CMS Pub. 100-04, ch. 24, § 50.1.3

Providers must access A/B MACs and DME MACs online applications, Medicare Part A

Direct Data Entry (DDE), Medicare Part B Professional Provider Telecommunications

Network (PPTN) and DME MAC Claim Status Inquiry (CSI) as directed by the A/B

MAC or DME MAC. A/B MACs and DME MACs are to permit access to DDE, PPTN

and DMCS by using the most cost-effective transmission solution, among the CMS-

sanctioned options, that meets the needs of their trading partners.

A/B MACs and CEDI may, but are not required to, support electronic transfers for

Medicare using 56 K connections for their asynchronous communications lines. For

asynchronous communications, A/B MACs and CEDI may, but are not required to,

support provider access through Transmission Control Protocol/Internet Protocol

(TCP/IP). If A/B MACs and CEDI do support TCP/IP, it must be compliant with

Internet Request for Comment (RFC) number 1122 and 1123, using Serial Line Internet

Protocol (SLIP) or Point-to-Point Protocol (PPP). For any EDI transfers over TCP/IP

connections, A/B MACs and CEDI must support using File Transfer Protocol (FTP) in a

secure manner which is supported within the FTP protocol in a consistent manner and

which takes advantage of existing security infrastructure and technology, compliant with

RFC 2228. FTP servers provide for user authentication through user ID/password

mechanisms. A/B MACs and CEDI must submit any other security mechanism in

addition to this to CMS for approval prior to implementation. A/B MACs and CEDI may

but are not required to support file compression for ASC X12 or NCPDP (CEDI only)

transactions. Compression is permitted between the contractor and its data center.

A/B MACs and CEDI may not limit the number of ASC X12 837 claim transactions or

the number of providers with transactions included in a single transmission, but they may

limit a single transmission to 5,000 claims if that is necessary for efficient operations.

For NCPDP, CEDI may not limit the number of transactions per batch except as noted

within the batch standard. However, they may limit a single physical file to having only

one batch. Server capacity must be adequate to support simultaneous sustained file

transfers from all configured communications lines.

A/B MACs and CEDI must accept and send all ASC X12 837 claim transactions as a

continuous byte stream or as a variable length record. A/B MACs and CEDI are not

permitted to require that provider EDI transaction data be broken down into 80 byte

segments and may not require any other deviation from the variable length format or the

continuous byte stream format. For example, submitters may not be forced to create each

segment as its own record by inserting carriage returns or line feeds. Only standard ASC

X12 envelopes may be used with ASC X12 transactions. Only standard NCPDP

envelopes may be used with NCPDP transactions (applies to CEDI only).

The ASC X12 and NCPDP transactions are variable-length records designed for wire

transmission. Medicare contractors must be able to accept them over a wire connection.

Each sender and receiver must agree on the blocking factor and/or other pertinent

telecommunication protocols.

Unless otherwise approved, A/B MACs, DME MACs and CEDI are only permitted to

accept EDI transactions via the Internet when explicitly directed by CMS. This ability

includes compliance with the operating rules for Section 1104 of the Affordable Care

Act.