Claims Error Manual for Claims Transactions (837P/I/D) Document Revision 2.3

Transcription

1 for Claims Transactions (837P/I/D) Document Revision 2.3 BCBS Rev. 2/15 Blue Cross & Blue Shield of Mississippi, A Mutual Insurance Company, is an independent licensee of the Blue Cross and Blue Shield Association.

2 Introduction This document is meant to provide information about the various Blue Cross & Blue Shield of Mississippi (BCBSMS) edits for Claims Transactions (837P/I/D). It is intended to be used as a guide for the resolution of the various errors and reject messages generated by the BCBSMS EDI front-end systems when claims are transmitted to the Plan. Unless otherwise directed by BCBSMS personnel, questions related to this guide and the technical information contained within should be directed to BCBSMS EDI Services at or Proprietary Statement: No part of this document may be reproduced, photocopied, or transmitted without the express prior consent of Blue Cross & Blue Shield of Mississippi. Disclaimer: Blue Cross & Blue Shield of Mississippi makes no warranties or representations with respect to the contents of the. Blue Cross & Blue Shield of Mississippi specifically and expressly disclaims any warranties either expressed or implied. This information is provided by Blue Cross & Blue Shield of Mississippi as a service to its associated trading partners. Blue Cross & Blue Shield of Mississippi disclaims any liability that may arise through the use and acceptance hereof by its said associate trading partners. In no event shall Blue Cross & Blue Shield of Mississippi be liable in connection with this service and any recipient or user of this by the use hereof, waives all claims against Blue Cross & Blue Shield of Mississippi for consequential, incidental or special damages, whether or not based upon negligence or breach of any duty in connection with this information, or strict liability in tort or any other cause of action arising, directly or indirectly, in respect to the use of the information provided herewith, or the failure or inaccuracy thereof, including but not limited to, damages for loss of production or injury to persons or property. Indemnification: any user of this shall indemnify, defend and hold harmless Blue Cross & Blue Shield of Mississippi, its officers, employees, directors, affiliated companies and agents from and against any and all third-party claims, actions, demands and lawsuits and all resulting costs, liabilities, damages and expenses, including reasonable attorney s fees arising out of any associated trading partner s use or misuse of these materials. Transactions and Response Reports Upon receipt of 837P/I/D Claims Transactions transactions, BCBSMS processes will edit the transactions for completeness, validity, and business rules. Results of this processing are reported via both human readable reports and EDI transactions which can be retrieved from our communications server. It is the responsibility of either the submitter or the end user provider to review the resulting report and/or EDI transactions to ensure accuracy of the Claims Transactions submissions and/or correct issues and resubmit. Please refer to the BCBSMS Claims Companion Guide for more details on the available transactions and reports. Version 5010 Document Revision 2.3 Page 2 of 40

3 Claims Transactions can encounter two levels of rules: Compliance errors where the applicable ASC X12 implementation rules are broken. These error codes begin with the letters CE and may require working with the EDI Services group and/or your vendor to determine the corrective action. Business rule errors where logical or BCBSMS specific rules are broken. Generally, eligibility edits begin with the letters EL and other business rules begin with either HB, CRE, or UB. Edits which begin with a prefix other than CRE, EL, HB, or UB are applied only to claims destined for other payers. Regardless of whether an error is a compliance error or a business rule error, the BCBSMS Error Code will be presented on both the EDI Front-end Processing Report (human readable) and the ASC X12 277CA transaction (within data element STC12). These codes are described in the table below. NOTE: 277CA transactions also contain the ASC X12 standard claim status category, claim status, and entity codes as required by that transaction. Compliance errors will also produce a 999 transaction which will contain more details about the data elements and/or transaction loops that were found to be in error. Error Codes Error Code AI0001 AI0002 AI0003 AI0004 AI0005 AI0006 AI0007 AI0008 AI0009 AI0010 AI0011 AI0012 AI0013 AI0014 AI0015 AI0016 AI0017 AI0018 AI0020 AI0021 AI0022 AI0023 AI0024 AI0025 Description Invalid Type Bill Invalid Admission Type Invalid Admission Source From date is greater than through date Total days must equal covered plus non-covered days Invalid NPI Invalid Date of Birth Invalid Admit Date Invalid Admission Type Invalid Admission Source Invalid Patient Status Invalid Patient Status Adjustment DCN missing or DCN on non-adjustment Invalid Patient Name Invalid Principal Diagnosis Admitting Diagnosis required Invalid Patient Gender Invalid Admit Hour Invalid Discharge Hour Invalid From Date Invalid Through Date Line non-covered charge must not be greater than line charge Invalid Facility Zip Invalid Bill Prov Zip Version 5010 Document Revision 2.3 Page 3 of 40

4 AI0026 Invalid Bill Prov Address AP0001 NPI cannot be spaces or zeroes AP0002 Rendering Provider cannot be spaces or zeroes AP0003 Patient last name cannot be spaces AP0004 Invalid Patient Date of Birth AP0005 Diagnosis 1 must be present except on Ambulance claims AP0006 Payor ID cannot be zeroes AP0007 Invalid Insured Name or Patient Relation AP0008 Insured ID cannot be spaces AP0009 Invalid Modifier AP0010 Invalid line item charge AP0011 From date not valid with Through date AP0012 Invalid Accident Symptom Date AP0013 Diagnosis 1 cannot be spaces AP0014 Line item From Date must not be before Patient Birth Date AP0015 Line item from date must not be after Line item to date AP0016 HCPC code cannot contain spaces AP0017 Invalid NDC unit of measure AP0018 Modifier is a duplicate AP0020 State is required only when auto accident CE0001 This segment is not valid CE0002 Segment invalid for version CE0003 Segment invalid for version CE0004 Invalid characters on this segment CE0005 Segment length exceeds valid length CE0006 CLM02 claim charge amount is not valid CE0007 Date value on HI segment not valid CE0008 Through date on HI segment date range not valid CE0009 From date on HI segment date range not valid CE0010 Value code (HI01-2) is not numeric CE0011 Occurrence Code date format qualifier (HI01-3) must be D8 CE0012 ISA01 element length not valid CE0013 ISA01 code not valid CE0014 ISA02 element length not valid CE0015 ISA03 element length not valid CE0016 ISA03 code not valid CE0017 ISA04 element length not valid CE0018 ISA05 element length not valid CE0019 ISA05 code not valid CE0020 ISA06 element length not valid CE0021 ISA07 element length not valid CE0022 ISA07 code not valid CE0023 ISA08 element length not valid CE0024 ISA09 element length not valid CE0025 ISA09 date not valid CE0026 ISA10 element length not valid CE0027 ISA11 element length not valid CE0028 ISA12 element length not valid CE0029 ISA12 code not valid Version 5010 Document Revision 2.3 Page 4 of 40

5 CE0030 ISA13 element length not valid CE0031 ISA14 element length not valid CE0032 ISA14 code not valid CE0033 ISA15 element length not valid CE0034 ISA15 code not valid CE0035 ISA16 element length not valid CE0036 ISA segment out of sequence CE0037 ISA segment terminator missing CE0038 GS01 element length not valid CE0039 GS02 element length not valid CE0040 GS03 element length not valid CE0041 GS04 element length not valid CE0042 GS04 date not valid CE0043 GS05 element length not valid CE0044 GS06 element length not valid CE0045 GS07 element length not valid CE0046 GS07 code not valid CE0047 GS08 element length not valid CE0048 GS segment out of sequence CE0049 GS element 2 must match ISA element 6 CE0050 GS element 3 must match ISA element 8 CE0051 GS08 version not valid CE0052 GS01 code not valid CE0053 ST01 element length not valid CE0054 ST01 code not valid CE0055 ST02 element length not valid CE0056 ST03 element length not valid CE0057 ST segment out of sequence CE0058 BHT01 element length not valid CE0059 BHT01 code not valid CE0060 BHT02 element length not valid CE0061 BHT02 code not valid CE0062 BHT03 element length not valid CE0063 BHT03 element length not valid CE0064 BHT04 element length not valid CE0065 BHT04 date not valid CE0066 BHT05 element length not valid CE0067 BHT06 element length not valid CE0068 BHT06 code not valid CE0069 BHT06 code not valid CE0070 BHT06 element length not valid CE0071 BHT segment out of sequence CE0072 REF01 code not valid CE0073 REF01 code not valid CE0074 REF02 element length not valid CE0075 REF02 element length not valid CE0076 REF03 element length not valid CE0077 REF04 element length not valid CE0078 REF segment out of sequence Version 5010 Document Revision 2.3 Page 5 of 40

6 CE0079 CE0080 CE0081 CE0082 CE0083 CE0084 CE0085 CE0086 CE0087 CE0088 CE0089 CE0090 CE0091 CE0092 CE0093 CE0094 CE0095 CE0096 CE0097 CE0098 CE0099 CE0100 CE0101 CE0102 CE0103 CE0104 CE0105 CE0106 CE0107 CE0108 CE0109 CE0110 CE0111 CE0112 CE0113 CE0114 CE0115 CE0116 CE0117 CE0118 CE0119 CE0120 CE0121 CE0122 CE0123 CE0124 CE0125 CE0126 CE0127 REF segment out of sequence REF segment out of sequence REF segment out of sequence REF segment out of sequence REF segment out of sequence NM101 code not valid NM101 code not valid NM102 code not valid NM103 element length not valid NM103 element length not valid NM104 element length not valid NM104 element length not valid NM105 element length not valid NM106 element length not valid NM107 element length not valid NM108 code not valid NM108 code not valid NM109 element length not valid NM110 element length not valid NM111 element length not valid NM112 element length not valid NM1 segment out of sequence NM1 segment out of sequence NM1 segment out of sequence NM1 segment out of sequence NM1 segment out of sequence NM1 segment out of sequence PER01 code not valid PER02 element length not valid PER03 code not valid PER03 code not valid PER04 element length not valid PER04 element length not valid PER05 code not valid PER05 code not valid PER06 element length not valid PER06 element length not valid PER07 code not valid PER07 code not valid PER08 element length not valid PER08 element length not valid PER09 element length not valid PER06 required element missing PER08 required element missing PER segment out of sequence PER segment out of sequence PER segment out of sequence PER segment out of sequence PER segment out of sequence Version 5010 Document Revision 2.3 Page 6 of 40

7 CE0128 CE0129 CE0130 CE0131 CE0132 CE0133 CE0134 CE0135 CE0136 CE0137 CE0138 CE0139 CE0140 CE0141 CE0142 CE0143 CE0144 CE0145 CE0146 CE0147 CE0148 CE0149 CE0150 CE0151 CE0152 CE0153 CE0154 CE0155 CE0156 CE0157 CE0158 CE0159 CE0160 CE0161 CE0162 CE0163 CE0164 CE0165 CE0166 CE0167 CE0168 CE0169 CE0170 CE0171 CE0172 CE0173 CE0174 CE0175 CE0176 PER04 element length not valid PER04 element must be numeric PER06 element length not valid PER06 element must be numeric PER08 element length not valid PER08 element must be numeric HL01 element length not valid HL02 element length not valid HL03 code not valid HL04 code not valid HL01 required element missing HL04 required element missing HL01 required element missing HL02 required element missing HL04 required element missing HL segment out of sequence HL segment out of sequence HL segment out of sequence HL segment out of sequence HL segment out of sequence HL segment out of sequence HL segment not in correct loop PRV01 code not valid PRV01 code not valid PRV02 code not valid PRV02 code not valid PRV03 element length not valid PRV03 element length not valid PRV04 element length not valid PRV06 element length not valid PRV segment out of sequence CUR01 code not valid CUR02 element length not valid CUR03 element length not valid CUR04 element length not valid CUR05 element length not valid CUR05 element length not valid CUR07 element length not valid CUR08 element length not valid CUR09 element length not valid CUR10 element length not valid CUR11 element length not valid CUR12 element length not valid CUR13 element length not valid CUR14 element length not valid CUR15 element length not valid CUR16 element length not valid CUR17 element length not valid CUR18 element length not valid Version 5010 Document Revision 2.3 Page 7 of 40

8 CE0177 CE0178 CE0179 CE0180 CE0181 CE0182 CE0183 CE0184 CE0185 CE0186 CE0187 CE0188 CE0189 CE0190 CE0191 CE0192 CE0193 CE0194 CE0195 CE0196 CE0197 CE0198 CE0199 CE0200 CE0201 CE0202 CE0203 CE0204 CE0205 CE0206 CE0207 CE0208 CE0209 CE0210 CE0211 CE0212 CE0213 CE0214 CE0215 CE0216 CE0217 CE0218 CE0219 CE0220 CE0221 CE0222 CE0223 CE0224 CE0225 CUR19 element length not valid CUR20 element length not valid CUR21 element length not valid CUR segment out of sequence CUR segment not in correct loop N301 element length not valid N302 element length not valid N301 required element missing N3 segment out of sequence N3 segment out of sequence N301 invalid address sequence N302 invalid address sequence N401 element length not valid N402 element length not valid N403 element length not valid N404 element length not valid N405 element length not valid N406 element length not valid N407 element length not valid N401 required element missing N402 required element missing N403 required element missing N403 us zip code must be numeric N403 zip code length not valid N403 zip code length not valid N403 zip code first 4 not numeric N403 zip code first 3 not numeric N403 zip code not numeric N403 zip code cannot be zeroes N4 segment out of sequence N402 state not valid N404 invalid country/territory/etc Payer Responsibility Sequence Number (SBR01) not valid Payer Responsibility Sequence Number (SBR01) not valid Individual Relationship Code (SBR02) not valid Individual Relationship Code (SBR02) not valid Insured Group or Policy Number (SBR03) element length not valid Insured Group or Policy Number (SBR03) element length not valid Plan Name (SBR04) element length not valid Insurance Type Code (SBR05) not valid Insurance Type Code (SBR05) not valid SBR06 code not valid SBR07 element length not valid SBR08 element length not valid Claim Filing Indicator (SBR09) not valid Claim Filing Indicator (SBR09) not valid Subscriber Information (SBR) segment out of sequence Subscriber Information (SBR) segment out of sequence Subscriber Information (SBR) segment out of sequence Version 5010 Document Revision 2.3 Page 8 of 40

9 CE0226 CE0227 CE0228 CE0229 CE0230 CE0231 CE0232 CE0233 CE0234 CE0235 CE0236 CE0237 CE0238 CE0239 CE0240 CE0241 CE0242 CE0243 CE0244 CE0245 CE0246 CE0247 CE0248 CE0249 CE0250 CE0251 CE0252 CE0253 CE0254 CE0255 CE0256 CE0257 CE0258 CE0259 CE0260 CE0261 CE0262 CE0263 CE0264 CE0265 CE0266 CE0267 CE0268 CE0269 CE0270 CE0271 CE0272 CE0273 CE0274 Subscriber Information (SBR) segment out of sequence Subscriber Information (SBR) segment out of sequence Subscriber Information (SBR) segment out of sequence Individual Relationship Code (PAT01) not valid Individual Relationship Code (PAT01) not valid PAT02 element length not valid PAT03 element length not valid PAT04 code not valid Date of Death Format Qualifier (PAT05) not valid Date of Death (PAT06) element length not valid Measurement Code (PAT07) not valid Weight (PAT08) element length not valid Pregnancy Indicator (PAT09) not valid Patient Information (PAT) segment out of sequence Patient Information (PAT) segment out of sequence DMG01 code not valid DMG02 element length not valid DMG03 code not valid DMG04 element length not valid DMG05 element length not valid DMG06 element length not valid DMG07 element length not valid DMG08 element length not valid DMG09 element length not valid DMG10 element length not valid DMG11 element length not valid DMG01 required element missing DMG02 required element missing DMG03 required element missing DMG segment out of sequence DMG segment out of sequence DMG02 date not valid CLM01 element length not valid CLM02 element length not valid CLM03 element length not valid CLM04 element length not valid CLM05 element length not valid CLM06 code not valid CLM07 code not valid CLM07 code not valid CLM08 code not valid CLM08 code not valid CLM09 code not valid CLM09 code not valid CLM10 code not valid CLM10 code not valid CLM11 element length not valid CLM12 code not valid CLM12 code not valid Version 5010 Document Revision 2.3 Page 9 of 40

10 CE0275 CE0276 CE0277 CE0278 CE0279 CE0280 CE0281 CE0282 CE0283 CE0284 CE0285 CE0286 CE0287 CE0288 CE0289 CE0290 CE0291 CE0292 CE0293 CE0294 CE0295 CE0296 CE0297 CE0298 CE0299 CE0300 CE0301 CE0302 CE0303 CE0304 CE0305 CE0306 CE0307 CE0308 CE0309 CE0310 CE0311 CE0312 CE0313 CE0314 CE0315 CE0316 CE0317 CE0318 CE0319 CE0320 CE0321 CE0322 CE0323 CLM13 element length not valid CLM14 element length not valid CLM15 element length not valid CLM16 code not valid CLM17 element length not valid CLM18 code not valid CLM19 code not valid CLM20 code not valid CLM20 code not valid NM1 no payer entered for this claim CLM segment out of sequence CLM segment out of sequence CLM segment out of sequence CLM segment out of sequence CLM segment out of sequence CLM segment out of sequence DTP01 code not valid DTP01 code not valid DTP02 code not valid DTP03 element length not valid DTP03 first 4 positions not numeric DTP03 minutes not valid DTP03 element length not valid DTP03 element length not valid DTP03 element length not valid DTP03 element length not valid DTP03 element not numeric DTP03 element not numeric DTP03 date not valid DTP01 required element missing DTP02 required element missing DTP03 required element missing DTP03 date not valid DTP03 date not valid DTP03 date not valid DTP03 time not valid DTP03 date/time not valid DTP03 date/time not valid DTP segment out of sequence DTP segment out of sequence DTP segment out of sequence DTP segment out of sequence DTP segment out of sequence DTP segment out of sequence CL101 required element missing CL101 element length not valid CL102 element length not valid CL103 element length not valid CL104 element length not valid Version 5010 Document Revision 2.3 Page 10 of 40

11 CE0324 CE0325 CE0326 CE0327 CE0328 CE0329 CE0330 CE0331 CE0332 CE0333 CE0334 CE0335 CE0336 CE0337 CE0338 CE0339 CE0340 CE0341 CE0342 CE0343 CE0344 CE0345 CE0346 CE0347 CE0348 CE0349 CE0350 CE0351 CE0352 CE0353 CE0354 CE0355 CE0356 CE0357 CE0358 CE0359 CE0360 CE0361 CE0362 CE0363 CE0364 CE0365 CE0366 CE0367 CE0368 CE0369 CE0370 CE0371 CE0372 CL1 element 1, 2, or 3 required CL1 segment out of sequence PWK01 code not valid PWK01 code not valid PWK02 code not valid PWK02 code not valid PWK03 element length not valid PWK04 element length not valid PWK05 code not valid PWK06 element length not valid PWK07 element length not valid PWK09 element length not valid PWK segment out of sequence PWK segment out of sequence PWK segment out of sequence PWK segment out of sequence PWK segment out of sequence PWK segment out of sequence CN101 code not valid CN102 element length not valid CN103 element length not valid CN104 element length not valid CN104 element length not valid CN105 element length not valid CN106 element length not valid CN1 segment out of sequence CN1 segment out of sequence CN1 segment out of sequence CN1 segment out of sequence CN1 segment out of sequence AMT01 code not valid AMT01 code not valid AMT02 element length not valid AMT03 element length not valid AMT segment out of sequence AMT segment out of sequence AMT segment out of sequence AMT segment out of sequence AMT segment out of sequence AMT segment out of sequence K301 element length not valid K302 element length not valid K301 required element missing K3 segment out of sequence K3 segment out of sequence K3 segment out of sequence K3 segment out of sequence K3 segment out of sequence NTE01 code not valid Version 5010 Document Revision 2.3 Page 11 of 40

12 CE0373 CE0374 CE0375 CE0376 CE0377 CE0378 CE0379 CE0380 CE0381 CE0382 CE0383 CE0384 CE0385 CE0386 CE0387 CE0388 CE0389 CE0390 CE0391 CE0392 CE0393 CE0394 CE0395 CE0396 CE0397 CE0398 CE0399 CE0400 CE0401 CE0402 CE0403 CE0404 CE0405 CE0406 CE0407 CE0408 CE0409 CE0410 CE0411 CE0412 CE0413 CE0414 CE0415 CE0416 CE0417 CE0418 CE0419 CE0420 CE0421 NTE01 code not valid NTE02 element length not valid NTE segment out of sequence NTE segment out of sequence NTE segment out of sequence NTE segment out of sequence NTE segment out of sequence NTE segment out of sequence NTE02 element has invalid data NTE multiple add segments invalid CR601 element length not valid CR601 code not valid CR602 element length not valid CR603 element length not valid CR603 code not valid CR604 element length not valid CR605 element length not valid CR606 element length not valid CR606 code not valid CR607 element length not valid CR607 code not valid CR608 element length not valid CR608 code not valid CR609 element length not valid CR610 element length not valid CR610 code not valid CR611 element length not valid CR612 element length not valid CR613 element length not valid CR614 element length not valid CR615 element length not valid CR615 code not valid CR616 element length not valid CR617 element length not valid CR617 code not valid CR618 element length not valid CR619 element length not valid CR620 element length not valid CR621 element length not valid CR601 required element missing CR602 required element missing CR605 required element missing CR606 required element missing CR607 required element missing CR608 required element missing CR617 required element missing CR6 segment out of sequence CRC01 code not valid CRC01 code not valid Version 5010 Document Revision 2.3 Page 12 of 40

13 CE0422 CE0423 CE0424 CE0425 CE0426 CE0427 CE0428 CE0429 CE0430 CE0431 CE0432 CE0433 CE0434 CE0435 CE0436 CE0437 CE0438 CE0439 CE0440 CE0441 CE0442 CE0443 CE0444 CE0445 CE0446 CE0447 CE0448 CE0449 CE0450 CE0451 CE0452 CE0453 CE0454 CE0455 CE0456 CE0457 CE0458 CE0459 CE0460 CE0461 CE0462 CE0463 CE0464 CE0465 CE0466 CE0467 CE0468 CE0469 CE0470 CRC02 code not valid CRC03 code not valid CRC03 element length not valid CRC04 code not valid CRC04 element length not valid CRC05 code not valid CRC05 element length not valid CRC06 code not valid CRC06 element length not valid CRC07 code not valid CRC07 element length not valid CRC01 required element missing CRC02 required element missing CRC03 required element missing CRC segment out of sequence CRC segment out of sequence CRC segment out of sequence CRC segment out of sequence HI01 element length not valid HI01 element length not valid HI02 element length not valid HI02 element length not valid HI03 element length not valid HI03 element length not valid HI04 element length not valid HI04 element length not valid HI05 element length not valid HI05 element length not valid HI06 element length not valid HI06 element length not valid HI07 element length not valid HI07 element length not valid HI08 element length not valid HI08 element length not valid HI09 element length not valid HI09 element length not valid HI10 element length not valid HI10 element length not valid HI11 element length not valid HI11 element length not valid HI12 element length not valid HI12 element length not valid HI01 required element missing HI segment out of sequence HI segment out of sequence HI segment out of sequence HI segment out of sequence HI segment out of sequence QTY01 code not valid Version 5010 Document Revision 2.3 Page 13 of 40

14 CE0471 CE0472 CE0473 CE0474 CE0475 CE0476 CE0477 CE0478 CE0479 CE0480 CE0481 CE0482 CE0483 CE0484 CE0485 CE0486 CE0487 CE0488 CE0489 CE0490 CE0491 CE0492 CE0493 CE0494 CE0495 CE0496 CE0497 CE0498 CE0499 CE0500 CE0501 CE0502 CE0503 CE0504 CE0505 CE0506 CE0507 CE0508 CE0509 CE0510 CE0511 CE0512 CE0513 CE0514 CE0515 CE0516 CE0517 CE0518 CE0519 QTY01 code not valid QTY02 element length not valid QTY03 element length not valid QTY04 element length not valid QTY01 required element missing QTY02 required element missing QTY03 required element missing QTY segment out of sequence QTY segment out of sequence QTY segment out of sequence QTY segment out of sequence HCP01 code not valid HCP02 element length not valid HCP03 element length not valid HCP04 element length not valid HCP04 element length not valid HCP05 element length not valid HCP06 element length not valid HCP06 element length not valid HCP07 element length not valid HCP08 element length not valid HCP09 code not valid HCP09 code not valid HCP10 element length not valid HCP11 code not valid HCP12 element length not valid HCP13 code not valid HCP14 code not valid HCP15 code not valid HCP02 required element missing HCP segment out of sequence HCP segment out of sequence HCP segment out of sequence HCP segment out of sequence HCP segment out of sequence CR701 code not valid CR702 element length not valid CR703 element length not valid CR7 segment out of sequence CR7 segment out of sequence HSD01 element length not valid HSD01 code not valid HSD02 element length not valid HSD03 code not valid HSD04 element length not valid HSD05 element length not valid HSD05 code not valid HSD06 element length not valid HSD07 element length not valid Version 5010 Document Revision 2.3 Page 14 of 40

15 CE0520 CE0521 CE0522 CE0523 CE0524 CE0525 CE0526 CE0527 CE0528 CE0529 CE0530 CE0531 CE0532 CE0533 CE0534 CE0535 CE0536 CE0537 CE0538 CE0539 CE0540 CE0541 CE0542 CE0543 CE0544 CE0545 CE0546 CE0547 CE0548 CE0549 CE0550 CE0551 CE0552 CE0553 CE0554 CE0555 CE0556 CE0557 CE0558 CE0560 CE0561 CE0562 CE0563 CE0564 CE0565 CE0566 CE0567 CE0568 CE0569 HSD07 code not valid HSD08 element length not valid HSD08 code not valid HSD element and 8 missing HSD segment out of sequence CAS01 element length not valid CAS01 code not valid CAS02 element length not valid CAS02 element cannot be spaces CAS03 element length not valid CAS04 element length not valid CAS05 element length not valid CAS06 element length not valid CAS07 element length not valid CAS08 element length not valid CAS09 element length not valid CAS10 element length not valid CAS11 element length not valid CAS12 element length not valid CAS13 element length not valid CAS14 element length not valid CAS15 element length not valid CAS16 element length not valid CAS17 element length not valid CAS18 element length not valid CAS19 element length not valid CAS01 required element missing CAS02 required element missing CAS03 required element missing CAS segment out of sequence OI01 element length not valid DIAGNOSIS and pointer mismatch DIAGNOSIS and pointer mismatch DIAGNOSIS and pointer mismatch DIAGNOSIS and pointer mismatch DIAGNOSIS and pointer mismatch DIAGNOSIS and pointer mismatch DIAGNOSIS and pointer mismatch DIAGNOSIS and pointer mismatch OI02 element length not valid OI03 element length not valid OI03 code not valid OI03 code not valid OI04 element length not valid OI04 code not valid OI04 code not valid OI05 element length not valid OI06 element length not valid OI06 code not valid Version 5010 Document Revision 2.3 Page 15 of 40

16 CE0570 CE0571 CE0572 CE0573 CE0574 CE0575 CE0576 CE0577 CE0578 CE0579 CE0580 CE0581 CE0582 CE0583 CE0584 CE0585 CE0586 CE0587 CE0588 CE0589 CE0590 CE0591 CE0592 CE0593 CE0594 CE0595 CE0596 CE0597 CE0598 CE0599 CE0600 CE0601 CE0602 CE0603 CE0604 CE0605 CE0606 CE0607 CE0608 CE0609 CE0610 CE0611 CE0612 CE0613 CE0614 CE0615 CE0616 CE0617 CE0618 OI06 code not valid OI segment out of sequence OI segment out of sequence MIA01 element length not valid MIA02 element length not valid MIA02 element length not valid MIA03 element length not valid MIA04 element length not valid MIA05 element length not valid MIA05 element length not valid MIA06 element length not valid MIA07 element length not valid MIA08 element length not valid MIA09 element length not valid MIA10 element length not valid MIA11 element length not valid MIA12 element length not valid MIA13 element length not valid MIA14 element length not valid MIA15 element length not valid MIA16 element length not valid MIA17 element length not valid MIA18 element length not valid MIA19 element length not valid MIA20 element length not valid MIA20 element length not valid MIA21 element length not valid MIA21 element length not valid MIA22 element length not valid MIA22 element length not valid MIA23 element length not valid MIA23 element length not valid MIA24 element length not valid MIA01 required element missing MIA segment out of sequence MOA01 element length not valid MOA02 element length not valid MOA03 element length not valid MOA03 element length not valid MOA04 element length not valid MOA04 element length not valid MOA05 element length not valid MOA05 element length not valid MOA06 element length not valid MOA06 element length not valid MOA07 element length not valid MOA07 element length not valid MOA08 element length not valid MOA09 element length not valid Version 5010 Document Revision 2.3 Page 16 of 40

17 CE0619 MOA elements missing CE0620 MOA segment out of sequence CE0621 MOA segment out of sequence CE0622 LX01 more than 450 service lines CE0623 LX01 element length not valid CE0624 LX01 service line must begin with 1 CE0625 LX01 service line number out of sequence CE0626 LX01 service line number > 450 CE0627 LX segment out of sequence CE0628 LX segment out of sequence CE0629 LX segment out of sequence CE0630 LX segment out of sequence CE0631 LX segment out of sequence CE0632 LX segment out of sequence CE0633 SV201 element length not valid CE0634 SV202 element length not valid CE0635 SV202 element length not valid CE0636 SV203 element length not valid CE0637 SV204 element length not valid CE0638 SV204 code not valid CE0639 SV204 code not valid CE0640 SV205 element length not valid CE0641 SV206 element length not valid CE0642 SV207 element length not valid CE0643 SV208 element length not valid CE0644 SV209 element length not valid CE0645 SV210 element length not valid CE0646 SV2 segment out of sequence CE0647 SVD01 element length not valid CE0648 SVD02 element length not valid CE0649 SVD03 element length not valid CE0650 SVD03 element length not valid CE0651 SVD03 element length not valid CE0652 SVD04 element length not valid CE0653 SVD06 element length not valid CE0654 SVD01 required element missing CE0655 SVD02 required element missing CE0656 SVD04 required element missing CE0657 SVD05 required element missing CE0658 SVD segment out of sequence CE0659 SVD segment out of sequence CE0660 SVD segment out of sequence CE0661 SVD segment out of sequence CE0662 SVD segment out of sequence CE0663 SVD segment out of sequence CE0664 SE01 element length not valid CE0665 SE02 element length not valid CE0667 SE01 required element missing CE0668 SE02 required element missing Version 5010 Document Revision 2.3 Page 17 of 40

18 CE0669 CE0670 CE0671 CE0672 CE0673 CE0674 CE0675 CE0676 CE0677 CE0678 CE0679 CE0680 CE0681 CE0682 CE0683 CE0684 CE0685 CE0686 CE0687 CE0688 CE0689 CE0690 CE0691 CE0692 CE0693 CE0694 CE0695 CE0696 CE0697 CE0698 CE0699 CE0700 CE0701 CE0702 CE0703 CE0704 CE0705 CE0706 CE0707 CE0708 CE0709 CE0710 CE0711 CE0712 CE0713 CE0714 CE0715 CE0716 CE0717 SE segment out of sequence SE segment out of sequence SE segment out of sequence SE segment out of sequence SE segment out of sequence SE segment out of sequence SE02 must equal ST02 GE01 element length not valid GE02 element length not valid GE01 required element missing GE02 required element missing GE segment out of sequence GE02 must equal GS06 IEA01 element length not valid IEA02 element length not valid IEA01 required element missing IEA02 required element missing IEA segment out of sequence IEA02 must equal ISA13 LIN01 element length not valid LIN02 code not valid LIN03 element length not valid LIN03 NDC code must be 11 digits LIN04 element length not valid LIN05 element length not valid LIN06 element length not valid LIN07 element length not valid LIN08 element length not valid LIN09 element length not valid LIN10 element length not valid LIN11 element length not valid LIN12 element length not valid LIN13 element length not valid LIN14 element length not valid LIN15 element length not valid LIN16 element length not valid LIN17 element length not valid LIN18 element length not valid LIN02 required element missing LIN03 required element missing LIN segment out of sequence LIN segment out of sequence LIN segment out of sequence LIN segment out of sequence CTP01 element length not valid CTP02 element length not valid CTP03 element length not valid CTP04 element length not valid CTP05 element length not valid Version 5010 Document Revision 2.3 Page 18 of 40

19 CE0718 CE0719 CE0720 CE0721 CE0722 CE0723 CE0724 CE0725 CE0726 CE0727 CE0728 CE0729 CE0730 CE0731 CE0732 CE0733 CE0734 CE0735 CE0736 CE0737 CE0738 CE0739 CE0740 CE0741 CE0742 CE0743 CE0744 CE0745 CE0746 CE0747 CE0748 CE0749 CE0750 CE0751 CE0752 CE0753 CE0754 CE0755 CE0756 CE0757 CE0758 CE0759 CE0760 CE0761 CE0762 CE0763 CE0764 CE0765 CE0766 CTP06 element length not valid CTP07 element length not valid CTP08 element length not valid CTP09 element length not valid CTP10 element length not valid CTP11 element length not valid CTP segment out of sequence CR101 code not valid CR102 element length not valid CR103 code not valid CR104 code not valid CR105 code not valid CR106 element length not valid CR107 element length not valid CR108 element length not valid CR109 element length not valid CR110 element length not valid CR1 segment out of sequence CR201 element length not valid CR202 element length not valid CR203 code not valid CR204 code not valid CR205 code not valid CR206 element length not valid CR207 element length not valid CR208 code not valid CR208 code not valid CR209 code not valid CR210 element length not valid CR211 element length not valid CR212 code not valid CR2 segment out of sequence CR2 segment out of sequence CR301 code not valid CR302 code not valid CR303 element length not valid CR304 element length not valid CR305 element length not valid CR3 segment out of sequence CR3 segment out of sequence CR501 code not valid CR502 element length not valid CR503 element length not valid CR504 element length not valid CR505 element length not valid CR506 element length not valid CR507 element length not valid CR508 element length not valid CR509 element length not valid Version 5010 Document Revision 2.3 Page 19 of 40

20 CE0767 CE0768 CE0769 CE0770 CE0771 CE0772 CE0773 CE0774 CE0775 CE0776 CE0777 CE0778 CE0779 CE0780 CE0781 CE0782 CE0783 CE0784 CE0785 CE0786 CE0787 CE0788 CE0789 CE0790 CE0791 CE0792 CE0793 CE0794 CE0795 CE0796 CE0797 CE0798 CE0799 CE0800 CE0801 CE0802 CE0803 CE0804 CE0805 CE0806 CE0807 CE0808 CE0809 CE0810 CE0811 CE0812 CE0813 CE0814 CE0815 CR510 element length not valid CR511 element length not valid CR512 code not valid CR513 code not valid CR514 code not valid CR515 code not valid CR516 element length not valid CR517 element length not valid CR518 element length not valid CR5 segment out of sequence SV101 element length not valid SV102 element length not valid SV103 code not valid SV103 code not valid SV104 element length not valid SV105 element length not valid SV106 element length not valid SV107 element length not valid SV108 element length not valid SV109 code not valid SV110 element length not valid SV111 code not valid SV112 code not valid SV113 code not valid SV114 element length not valid SV115 element length not valid SV115 code not valid SV116 element length not valid SV117 element length not valid SV118 element length not valid SV119 element length not valid SV120 element length not valid SV121 element length not valid SV1 segment out of sequence SV101 line item HCPC missing SV102 line item charge not numeric SV501 element length not valid SV502 element length not valid SV502 element length not valid SV503 element length not valid SV504 element length not valid SV505 element length not valid SV506 element length not valid SV506 element length not valid SV507 element length not valid SV5 segment out of sequence SV501 line item procedure code missing SV504 line item charge not numeric SV505 line item charge not numeric Version 5010 Document Revision 2.3 Page 20 of 40