MSP Auxiliary File Errors

30.3 - MSP Auxiliary File Errors (Rev. 12078; Issued:06-14-23; Effective: 05-29-23; Implementation: 05-29-23) The term Medicare beneficiary identifier (Mbi) is a general term describing a beneficiary's Medicare identification number. For purposes of this manual, Medicare beneficiary identifier references both the Health Insurance Claim Number (HICN) and the Medicare Beneficiary Identifier (MBI) during the new Medicare card transition period and after for certain business areas that will continue to use the HICN as part of their processes. Maintenance transactions to the MSP Auxiliary file reject invalid data with errors identified by a value of "SP" in the disposition field on the Reply Record. A trailer of "08" containing up to four error codes will always follow. Listed below are the possible MSP Maintenance Transaction error codes with a general description. Error Code Definition Valid Values SP11 Invalid MSP transaction record type "HUSP," "HISP," or "HBSP" SP12 Invalid Medicare beneficiary identifier Valid Medicare beneficiary identifier SP13 Invalid Beneficiary Surname Valid Surname SP14 Invalid Beneficiary First Name Initial Valid Initial SP15 Invalid Beneficiary Date of Birth Valid Date of Birth SP16 Invalid Beneficiary Sex Code 0=Unknown, 1=Male, 2=Female SP17 Invalid Contractor Number CMS Assigned Contractor Number SP18 Invalid Document Control Number Valid Document Control Number SP19 Invalid Maintenance Transaction Type 0=Add/Change MSP Data transaction, 1=Delete MSP Data Transaction SP20 Invalid Validity Indicator Y= Beneficiary has MSP Coverage, I= Entered by the A/B MAC or DME MAC – MSP Contractor investigate, N -No MSP coverage SP21 Invalid MSP Code A=Working Aged B=ESRD C= Conditional Payment D= No Fault E= Workers' Compensation Error Code Definition Valid Values F= Federal G= Disabled H= Black Lung L= Liability SP22 Invalid Diagnosis Code 1-5 Valid Diagnosis Code SP23 Invalid Remarks Code 1-3 See the Valid Remarks Codes Below SP24 Invalid Insurer Type See definitions of Insurer Type codes below SP25 Invalid Insurer Name An SP25 error is returned when the MSP Insurer Name is equal to one of the following: Supplement Supplemental Insurer Miscellaneous CMS Attorney Unknown None N/A Un Misc NA NO BC BX BS BCBX Blue Cross Blue Shield Medicare Medicaid Alphabetic, Numeric, Space, Comma, & - ' . @ # / ; : Insurer Name must be present if Validity Indicator = Y SP26 Invalid Insurer Address 1 and/or Address 2 Alphabetic, Numeric, Space, Comma, & - ' . @ # / ; : Error Code Definition Valid Values SP27 Invalid Insurer City Alphabetic, Numeric, Space, Comma, & - ' . @ # / ; : SP28 Invalid Insurer State Must match U.S. Postal Service state abbreviation table. SP29 Invalid Insurer Zip Code If present, 1st 5 digits must be numeric. If foreign country "FC" state code, the nine positions may be spaces. SP30 Invalid Policy Number Alphabetic, Numeric, Space, Comma, & - ' . @ # / ; : SP31 Invalid MSP Effective Date (Mandatory) Non-blank, non-zero, numeric, number of days must correspond with the particular month. MSP Effective Date must be no more than 3 months in the future from the current date. SP32 Invalid MSP Termination Date Must be numeric; may be all zeroes if not used; if used, date must correspond with the particular month for GHP records. The MSP Termination Date is Greater than Six Months from the current date for non-Group Health Plan MSP Auxiliary Records. SP33 Invalid Patient Relationship The following codes are valid for all MSP Auxiliary occurrences regardless of accretion date: 01 = Self; the beneficiary is the policy holder or subscriber for the other GHP insurance reflected by the MSP occurrence –or- Beneficiary is the injured party on the Workers Compensation, No- Fault, or Liability claim 02 =Spouse or Common Law Spouse Error Code Definition Valid Values 03 = Child 04 = Other Family Member 20 = Life Partner or Domestic Partner The following codes are only valid on MSP Auxiliary occurrences with accretion dates PRIOR TO 4/4/2011: 05 = Step Child 06 = Foster Child 07 = Ward of the Court 08 = Employee 09 = Unknown 10 = Handicapped Dependent 11 = Organ donor 12 = Cadaver Donor 13 = Grandchild 14 = Niece/Nephew 15 = Injured Plaintiff 16 = Sponsored Dependent 17 = Minor Dependent of a Minor Dependent 18 = Parent 19 = Grandparent 20 = Life Partner or Domestic Partner SP34 Invalid subscriber First Name Alphabetic, Numeric, Space, Comma, & - ' . @ # / ; : SP35 Invalid Subscriber Last Name Alphabetic, Numeric, Space, Comma, & - ' . @ # / ; : SP36 Invalid Employee ID Number Alphabetic, Numeric, Space, Comma, & - ' . @ # / ; : SP37 Invalid Source Code Spaces, A through W, 0 – 19, 21, 22, 25, 26, 39, 41, 42, 43. See §10.2 for definitions of valid CWF Source Codes. Error Code Definition Valid Values SP38 Invalid Employee Information Data Code Spaces if not used, alphabetic values P, S, M, F. See §30.3.4 for definition of each code. SP39 Invalid Employer Name Spaces if not used. Valid Values: Alphabetic, Numeric, Space, Comma, & - ' . @ # / ; : SP40 Invalid Employer Address Spaces if not used. Valid Values: Alphabetic, Numeric, Space, Comma, & - ' . @ # / ; : SP41 Invalid Employer City Spaces if not used. Valid Values: Alphabetic, Numeric, Space, Comma, & - ' . @ # / ; : SP42 Invalid Employer State Must match U.S. Postal Service state abbreviations. SP43 Invalid Employer ZIP Code If present, 1st 5 digits must be numeric. If foreign country ‘FC’ is entered as the state code, and the nine positions may be spaces. SP44 Invalid Insurance Group Number Spaces if not used. Valid Values: Alphabetic, Numeric, Space, Comma, & - ' . @ # / ; : SP45 Invalid Insurance Group Name Spaces if not used. Valid Values: Alphabetic, Numeric, Space, Comma, & - ' . @ # / ; : SP46 Invalid Pre-paid Health Plan Date Numeric; number of days must correspond with the particular month. SP47 Beneficiary MSP indicator not on for delete transaction. Occurs when the code indicating the existence of MSP auxiliary record is not equal to "1" and the MSP maintenance transaction type is equal to ‘1.’ SP48 MSP auxiliary record not found for delete data transaction See MSP Auxiliary Record add/update and delete function procedures above. Error Code Definition Valid Values SP49 MSP auxiliary occurrence not found for delete data transaction See MSP Auxiliary Record add/update and delete function procedures above. SP50 Invalid function for update or delete Contractor number unauthorized See MSP Auxiliary Record add/update and delete function procedures above SP51 MSP Auxiliary record has 17 occurrences and none can be replaced SP52 Invalid Patient Relationship Code which is mandatory for MSP Codes A, B and G when the Validity Indicator is "Y" Accretion Dates prior to 4/4/2011: Patient Relationship must be 01 or 02 for MSP Code A (Working Aged). Patient Relationship must be 01, 02, 03, 04, 05, 18 or 20 for MSP Codes B (ESRD) and G (Disabled). Accretion Dates 4/4/2011 and subsequent: Patient Relationship must be 01 or 02 for MSP Code A (Working Aged). Patient Relationship must be 01, 02, 03, 04, or 20 for MSP Codes B (ESRD) and G (Disabled). SP53 The maintenance transaction was for Working Aged EGHP and there is either a ESRD EGHP or Disability EGHP entry on file that has a termination date after the Effective date on the incoming transaction or is not terminated, and the contract number on the maintenance transaction is not equal to "11102," "11104," “11105," "11106," "33333," "66666,", "77777," "88888," or "99999." SP54 MSP Code A, B or G has an Effective date that is in conflict with the calculated age 65 date of the Bene. For MSP Code A, the Effective date must not be less than the date at age 65. For MSP Code G, the Effective date must not be greater than the date at age 65. SP55 MSP Effective date is less than the earliest Error Code Definition Valid Values Bene Part A or Part B Entitlement Date. SP56 MSP Prepaid Health Plan Date must be = to or greater than MSP Effective date or less than MSP Termination date. SP57 Termination Date Greater than 6 months prior to date added for Contractor numbers other than 11100 – 11119, 11121, 11122, 11126, 11139, 11141, 11142, 11143, 33333, 55555, 77777, 88888, and 99999. SP58 Invalid Insurer type, MSP code, and validity indicator combination. If MSP code is equal to "A" or "B" or "G" and validity indicator is equal to "I" or "Y" then insurer type must not be equal to spaces. Mapped coverage type must equal “J”, “K”, or “A”. SP59 Invalid Insurer type, and validity indicator combination If validity indicator is equal to "N" then insurer type must be equal to spaces. SP60 Other Insurer type for same period on file (Non "J" or "K") Insurer type on incoming maintenance record is equal to "J" or "K" and Insurer type on matching aux record is not equal to "J" or "K." Edit applies only to MSP codes: A - Working Aged, B - ESRD EGHP, G - Disability EGHP SP61 Other Insurer type for same period on file ("J" or "K") Insurer type on incoming maintenance record is not equal to "J" or "K" and Insurer type on matching aux record is equal to "J" or "K." Edit applies only to MSP codes: A - Working Aged, B - ESRD EGHP, G - Disability EGHP SP62 Incoming term date is less than MSP Effective date. SP66 MSP Effective date is greater than the Effective date on matching occurrence on auxiliary file SP67 Incoming term date is less than posted term date for Provident SP72 Invalid Transaction attempted A HUSP add transaction is received from a A/B MAC and DME MAC (non-MSP Contractor) with a validity indicator other than "I." SP73 Invalid Term Date/Delete Transaction A MAC attempts to change a Term Date on an MSP Error Code Definition Valid Values Auxiliary record with a "I" or "Y" Validity Indicator that is already terminated, or trying to add Term Date to "N" record. SP74 Invalid cannot update "I" record. A MAC submits a HUSP transaction to update/change an "I" record or to add an "I" record and a match MSP Auxiliary occurrence exists with a "I" validity indicator. SP75 Invalid transaction, no Medicare Part A benefits A HUSP transaction to add a record with a Validity Indicator equal to "I" (from an A/B MAC or DME MAC) or "Y" (from the MSP Contractor) with an MSP Type equal to "A," "B," "C," or "G" and the effective date of the transaction is not within a current or prior Medicare Part A entitlement period, or the transaction is greater than the termination date of a Medicare entitlement period. SP76 MSP Type is equal to W (Workers’ Compensation Medicare Set-Aside) and there is an open MSP Type E (Workers’ Compensation) record. SP77 A diagnosis cannot be added to this occurrence by a Part A/Part B/DME MAC. SP78 The diagnosis code submitted is not allowed on an MSP Type 'D' record. When an incoming HUSP transaction with a Validity Indicator equal to 'I' or 'Y' is received from an A/B, DME MAC or the MSP Contractor for an MSP Type 'D' record, and the transaction contains one of the CMS identified ICD 9 or ICD 10 diagnosis codes. Error Code Definition Valid Values SP79 A MAC attempts to create/enter a value in the ORM field on the incoming I HUSP record (makes sure that a MAC cannot update or overlay an ORM value in the ORM field). Valid Values for the 1-byte ORM indicator on the CWF MSP Detail screen (MSPD) are: Y (Yes) or a space. A “Y” ORM indicator value denotes that the ORM existed for a period of time, not necessarily that it currently exists. An ORM indicator of a “space” implies that an RRE has not assumed ORM. SP80 A MAC attempted to create/enter an ORM indicator on an MSP record other than a D, E, and L. The 1- byte ORM indicator (valid values = Y or a space) shall only be received on HUSP transactions with MSP Codes “D, E, and L.” SP81 A contractor, other than the following contractor numbers of 11100, 11110, 11122, 11141, and 11142, attempts to update, remove or set the existing ORM record indicator of a “Y” to a “space.” To ensure that no other entity than the following contractor numbers (11100, 11110, 11122, 11142, and 11142) can modify an existing record’s ORM indicator to equal a “space,” if originally it was a “Y.” SP82 MSP Type 'L' or 'D' does not exist. When an incoming HUSP transaction is submitted for LMSA (MSP Type S) and no Liability (MSP Type L) MSP Auxiliary record exists; or when an incoming HUSP transaction is submitted for NFMSA (MSP Type T) and no No-Fault Auto (MSP Type D) MSP Auxiliary record exists. SP83 No Termination Date present for a Liability or No-Fault Auto occurrence. When an incoming HUSP transaction is submitted for LMSA (MSP Type S) and the Liability (MSP Type L) record on the MSP Auxiliary File does not have a Termination Date; or when an incoming HUSP transaction is submitted Error Code Definition Valid Values for NFMSA (MSP Type T) and the No-Fault Auto (MSP Type D) record on the MSP Auxiliary File does not have Termination Date. SP84 Invalid Effective date for LMSA or NFMSA or open record. An HUSP transaction is submitted by contractor '11144' or '11100' for LMSA (MSP Type S) and posted to the MSP Aux file is a Liability (MSP Type L) with a Termination Date. If the Effective Date of the LMSA (MSP Type S) is not one day after the Termination Date of the Liability (MSP Type L). If the Effective Date of the LMSA (MSP Type S) is one day after the Termination Date of the Liability (MSP Type L), and the diagnosis codes on the LMSA (MSP Type S) are not an Exact or not a Family Match with the Liability (MSP Type L) diagnosis codes. AND/OR An HUSP transaction is submitted by contractor '11145' or '11100' for NFMSA (MSP Type T) and posted to the MSP Aux file is a No-Fault (MSP Type D) with a Termination Date. If the Effective Date of the NFMSA (MSP Type T) is not one day after the Termination Date of the No-Fault (MSP Type D). Error Code Definition Valid Values If the Effective Date of the NFMSA (MSP Type T) is one day after the Termination Date of the No-Fault (MSP Type D), and the diagnosis codes on the NFMSA (MSP Type T) are not an Exact or not a Family Match with the No- Fault (MSP Type D). SP91 Invalid Employer Size (Mandatory). Field must contain a numeric character. SP99 Medicare ID (HICN or MBI) required if individual is less than 45 years of age.