Nebraska Medicaid Program

Electronic Data Interchange (EDI)

Electronic Claim FAQ

277 Claims Acknowledgment

The HIPAA 5010 277 Claims Acknowledgment Transaction is an acknowledgment of receipt of claim submission(s) at the pre-processing stage; which is the process that determines whether or not to introduce the claim into the MMIS adjudication system. Claims will be reported back to the Trading Partner as either ‘accepted’ or ‘rejected’.

The 277 Claims Acknowledgment Transaction may report at the Information Receiver Level, Provider Level, Claim Level and Line level, providing the following information:

  • Reports total claims accepted and total claims rejected.

  • Reports total accepted billed amounts and total rejected billed amounts.

  • Claims that have been accepted are reported with the assigned MMIS claim number.

  • Claims that have been rejected are reported with a HIPAA X12 Claim Status Category Code and Claim Status Code(s). Up to 3 may be reported for a claim.

  • Service line information is included when a service line causes the rejection of a claim.

Where can I find Sample Electronic Claim Activity Reports?

Sample Electronic Claim Activity (ECA) Reports are available online and can be found here: www.dhhs.ne.gov/medicaid/Pages/med_edirep.aspx

  • Nebraska Medicaid uses national codes for reporting on the Electronic Claim Activity Reports. Click here Washington Publishing Company (WPC) HIPAA Code List to connect to the web site where national codes are maintained.
  • Medicaid Deleted Claims and Medicaid Electronic Claim Activity (ECA) reports use: “Claim Status Codes” and “Claim Status Category Codes."

When can an electronic claim be voided?

  • A claim can only be voided if it has yet to been processed.  A claim that has been rejected, deleted, paid, or denied cannot be voided.
  • If the claim has been rejected or deleted you must resubmit the claim.
  • If the claim has been paid in error or denied you must follow the outlined adjustment procedure.  More information on Nebraska Medicaid's adjustment procedure can be found in the 471 Appendix PDF 471-000-99.

Medicaid EDI Help Desk

866-498-4357 (toll free) or 471-9461 (in Lincoln)

 

 

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