Nebraska Medicaid Program
Electronic Data Interchange (EDI)
EDI Trading Partner Reports
Currently when a file fails compliance, you receive a .txt file with information regarding the error. The file name follows the naming convention EDI000000XXX.ERROR.D20170215.T020904279.ZIP.
Example of the current Error Report
Soon we will be upgrading our EDI Platform and the error report format will change from .txt to an HTML file with significantly more detail. The file name will follow the same naming convention EDI000000XXX.ERROR.D20170215.T020904279.ZIP.
Here is an example of the improved report
More details will be sent in a Trading Partner Alert prior to the implementation of this change.
Claim Reports For EDI Trading Partners
Electronic Claim Activity (ECA) Report – Rejected Claims
Electronic Claim Activity (ECA) Report – Deleted Claims
Codes Used on Electronic Reports
Nebraska Medicaid uses national codes for reporting on the electronic remittance advice and other reports. Click here Washington Publishing Company (WPC) HIPAA Code List to connect to the web site where national codes are maintained.
- Medicaid Remittance Advice uses “Claim Adjustment Reason Codes” and “Remittance Advice Remark Codes.”
- Medicaid Deleted Claims and Medicaid Electronic Claim Activity (ECA) reports use: “Claim Status Codes” and “Claim Status Category Codes.”
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.
Documents in PDF format require the use of Adobe Acrobat Reader which can be downloaded for free from Adobe Systems, Inc.