CEDI Receipt Control and Balancing

50.4.2 - CEDI Receipt Control and Balancing (Rev. 2803, Issued: 10-28-13, Effective: 09-17-13, Implementation: 09-17-13) CEDI, upon receiving a submitted ASC X12 837 professional claim and/or NCPDP D.0 file from a Trading Partner, will run the file through their Commercial Off The Shelf (COTS) translator. The COTS translator creates an ASC X12 837 professional claim or NCPDP flat file, includes a CTRD record for each ISA/IEA and each Batch Header/Trailer present, forwards the flat file to the EDC, and stores the CTRD record to a database. The EDC updates the Receipt, Control and Balancing Detail Record (CTRD) creating a CTRD Response. This file is sent back to CEDI who in turn triggers an alert when an out of balance condition has been reported, matches the response to the original CTRD record and stores the updated record to a database. This process will check to be sure what was sent to the EDC is what the EDC received and to update the CTRD record. If it balances, the file continues along through the DME MACs VMS cycle. If it does not balance, the file will not continue. The CTRD record contained in the database is updated with the counts (which identifies which pat of the file is out of balance). CEDI will review the CTRD response file for the out of balance reason and resolve the issue. If necessary, a CTRR resubmission will be sent.