Acknowledgements

50.3.3 - Acknowledgements (Rev. 13105; Issued- 04-10-25; Effective: 05-12-25; Implementation: 05-12-25) The A/B MAC’s front end process uses the transaction appropriate CMS edits spreadsheet to determine whether an edit failure necessitates the rejection of the entire transaction set via the ASC X12 TA1 interchange acknowledgment or ASC X12 999 implementation acknowledgment edit, back to the submitter or whether those errors are accepted and passed onto the CCEM for claim level rejection via the ASC X12 277CA claim acknowledgment. Errors that the translator passes to the CCEM are referred to as ASC X12 999 implementation acknowledgment “Accepted, but Errors Noted” (ASC X12 999E implementation acknowledgment) edits. The CCEM will receive CMS defined 837 and 276 flat files from the A/B MAC’s translator. The CCEM will flag any 837 flat file data in error and will report that data back to the submitter via the ASC X12 277CA claim acknowledgment. Any 276 flat file data in error will be reported back to the submitter via an ASC X12 277 claim status request response transaction. All accepted data will be sent to the SSM for processing. 1. If the translator sets an edit that does not necessitate rejection of the entire ST-SE transaction set (ASC X12 999E implementation acknowledgment edit), the contractor front end: a. Creates an ‘STC’ segment to document the error and inserts it into the ASC X12 837 claim CMS defined flat file following the segment containing the error. b. Returns the ASC X12 999 implementation acknowledgment to the submitter indicating the affected ST-SE transaction was accepted with errors noted. c. Inserts a receipt date segment (+RC DTP segment) into the ASC X12 837 claim CMS defined flat file. d. Creates a skeleton (350 character space filled) Control Record (CTR segment) and, if desired, populates CTR17. The CTR is placed in front of each ISA segment. e. Submits the ASC X12 837 claim CMS defined flat file containing STC error segments to the CCEM. 2. If the translator does not set any edits, the contractor front end: a. Returns the ASC X12 999 implementation acknowledgment to the submitter indicating the affected ST-SE transaction was accepted. b. Inserts a receipt date segment (+RC DTP segment) into the ASC X12 837 claim CMS defined flat file. c. Creates a skeleton CTR segment and if desired, populates CTR17. The CTR is placed in front of each ISA segment. d. Submits the ASC X12 837 claim CMS defined flat file to the CCEM.