Claims Basic Reply

20.3.2 - Claims Basic Reply (Rev. 4009, Issued: 03-23-18, Effective: 04-23-18, Implementation: 04-23-18) When the Host receives each claim or adjustment, it searches the Beneficiary File to find the Beneficiary Record. If the Beneficiary Record is found, the record is processed and a reply record is transmitted to the MAC. See §20.3.3, for an explanation of the procedure if the Beneficiary Record is not found ("Not in File.") The record type returned by CWF is dictated by the claim record type as follows: • A/B MAC (B) Basic Reply Record - Reply record for each CWF A/B MAC (B) bill (HUBC) processed. • DMEPOS Basic Reply Record - Reply record for each CWF DMEPOS bill (HUDC) processed. • Inpatient/SNF Bill Basic Reply Record - Reply record for each Inpatient/SNF bill (HUIP) processed. • Outpatient/Home Health Bill Basic Reply Record - Reply record for each Outpatient/Home Health bill (HUOP and HUHH) processed • NOE/Hospice Bill Basic Reply Record - Reply record for each Hospice Notice of Election and all subsequent Hospice bills (HUHC) processed. Each reply record will contain a disposition code and error code that indicates the action taken on the bill by the Host and what action the MAC should take next. The following is a list of actions that CWF may take on a claim record. Disposition codes, cross-reference/alpha search/NIF situations, their associated trailers, and bill recycling instructions are also included: