The Complete Disposition and SP Edit Code List. For your reference, we are including the codes that constitute the complete set of Disposition and SP Edits. These are all the edit and disposition codes that the Centers for Medicare & Medicaid Services (CMS) may use in an Update File Response forwarded to an Agreeing Partner. Subsets are shown elsewhere in the business rules, above. Keep in mind that not all these codes will apply to all response files you can receive from the Benefits Coordination & Recovery Center (BCRC). Please contact the BCRC if you have questions about any of the Disposition or SP Edit codes. NOTES: • Codes marked with an asterisk (*) are "front end" consistency edits. These codes show conditions on the face of the record that are unrecognizable or unallowable for that field (e.g., the field requires numeric characters but the submitted record contains alpha characters). • Codes that do not have an asterisk (*) show discrepancies that result from information on the submitted record conflicting with or not matching the information on CMS’s Systems.
The Complete Disposition and SP Edit Code List. For your reference, we are including the codes that constitute the complete set of Disposition and SP Edits. These are all the edit and disposition codes that the Centers for Medicare & Medicaid Services (CMS) may use in an Update File Response forwarded to an Agreeing Partner. Subsets are shown elsewhere in the business rules, above. Keep in mind that not all these codes will apply to all response files you can receive from the Benefits Coordination & Recovery Center (BCRC). Please contact the BCRC if you have questions about any of the Disposition or SP Edit codes. NOTES: Codes marked with an asterisk (*) are "front end" consistency edits. These codes show conditions on the face of the record that are unrecognizable or unallowable for that field (e.g., the field requires numeric characters but the submitted record contains alpha characters). Codes that do not have an asterisk (*) show discrepancies that result from information on the submitted record conflicting with or not matching the information on CMS’s Systems. DISPOSITION AND SP EDIT CODE LIST Table 14: Disposition Codes CMS may use in an Update file Response forwarded to an Agreeing Partner Disposition Code Description 01 Record accepted by Common Working File (CWF) as an “Add” or a “Change” record. SP Transactions edit; record returned with at least one SP or RX edit (specific SP and RX edits are described below). 50 Record still being processed by CMS. Internal CMS use only; no Agreeing Partner action is required. 51 Beneficiary is not in file on CMS System. Record will not be recycled. Beneficiary most likely not entitled to Medicare. Agreeing Partner should re-verify beneficiary status based on information in its files. 52 Record still being processed by CMS. Internal CMS use only; no Agreeing Partner action is required. 53 Record in alpha match at CMS. Internal CMS use only; no Agreeing Partner action is required. 55 Name/Personal Characteristic Mismatch. Name or personal characteristic of beneficiary does not match the Health Insurance Claim Number (HICN) on Medicare's files. Agreeing Partner needs to re-verify name, XXXX, date of birth and sex based on information in its files; then resubmit on next exchange file. 61 Cross-Reference Data Base Problem. Internal CMS use only; no Agreeing Partner action is required. Disposition Code Description AB CWF problem that can only be resolved by CWF Technician. Internal CMS use only; no Agreeing Partner action is required. CI Processing Error. Interna...
