CMS Pub. 100-04, ch. 24, § 70.1

As described in section 40.1.1, the A/B MACs, DME MACs and CEDI shall support the

current versions adopted under HIPAA of the following transactions and their

implementation guides for the electronic exchange of data with Medicare

providers/submitters/receivers/COB trading partners. Electronic transactions that do not

fully comply with the implementation guide requirements for these formats will be

rejected.

– ASC X12 837 claim, institutional, professional and dental

– NCPDP telecommunication and equivalent batch standard for retail

prescription drug claims (applicable for CEDI and DME MACs only) and

COB (see § 40.1 of this chapter for additional information);

– ASC X12 835 remittance advice (see chapter 22 for additional information);

and

– ASC X12 276/277 claim status request and response (see chapter 31 for

additional information).

Links to sources of implementation guides for these standards are available at

• www.cms.hhs.gov/ElectronicBillingEDITrans

Although not mandated by HIPAA, as noted in § 40.1.2, CMS also requires that A/B

MACs and CEDI issue an ASC X12 999 implementation acknowledgment transaction to

electronic claim submitters to acknowledge receipt of claims (except where waived by a

submitter) and to report syntax errors related to any ASC X12 transactions submitted to

Medicare.

See Pub.100-09, the Medicare Contractor Beneficiary and Provider Communications

Manual, regarding contractor requirements for furnishing Medicare claim remittance

advice print software updates information to providers via the Internet and alternate

methods to be used to furnish information to those providers that lack Internet access.

An overview of any changes to existing specifications, including effective dates will be

issued to providers via A/B MACs and CEDI bulletins, on contractor Web pages, and

will also be available via the Internet as Manual transmittals which can be viewed via a

link from www.cms.hhs.gov/ElectronicBillingEDITrans/01_Overview.asp to the separate

page for each EDI transaction format supported by Medicare fee-for-service plans.