CMS Pub. 100-04, ch. 24, § 50.5

All claim submitters must produce accurate electronic test claims before allowed to

submit HIPAA format claim transactions in production. All submitters must send the

A/B MAC or CEDI a test file containing at least 25 claims, which are representative of

their practice or services. A/B MACs and CEDI may, based on individual consideration,

increase or decrease the number of claims required to adequately test any given

submitter. A/B MACs and CEDI will subject test claims to standard syntax and IG

semantic data edits and will provide documentation when edits detect errors.

• Standard syntax testing validates the programming of the incoming file and

includes file layout, record sequencing, balancing, alpha-numeric/numeric/date

file conventions, field values, and relational edits. Test files must pass 100

percent of the standard syntax edits before production is approved. An ASC X12

999 implementation acknowledgment will be used to validate compliance with

syntax data.

• IG Semantic Data testing validates data required for claims processing, e.g.,

procedure/diagnosis codes, modifiers. A submitter must demonstrate, at a

minimum, a 95 percent accuracy rate in data testing before production is approved

where, in the judgment of the A/B MAC or CEDI, the vendor/submitter will make

the necessary correction(s) prior to submitting a production file. An ASC X12

277CA claim acknowledgment will be used to validate compliance with semantic

data.