CEDI Acknowledgments for ASC X12 Version 5010 and

50.4.3 - CEDI Acknowledgments for ASC X12 Version 5010 and NCPDP D.0. Transactions (Rev. 2803, Issued: 10-28-13, Effective: 09-17-13, Implementation: 09-17-13) Trading Partners transmit their ASC X12 5010 transactions and CEDI performs the following functions. 1. CEDI front end performs Standard and Implementation Guide edits on the ASC X12 837 claims. These edits include, but are not limited to, edits on the ASC X12 837 professional claim edit spreadsheet tagged for ASC X12 TA1 interchange acknowledgment and ASC X12 999R and 999E implementation acknowledgment responses. Please refer to the CMS website for a copy of the ASC X12 837 professional claim edit spreadsheet. 2. CEDI uses the ASC X12 837 professional claim edit spreadsheet to determine whether an edit failure necessitates the rejection of the entire ASC X12 837 transaction set (ASC X12 999R implementation acknowledgment edit) or whether those files should be passed on for further business validation editing, resulting in a claim level rejection via the ASC X12 277CA claim acknowledgment. Errors that the translator identifies at the 999 level and passes on for further business validation and ASC X12 277CA claim acknowledgment issuance are referred to as ASC X12 999E implementation acknowledgment edits on the ASC X12 837 professional claim edit spreadsheet. 3. If the ASC X12 837 professional claim edit necessitates rejection of the entire ST- SE transaction set (ASC X12 999R implementation acknowledgment edit), CEDI returns the ASC X12 999 implementation acknowledgment to the Trading Partner indicating the affected ST-SE was rejected. The transaction set is not passed for further processing. 4. If the ASC X12 837 professional claim edit sets an edit that does not necessitate rejection of the entire ST-SE transaction set (ASC X12 999E implementation acknowledgment edit), CEDI will: a. Return the ASC X12 999 implementation acknowledgment to the Trading Partner indicating the affected ST-SE transaction was accepted with errors. b. Continue with performing the ASC X12 837 professional claim edit at the Business Validation level. c. Read the beneficiary state code submitted on the accepted claims for use in performing appropriate Business Validation editing (ASC X12 277CA claim acknowledgment) at the DME MAC level. d. If an ASC X12 999E implementation acknowledgment error is listed with a coordinating ASC X12 277CA claim acknowledgment, any claims falling subordinate to the level at which the ASC X12 999E implementation acknowledgment error occurred will be rejected. 5. If CEDI does not set any ASC X12 999E implementation acknowledgment edits, CEDI will: a. Return ASC X12 999 implementation acknowledgment to the Trading Partner indicating the affected ST-SE transaction was accepted. b. Continue performing the ASC X12 837 professional claim edit at the Business Validation level. 6. After all ASC X12 837 professional claim edits have been performed, and claims have successfully passed any ASC X12 999R implementation acknowledgment, ASC X12 999E implementation acknowledgment, or ASC X12 277CA claim acknowledgment level editing, CEDI will: a. Assign the CCN to the accepted ASC X12 837 claims. b. Insert a receipt date segment (+RC DTP segment) into the ASC X12 837 flat file. c. Create a control record (CTR segment) containing the appropriate counts. The CTR is placed in front of each ISA segment on the ASC X12 837 flat file. 7. CEDI will create the ASC X12 277CA claim acknowledgment transactions to be returned to the Trading Partner, containing all ASC X12 277CA claim acknowledgment errors that may have occurred at the ASC X12 999E implementation acknowledgment or Business Validation level. 8. CEDI will deliver the ASC X12 837 flat files to the EDC for the appropriate DME MAC. Trading Partners transmit their NCPDP D.0 transactions to and CEDI performs the following functions. 1. CEDI front end performs Standard and Implementation Guide edits on the NCPDP claims. These edits include, but are not limited to, edits on the NCPDP edit spreadsheet tagged for NCPDP transmission response. 2. CEDI uses the NCPDP edit spreadsheet to determine whether an edit failure necessitates the rejection of the entire NCPDP batch or an individual claim. 3. CEDI will read the beneficiary state code submitted on the accepted claims for use in performing appropriate Business Validation editing at the DME MAC level. 4. After all NCPDP edits have been performed, CEDI will assign the CCN to the accepted NCPDP claims. 5. CEDI will return the NCPDP transmission response showing accepted and rejected batches and individual claims as well as the CCN for all accepted claims. 6. Create the NCPDP flat file for each DME MAC with claims for their Jurisdiction. 7. CEDI will deliver the NCPDP flat files to the EDC for the appropriate DME MAC.