US · guidance
CMS Pub. 100-04, ch. 27, § 20.3.3.4
Disposition Code 53 (Record in CMS Alpha Match)
• If CMS sends a claim to alpha search, it must send a disposition code 53 to the
Host. The Host puts a code 53 on its TNIF file.
• The Satellite receives code 53 and Trailer 08 with a 5052 error code on the next
recycle of the claim.
• The Satellite must recycle the claim 15 working days after receiving this code.
• If an AAR response is not received after the receipt of the third code 53 for the
same claim, the Satellite must deny the claim using the following messages:
MSN message 5.1: "Our records show that you do not have Medicare
entitlement under the number shown on this notice. If you do not agree,
please contact your local Social Security office."
Group Code CO, Claim Adjustment Reason Code (CARC) 16
(Claim/service lacks information or has submission/billing error(s) which
is needed for adjudication. Do not use this code for claims
attachment(s)/other documentation. At least one Remark Code must be
provided (may be comprised of either the NCPDP Reject Reason Code, or
Remittance Advice Remark Code that is not an ALERT.) Note: Refer to
the 835 Healthcare Policy Identification Segment (loop 2110 Service
Payment Information REF), if present), and Remittance Advice Remark
Code (RARC) N382 - Missing/incomplete/invalid patient identifier.
History
(Rev. 4047, Issued: 05-11- 18, Effective: 08-13-18, Implementation: 08-13-18)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
83e4b6fa9901e0dfabf0dc3bf37d03123f3b411adf32cda9eb8770420934ecf4
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