Electronic Data Interchange Trading Partner Reports

page description

The Error Report is provided to the trading partner as an HTML file. The file name will follow the standard Nebraska Medicaid naming convention: EDI000000XXX.ERROR.D20170215.T020904279.ZIP.

Example of error report

Electronic claim activity (ECA) report – rejected claims

Electronic claim activity (ECA) report – deleted claims

Nebraska Medicaid uses national codes for reporting on the electronic remittance advice and other reports. See the link below to find the web site where national codes are maintained.

https://x12.org/codes​

• 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."

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.