Medicare Claims Processing Manual (Pub. 100-04), Ch. 27 § 20.3.3

Not in Host's File (NIF)

Last amended: 2018Year: 2018Length: 225 wordsOfficial source
20.3.3 - Not in Host's File (NIF) (Rev. 4009, Issued: 03-23-18, Effective: 04-23-18, Implementation: 04-23-18) When the Host receives a claim record from a MAC, it first searches its beneficiary and cross reference files. If it does not find the beneficiary's record in either place, it searches the Transfer Not in File (TNIF) file. If the record is not found there, the Host puts a response on the reply record in the form of a disposition code 50 or 52, indicating that the Beneficiary Record for which the MAC submitted a claim record is not located at the MAC's Host. The TNIF file contains a record of every beneficiary for whom the Host has received a claim, and whose records are located at another Host. It shows at which Host the beneficiary file resides. If the Beneficiary Record is located at another Host, the original Host checks the out-of-service area response file to see if the claim record response is already waiting there. If there is not a response waiting, the claim is sent to the proper Host for processing. If there is a response, the Host gives that information to the MAC. There are many disposition codes that are returned to the MAC for various NIF situations. Following is a list of codes and actions the MAC takes in response to each disposition code.
Medicare Claims Processing Manual (Pub. 100-04), Ch. 27 § 20.3.3: Not in Host's File (NIF) | Justis AI