULTS

Once you have transmitted a test file, please verify that the file was received. The transmission log
can be viewed from option #5 at the claims submission menu. The following business day you will
receive an electronic 997 Acknowledgment report and a “Test Error Summary Report” (providing the
997 Acknowledgment was accepted in the CABBS mailbox). This report will verify that you have
transmitted a test claims file, but it is not a confirmation that the testing is complete, or that you
can begin submitting production claims. The EDI Testing Coordinator will contact you directly and
provide you with feedback and test results. In addition, your test file will be analyzed according to
your specific billing requirements.

The Testing Coordinator will contact you within three business days from the day your file and all
associated reports are received. Depending on the results, you will either be approved for production
and will be instructed to change your “Test” indicator in your program to “Production” status or you
will asked to re-submit your test with the appropriate corrections. Please contact your local EDI
department if you do not receive a call within three business days of sending your test claims.

NHIC, Corp.
75 Sgt. William Terry Drive
Hingham, MA 02044
www.medicarenhic.com
MAN-EDI-0007 V2.0 Release date: 12/08/2010
The controlled version of this document resides on the NHIC Quality Portal (SharePoint). Any other version or copy, either electronic or
paper, is uncontrolled and must be destroyed when it has served its purpose.
.
Page11

CLAIM DATA FOR TESTING


The following is a list of required claims needed to successfully complete your testing. A minimum of
25 claims are required to ensure all essential EDI criteria are tested completely. Remember, certain
requirements may be waived depending on your EDI submission requirements. Ask your EDI Testing
Coordinator for details.

If You Are A Vendor / Billing Service or Clearing House

Submit the following types of claims:

1. Patient with a secondary supplemental insurance, Medicaid or Medigap (SBR*S – Loop


2320, 2330A, 2330B)
2. Facility name and address (NM1*FA – Loop 2310D)
3. Hospital Admission Date (DTP*435 – Loop 2300)
4. Referring physician name and NPI # (NM1*DN – Loop 2310A or 2420F)
5. Comment /Note (NTE*ADD – Loop 2300 or 2400)
6. Date last seen (date when patient last saw their primary doctor). (DTP*304 – Loop 2300 or
2400)
7. CLIA number (when a submitter bills for laboratory work) (REF*X4 – Loop 2300 or 2400)
8. Medicare Secondary Payer (MSP) (AMT*D, AMT*B6 – Loop 2320; CN1, AMT*AAE –
Loop 2400; SVD, DTP*573 – Loop 2430)

If You Bill For Podiatry Services

Submit the following types of claims:


1. Patient with a secondary supplemental insurance, Medicaid or Medigap (SBR*S – Loop 2320,
2330A, 2330B)
2. Facility name and address (visit or surgery) (NM1*FA – Loop 2310D)
3. Name and NPI Number of the supervising provider (NM1*DQ -Loop 2310E)
4. Comments/Note (NTE*ADD – Loop 2300 or 2400)
5. Date last seen (Date when patient last saw their primary doctor) (DTP*304 – Loop 2300 or 2400)

NHIC, Corp.
75 Sgt. William Terry Drive
Hingham, MA 02044
www.medicarenhic.com
MAN-EDI-0007 V2.0 Release date: 12/08/2010
The controlled version of this document resides on the NHIC Quality Portal (SharePoint). Any other version or copy, either electronic or
paper, is uncontrolled and must be destroyed when it has served its purpose.
.
Page12

If You Bill For Chiropractic Services

Submit the following types of claims:


1. Patient with a secondary supplemental insurance, Medicaid or Medigap (SBR*S – Loop 2320,
2330A, 2330B)
2. Initial treatment date (DTP*454 – Loop 2300 or 2400)

If You Are An Independent Physiological Laboratory (IPL)

Submit the following types of claims:


1. Referring physician name and NPI # (NM1*DN – Loop 2310A or 2420F)
2. CLIA number (when a doctor or laboratory bills for lab work. (REF*X4 – Loop 2300 or 2400)
3. Homebound indicator (CRC*75 – Loop 2300)
4. Modifier 90, purchase service (when a lab sent a test to an outside lab) (SV1*HC – Loop 2400)
5. Total purchase service amount paid (not for Spec 69) (AMT*NE – Loop 2300)
6. Purchase service provider name (NM1*QB – Loop 2310C or 2420B)
7. Service facility location (NM1*TL/LI – Loop 2310D or 2420C)

If You Bill Ambulance Services

Submit the following types of claims:


1. Patient with a secondary supplemental insurance, Medicaid or Medigap (SBR*S – Loop 2320,
2330A, 2330B)
2. Origin location , address, city, state, zip code (NM1*77 – Loop 2310D)
3. Admission date, if applicable (DTP*435 – Loop 2300)
4. Comment / Note (NTE*ADD – Loop 2300 or 2400)
5. Mileage (CR1*LB – Loop 2300 or 2400)
6. Ambulance transport information (CR1*LB – Loop 2300)
7. Ambulance certification (CRC*07 – Loop 2300)

NHIC, Corp.
75 Sgt. William Terry Drive
Hingham, MA 02044
www.medicarenhic.com
MAN-EDI-0007 V2.0 Release date: 12/08/2010
The controlled version of this document resides on the NHIC Quality Portal (SharePoint). Any other version or copy, either electronic or
paper, is uncontrolled and must be destroyed when it has served its purpose.
.
Page13

If You Bill Physical Therapy Services

Submit the following types of claims:


1. Patient with a secondary supplemental insurance, Medicaid or Medigap (SBR*S – Loop 2320,
2330A, 2330B)
2. Referring physician name and NPI # (NM1*DN – Loop 2310A or 2420F)
3. Comment / Note (NTE*ADD – Loop 2300 or 2400)
4. Date Last Seen (DTP*304 – Loop 2300)

If You Provide Doctor’s Office Services

Submit the following types of claims:


1. Patient with a secondary supplemental insurance, Medicaid or Medigap (SBR*S – Loop 2320,
2330A, 2330B)
2. Hospital or nursing home service (visit or surgery) (NM1*FA – Loop 2310D)
3. Admission date, if applicable (DTP*435 – Loop 2300)
4. Referring physician name and NPI # (NM1*DN – Loop 2310A or 2420F)
5. Comment / Note (NTE*ADD – Loop 2300 or 2400)
6. CLIA number (Only if your doctor bills for laboratory service) (REF*X4 – Loop 2300 or 2400)
7. Modifier 90, purchase service (when a lab test is sent to an outside lab) (SV1*HC – Loop 2400)
8. Total purchase service amount paid (not for Spec 69) (AMT*NE – Loop 2300)
9. Purchase service provider name (NM1*QB – Loop 2310C or 2420B)
10. Hospice information (Only if apply to hospice patient) (CRC*70 – Loop 2400)

If You Are A Radiological Practice

Submit the following types of claims:


1. Patient with a secondary supplemental insurance, Medicaid or Medigap (SBR*S – Loop 2320,
2330A, 2330B)
2. Referring physician name and NPI # (NM1*DN – Loop 2310A or 2420F)
3. Submit mammogram certification number, if applicable (REF*EW – Loop 2300)
4. Submit Comment / Note (NTE*ADD – Loop 2300 or 2400)

NHIC, Corp.
75 Sgt. William Terry Drive
Hingham, MA 02044
www.medicarenhic.com
MAN-EDI-0007 V2.0 Release date: 12/08/2010
The controlled version of this document resides on the NHIC Quality Portal (SharePoint). Any other version or copy, either electronic or
paper, is uncontrolled and must be destroyed when it has served its purpose.
.
Page14

If You Bill Anesthesia Services

Submit the following types of claims:


1. Anesthesia Minutes (SV103 = MJ - Loop 2400, SV104 = # of minutes – Loop 2400)

Please Note: Vendors, Custom Systems, Clearing Houses, and Billing Services are required to
test specified fields listed above regardless of specialty or practice type.

THE CABBS ONLINE ERROR SUMMARY REPORT


The Claims Editing Process
The process of pre-editing claim information for accuracy is one of the advantages of billing
electronically. Claims needing correction can be retransmitted right away to NHIC, Corp. ensuring
faster payment.

After transmitting a file to CABBS (Carrier Bulletin Board System) there are several levels of editing
the file must pass before claims can be accepted into the Medicare system for processing.

I. CABBS-level edits

CABBS edits are the first level of editing. Failure to pass the CABBS-level edits will result
in the rejection of the entire file. Within seconds of CABBS receiving your transmission a
message from the CABBS Claim Editor appears in your electronic mailbox. This message,
known as the CABBS Transmission Log, tells you whether or not CABBS has accepted the
file. It is an acknowledgement that your system has communicated with our system
successfully and hasn’t encountered any of the CABBS edits. For assistance with errors at
the CABBS level edits, please call the EDI Department of the NHIC, Corp. office that
processes your claims.

II. 997 level edits

The next level of editing produces the Functional Acknowledgement Transaction Set (997
report). This transaction set (997 report) indicates the results of the syntactical analysis of
electronically encoded documents. The 997 report is delivered to your CABBS mail box the
day after the file was submitted.

NHIC, Corp.
75 Sgt. William Terry Drive
Hingham, MA 02044
www.medicarenhic.com
MAN-EDI-0007 V2.0 Release date: 12/08/2010
The controlled version of this document resides on the NHIC Quality Portal (SharePoint). Any other version or copy, either electronic or
paper, is uncontrolled and must be destroyed when it has served its purpose.
.
Page15
III. Pre Pass Edits

Before claims are accepted into the Medicare system for processing they are subject to a
number of "pre-pass" edits. These edits may be applicable to the entire file, a batch of claims
within the file, or an individual claim within a batch. Any file, batch, or claim, that does not
pass this level of editing, will be listed in the Error Summary Report (ESR). The ESR is a
notification you will receive from NHIC, Corp. that a claim, batch, or file has been rejected.
It is critical that all electronic submitters have access to this information. Claims rejected at
the pre-pass level are not listed on the Medicare Summary Notice. If you need assistance
with errors at the pre-pass level, please call the EDI Department of the NHIC, Corp. office
that processes your Claims (The New England toll free number is: 1-877-386-1056).
When a claim passes this level of editing successfully it is assigned a unique Internal Control
Number (ICN) and uploaded to NHIC, Corp.’s system for processing.

When calling the Medicare Provider Customer Service numbers for claims assistance, remember
representatives can only give information on claims accepted into the Medicare system. They do not
have access to information about claims that were rejected at the CABBS level, 997 Functional
Acknowledgement level, or pre-pass edit level. All submitters should check their CABBS Electronic
Mail and Error Summary Report after each transmission to make sure all claims were received
successfully. A complete listing of NHIC, Corp. CABBS edits and pre-pass edits and their resolutions
are available in the CABBS User Guide located in the EDI Download Center of the NHIC, Corp. Web
site.

Keeping Track of Your Claim Submissions – CABBS Mailbox:


Within seconds after the transmission is complete the CABBS Claim Editor will generate a message,
which appears in your CABBS mailbox (see Electronic Mail Menu). This is your transmission log
indicating CABBS has received your claim file successfully. If your file has passed this level of
editing (CABBS-level editing) the following transmission log message will appear in your CABBS
mailbox:

 "Initial transmission successful". For a more complete review of your transmission and
final acceptance, please review your 997 functional acknowledgement (s) in your CABBS
mailbox the next business day”.

Your ANSI 997 Functional Acknowledgement (this is the 997 level of editing) message is available
between 9:00 a.m. and 12:00 noon the next business day in your CABBS mailbox, and will contain
more information regarding this next level of editing. If the ANSI 997 report shows a rejection, your
entire file was rejected at the translator level and no Error Summary Report will be produced. If you
require assistance with interpreting the ANSI 997 reports please contact your software vendor.

NHIC, Corp.
75 Sgt. William Terry Drive
Hingham, MA 02044
www.medicarenhic.com
MAN-EDI-0007 V2.0 Release date: 12/08/2010
The controlled version of this document resides on the NHIC Quality Portal (SharePoint). Any other version or copy, either electronic or
paper, is uncontrolled and must be destroyed when it has served its purpose.
.
Page16

The Error Summary Report (the next level of editing – known as the pre-pass edit level) will be
posted to your CABBS electronic mailbox sometime between 9:00 a.m. and 12:00 noon the next
business day. It will remain there for 30 calendar days. You will receive only one validation report
for each business day you transmit claims to CABBS successfully even if you transmit several times in
one day. If error messages appear on your report, please refer to the list of "Pre-pass Edits List" for
more information. This list is available in the CABBS User Guide located on the NHIC, Corp. Web
site (www.medicarenhic.com). If you require assistance with interpreting the Error Summary report
please contact your software vendor.

NHIC, Corp. will guarantee same-day acceptance for claim files that have been processed by the
CABBS Claim Editor by 5:00 p.m. Claims received after 5:00 p.m. will be counted as received the
next business day.

Availability of CABBS Error Summary Reports:

Claim File Transmitted Error Summary Report available:

Monday - Thursday, before 5:00 p.m. Next business day


Monday - Thursday, after 5:00 p.m. Two business days
Friday before 5:00 p.m. Monday
Friday after 5:00 p.m., Saturday, Sunday Tuesday
Holidays Allow 1 additional business day

The Error Summary Report will be posted to your CABBS electronic mailbox, as noted above, after
you send your file. The report may be downloaded to your computer for reformatting and printing.
Please do not delete the Error Summary Reports or ANSI 997s from your mailbox unless you are sure
they are no longer needed. Each electronic mail message is automatically deleted from the CABBS
after 30 calendar days. Mail deleted from your mailbox may not be recoverable.

You will receive one validation report for each business day that you transmit claims to CABBS
successfully, even if you transmit several times per day. If error messages appear on your Error
Summary Report, please refer to the list of "Pre-pass Edits" for more information. The list is available
for download from the User Reference File Library or from our web site at www.medicarenhic.com.
You may also request a copy from the NHIC, Corp. EDI department.

The Different Sections of the Error Summary Report:

• The Error Summary Report contains three sections. The first section shows the total number
of batches and claims, total charges per batch, and total dollar amounts for all batches
accepted and/or rejected. The Internal Control Numbers (ICN’s) assigned to the accepted
claims are also displayed.

NHIC, Corp.
75 Sgt. William Terry Drive
Hingham, MA 02044
www.medicarenhic.com
MAN-EDI-0007 V2.0 Release date: 12/08/2010
The controlled version of this document resides on the NHIC Quality Portal (SharePoint). Any other version or copy, either electronic or
paper, is uncontrolled and must be destroyed when it has served its purpose.
.
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• The Provider Summary section lists claim acceptance/ rejections for individual providers.
This section is especially helpful to submitters who send claims for multiple providers (or
multiple groups) within the same file transmission.

• The Message Summary section lists all pre-pass edit messages and the number of times each
edit failed for all providers within the report. Submitters can easily identify potential billing
problems with this information.

• If any claim, batch, or file has been rejected, one or more error codes will appear on the Error
Summary Report. Each error code has a text message explaining the error. More detailed
information is available in the "Pre-pass Edits" list. Files, batches, or claims that are rejected
at the pre-pass level need to be corrected and retransmitted.

When used consistently, the Error Summary Report is a powerful tool to help you track claim
acceptance status while giving you necessary information to correct and retransmit rejected claims
immediately without effecting cash flow.
Version Date Reviewed By Approved By Summary of changes

1.0 7/06/2010 Kathleen Wells Denise Noland Release of document on the new NHIC Quality Portal

2.0 12/08/2010 Kathleen Wells Denise Noland Annual Review – No changes

NHIC, Corp.
75 Sgt. William Terry Drive
Hingham, MA 02044
www.medicarenhic.com
MAN-EDI-0007 V2.0 Release date: 12/08/2010
The controlled version of this document resides on the NHIC Quality Portal (SharePoint). Any other version or copy, either electronic or
paper, is uncontrolled and must be destroyed when it has served its purpose.
.