Disposition Code 50 (Not in File)

20.3.3.1 - Disposition Code 50 (Not in File) (Rev. 4009, Issued: 03-23-18, Effective: 04-23-18, Implementation: 04-23-18) Disposition code 50 can come with any of the following seven error codes: 1. With Error Code 5052 - Beneficiary Identification Incorrect - The name and/or claim number shown on the bill is incorrect or claim number is not in file. If the TNIF file does not indicate another Host, the beneficiary's records may not have been assigned to a Host and are still resident at CMS or the beneficiary was assigned to another Host site and the TNIF File was not updated. When the Host is not sure which is the case, it gives disposition code 50 and Trailer 08 with error code 5052 on the reply to the MAC. A/B MACs and DME MACs verify through inquiry to the Host that the HICN is correct on the bill. If the bill is correct, and the Host HIMR agrees with the reject (no record), A/B MACs and DME MACs must notify the Host of the error. The Host will contact CMS to determine eligibility. 2. With Error Code 5054 - The Host returns code 50 with Trailer 08 and error code 5054 when an auxiliary indicator is present on the CWF Beneficiary Master Record, but no auxiliary record is found. • Concurrent with this response to the MAC, the Host sends a request for transfer to CMS requesting the beneficiary's records from CMS' Master File. • The A/B MAC or DME MAC must recycle the claim every four working days until an approval, adjustment or reject (AAR) response is received, or 45 working days have passed since receipt of the original code 50. • The A/B MAC or DME MAC reports through locally established procedures to the Host if 45 days pass with no AR response. 3. With Error Code 5055 - The Host returns code 50 with Trailer 08 and error code 5055 (Beneficiary Blocked at CWF Host and CMS Batch Pending Clerical Update) if CMS must investigate a beneficiary's entitlement because of suspicion of fraud or abuse. The MAC recycles the claim every 15 working days until otherwise notified. Definition of Day One for CWF MAC Recycle - Day one is the day that the MAC receives the disposition code back from the Host. For example, a MAC sends the update file to the Host on Monday, April 1, at 10 p.m. The MAC receives the response file from its Host site at 9 a.m. Tuesday, April 2. Tuesday, April 2, is day one for MAC recycle. 4. With Error Code 5056 - The Host returns code 50 with Trailer 08 and error code 5056 (Skeleton - No Beneficiary Record on HI Master File) when the HICN involved is for a beneficiary whose date of death is prior to 1975. • The records for these beneficiaries have been purged from the file. • A/B MACs and DME MACs research the HICN and confirm that the HICN submitted on the claim is correct. If incorrect, it resubmits the claim with the correct HICN. • If the originally submitted HICN was correct, A/B MACs and DME MACs refer the case to the RO. 5. With Error Code 5057 - The Host returns disposition code 50 with Trailer 08 and error code 5057 (Skeleton on HI Master File). This indicates that the beneficiary has died. • There has been no claims activity for six months since date of death, and the beneficiary information is located on the inactive file. • A/B MACs and DME MACs research the HICN and confirm that the HICN submitted on the claim is correct. If incorrect, resubmit the claim with the correct HICN. • If the originally submitted HICN was correct, the A/B MAC or DME MAC recycles the claim every 15 working days to allow CMS time to retrieve the records. • After 45 working days have passed with no approval, adjustment, or reject (AAR) response, MACs contact their RO. 6. With Error Code 5058 - The Host returns disposition code 50 with Trailer 08 and error code 5058 (Blocked). The records have been blocked due to cross-reference activity. There are two numbers for one beneficiary, both of which show claims activity. The information is manually placed under one primary number in one record. • MACs recycle the claim every 15 working days to allow time for CMS processing. • After receiving a second code 58, they contact the RO. 7. With Error Code 5059 - The Host returns this as disposition code 50 and Trailer 08 with error code 5059 (Frozen). Miscellaneous clerical corrections are being made to these beneficiary records. • MACs recycle the claim every 15 working days. • After receiving a second code 59, the A/B MACs or DME MACs contact the RO.