Rejected

20.3.2.4 - Rejected (Rev. 4009, Issued: 03-23-18, Effective: 04-23-18, Implementation: 04-23-18) The claim record contains errors that prevent CWF from posting the claim to history. The claim is returned to the MAC with codes explaining the errors. The MAC must correct the CWF Claim Record and resubmit it. • Disposition Code ER, UR, CR, or AA, as Appropriate - There will never be a combination of ER, UR, CR, and AA error codes on the same reply. • Consistency Error Codes (ER) - Consistency edits examine the information on the claim itself. The consistency error codes indicate the errors in consistency found on the claim. These codes are returned on Basic Reply Trailer 08 and can contain up to four consistency error codes. • Utilization Error Codes (UR) - Utilization edits compare the information on the CWF Claim Record with the information found on the CWF Beneficiary Master Record. The utilization error codes indicate discrepancies between the CWF Claim Record and the CWF Beneficiary Master Record. Since the CWF Beneficiary Master Record is presumed to be correct, these codes inform the MAC what corrections it must make. The code is returned on basic reply Trailer 08 and contains only one utilization error code. FPS: If FPS denies the claim record, CWF will stop processing the claim and return a response back to the MAC with FPS error code. • Disposition Code UR – The utilization error code indicate the errors found on the claim. These codes are returned on Basic Reply Trailer 08, 48 and 49 indicating partial denial (FPSD) or full denial of the claim (FPSH). • A/B Crossover Edits (CR) - When the Host receives a Part A bill, CWF automatically checks the information in the record against the beneficiary's history files for both Part A and Part B utilization. If there is a conflict (or "crossover") of services, CWF will generate an A/B Crossover error code. These are returned on the reply Trailer 13 and will contain only one A/B crossover error code.