CMS Pub. 100-04, ch. 27, § 80.2

The results of CWF error processing is controlled by different set of components. There

are specific error codes for each claim type and maintenance transactions. Claims have a

Consistency, Utilization, A/B Crossover, and Duplicate error codes.

Transactions for Medicare Secondary Payer (MSP), End Stage Renal Disease (ESRD),

Certificate of Medical Necessity (CMN), Beneficiary other insurance (BOI), Libby

Montana (HUEP), Prior Authorization (HUPA),and IVIG error codes are also available.

Below are the list of high level error functions performed during the CWF processing

1. Inpatient, SNF, Outpatient, Home Health, and Hospice consistency edits,

2. Part B/DMEPOS consistency edits,

3. Entitlement edits,

4. Duplicate edits,

5. Inpatient, SNF, Outpatient, Home Health, and Hospice utilization edits,

6. Part B/DMEPOS utilization edits,

7. A/B Crossover edits,

8. Medicare Secondary Payer (MSP) consistency/utilization edits,

9. MSP transaction (HUSP) edits,

10. Certified Medical Necessity (CMN) consistency/utilization edits,

11. CMN transaction (HUCM) edits,

12. End Stage Renal Decease (HURD) consistency/utilization edits,

13. ESRD transaction (HURD) edits,

14. Beneficiary Other Information (BOI)/Claim based crossover edits,

15. BOI transaction (HUBO) edits,

16. Libby Montana (HUEP) project edits,

17. Prior Authorization (PRAU) consistency/utilization edits,

18. PRAU transaction (HUPA) edits,

19. Immune Globulin (IVIG) consistency/utilization edits,

20. IVIG transaction (HUIV) edits, and

21. BDS/FPS and other processing edits.