100-05 Medicare Secondary Payer Manual: Chapter 5.1 - ECRS Web User Guide
us-cms-medicare-manuals-pub-100-05-msp105c05_att1pdf100-05 Medicare Secondary Payer Manual: Chapter 5.1 - ECRS Web User GuideGuidance
Electronic Correspondence Referral System on the Web (ECRS Web) User Guide Version 8.0 Rev. 2026/13 April COBR-Q2-2026-v8.0
ECRS User Guide Confidentiality Statement Confidentiality Statement The collection of this information is authorized by Section 1862(b) of the Social Security Act (codified at 42 U.S.C 1395y(b)) (see also 42, C.F.R. 411.24). The information collected will be used to identify and recover past conditional and mistaken Medicare primary payments and to prevent Medicare from making mistaken payments in the future for those Medicare Secondary Payer situations that continue to exist. The Privacy Act (5 U.S.C. 552a(b)), as amended, prohibits the disclosure of information maintained by the Centers for Medicare & Medicaid Services (CMS) in a system of records to third parties, unless the beneficiary provides a written request or explicit written consent/authorization for a party to receive such information. Where the beneficiary provides written consent/proof of representation, CMS will permit authorized parties to access requisite information.
ECRS User Guide Table of Contents iii TABLE OF CONTENTS Chapter 1 : Summary of Version 8.0 Updates .......................................................... 1-1 Chapter 2 : Introduction............................................................................................. 2-1 2.1 What is ECRS? ...............................................................................................................2-1 2.2 ECRS Web CBTs ............................................................................................................2-1 2.3 About this Guide ..............................................................................................................2-1 2.4 How to Use the Required Data Reference Tables ...........................................................2-2 2.5 User Guide Conventions .................................................................................................2-2 2.6 Basic Functions ...............................................................................................................2-3 2.6.1 IDM Registration and ECRS Access .................................................................2-3 2.6.2 ECRS Login ......................................................................................................2-3 2.6.3 Main Menu ........................................................................................................2-7 2.6.4 Navigation Links ...............................................................................................2-9 2.6.5 Completed ECRS Requests and Inquiries ......................................................2-10 Chapter 3 : CWF Assistance Request Transactions ............................................... 3-1 3.1 Adding a CWF Assistance Request Transaction .............................................................3-1 3.1.1 Retrieving Beneficiary Information ....................................................................3-1 3.1.2 About Action Codes ..........................................................................................3-1 3.2 CMS MSP Hierarchy Requirements ................................................................................3-2 3.2.1 MSP Hierarchy Background ..............................................................................3-2 3.2.2 MSP Hierarchy Requirements ...........................................................................3-2 3.3 About Matching Criteria for Inquiries and Transactions....................................................3-3 3.4 Action Requested Page ...................................................................................................3-3 3.4.1 Importing HIMR MSP Information for CWF Assistance Requests .....................3-5 3.5 CWF Auxiliary Record Information Page .........................................................................3-8 3.5.1 Automated Action Code Impacts .....................................................................3-10 3.6 Informant Information Page ...........................................................................................3-11 3.7 Insurance Information Page ..........................................................................................3-13 3.8 Employment Information Page ......................................................................................3-16 3.9 Additional Information Page ..........................................................................................3-18 3.10 Comments and Remarks Page......................................................................................3-20 3.11 Summary Page .............................................................................................................3-21 3.12 Viewing, Updating, and Deleting CWF Assistance Request Transactions .....................3-23 3.12.1 View Transactions...........................................................................................3-24 3.12.2 Update Transactions .......................................................................................3-25 3.12.3 Delete Transactions ........................................................................................3-27 Chapter 4 : MSP Inquiry Transactions...................................................................... 4-1 4.1 Adding an MSP Inquiry Transaction ................................................................................4-1 4.1.1 Retrieving Beneficiary Information ....................................................................4-1 4.1.2 Common MSP Sources.....................................................................................4-1 4.2 Action Requested Page ...................................................................................................4-1 4.2.1 Navigation Links ...............................................................................................4-2 4.3 MSP Information Page ....................................................................................................4-4
ECRS User Guide Table of Contents iv 4.4 Informant Information Page .............................................................................................4-6 4.5 Insurance Information Page ............................................................................................4-8 4.6 Employment Information Page ......................................................................................4-12 4.7 Additional Information Page ..........................................................................................4-13 4.8 Prescription Drug Page .................................................................................................4-15 4.9 Summary Page .............................................................................................................4-18 4.10 Viewing, Updating, and Deleting MSP Inquiry Transactions ..........................................4-20 4.10.1 View Transactions...........................................................................................4-21 4.10.2 Update Transactions .......................................................................................4-22 4.10.3 Delete Transactions ........................................................................................4-24 Chapter 5 : Prescription Drug Assistance Request Transactions ......................... 5-1 5.1 Adding a Prescription Drug Assistance Request Transaction ..........................................5-1 5.1.1 Retrieving Beneficiary Information ....................................................................5-1 5.2 Prescription Drug Hierarchy Requirements......................................................................5-1 5.2.1 Prescription Drug Hierarchy Background ..........................................................5-1 5.2.2 Prescription Drug Hierarchy Requirements .......................................................5-1 5.3 Action Requested Page ...................................................................................................5-2 5.3.1 Navigation Links ...............................................................................................5-2 5.3.2 Automated Action Code Impacts .......................................................................5-8 5.4 Informant Information Page .............................................................................................5-8 5.5 Insurance Information Page ..........................................................................................5-10 5.6 Employment Information Page ......................................................................................5-13 5.7 Additional Information Page ..........................................................................................5-14 5.8 Comments and Remarks Page......................................................................................5-15 5.9 Summary Page .............................................................................................................5-15 5.10 Viewing, Updating, and Deleting Prescription Drug Assistance Request Transactions ..........................................................................................................................5-17 5.10.1 View Transactions...........................................................................................5-18 5.10.2 Update Transactions .......................................................................................5-19 5.10.3 Delete Transactions ........................................................................................5-22 Chapter 6 : Prescription Drug Inquiry Transactions ............................................... 6-1 6.1 Adding a Prescription Drug Inquiry Transaction ...............................................................6-1 6.1.1 Retrieving Beneficiary Information ....................................................................6-1 6.1.2 Common Prescription Drug Sources .................................................................6-1 6.2 Initial Information Page ....................................................................................................6-1 6.2.1 Navigation Links ...............................................................................................6-2 6.3 Additional Information Page ............................................................................................6-3 6.4 Prescription Drug Inquiry Prescription Drug Page............................................................6-6 6.5 Summary Page ...............................................................................................................6-9 6.6 Viewing, Updating, and Deleting Prescription Drug Inquiries .........................................6-11 6.6.1 Tracking Prescription Drug Inquiries ...............................................................6-11 6.6.2 View Transactions...........................................................................................6-13 6.6.3 Update Transactions .......................................................................................6-14 6.6.4 Delete Transactions ........................................................................................6-17 Chapter 7 : Reports .................................................................................................... 7-1
ECRS User Guide Table of Contents v 7.1 Navigation Links ..............................................................................................................7-1 7.2 Contractor Workload Tracking Report .............................................................................7-1 7.3 Consolidated ECRS Workload Search ............................................................................7-4 7.4 CMS Workload Tracking Report ......................................................................................7-7 7.5 QASP Report ................................................................................................................7-10 Chapter 8 : Uploading and Downloading Files ........................................................ 8-1 8.1 Navigation Links ..............................................................................................................8-1 8.2 Upload Assistance Request and Inquiry Files..................................................................8-1 8.3 Download Assistance Request and Inquiry Response Files ............................................8-2 8.4 Alternative File Submission Options ................................................................................8-4 8.5 File Submission Errors ....................................................................................................8-5 Chapter 9 : Identification Management (IDM) Registration, Remote Identity Proofing (RIDP), and Multi-Factor Authentication (MFA) ....................................... 9-1 9.1 Introduction .....................................................................................................................9-1 9.2 About RIDP and MFA ......................................................................................................9-1 9.3 EIDM Users .....................................................................................................................9-1 9.3.1 Login Process ...................................................................................................9-2 9.4 New Users.......................................................................................................................9-2 9.4.1 Login Process ...................................................................................................9-2 9.5 Self-Service Dashboard and Features .............................................................................9-5 9.5.1 My Profile ..........................................................................................................9-6 9.5.2 Manage MFA Devices .......................................................................................9-7 9.5.3 (Application and) Role Requests .......................................................................9-9 9.5.4 My Requests ...................................................................................................9-10 9.5.5 Manage My Roles ...........................................................................................9-11 9.5.6 Forgot Password .............................................................................................9-11 9.5.7 Unlock Account ...............................................................................................9-14 9.5.8 Forgot User ID ................................................................................................9-16 9.6 Expired Passwords........................................................................................................9-18 9.7 Completing Remote Identity Proofing (RIDP) ................................................................9-19 9.7.1 Problems with Verification? .............................................................................9-21 9.7.2 Manual Identity Proofing .................................................................................9-21 Appendix A : CWF Assistance Request Required Data Reference....................... A-1 Appendix B : MSP Inquiry Required Data Reference ............................................. B-1 Appendix C : Prescription Drug Assistance Request Required Data Reference ................................................................................................................... C-1 Appendix D : Prescription Drug Inquiry Required Data Reference....................... D-1 Appendix E : Reason and Action Codes .................................................................. E-1 Appendix F : CWF Remark Codes ............................................................................ F-1 Appendix G : File Layouts ........................................................................................ G-1 G.1 CWF Assistance Request File Layouts........................................................................... G-1 CWF Assistance Request Header Record ...................................................................... G-1 CWF Assistance Request Trailer Record ....................................................................... G-2 CWF Assistance Request Detail Record ........................................................................ G-3
ECRS User Guide Table of Contents vi CWF Assistance Request Response Header Record ................................................... G-24 CWF Assistance Request Response Detail Record ..................................................... G-25 G.2 Prescription Drug Assistance Request File Layouts ..................................................... G-30 Prescription Drug Assistance Request Header Record................................................. G-30 Prescription Drug Assistance Request Trailer Record .................................................. G-31 Prescription Drug Assistance Request Detail Record ................................................... G-32 Prescription Drug Assistance Request Response Header Record ................................ G-41 Prescription Drug Assistance Request Response Detail Record .................................. G-42 G.3 MSP Inquiry File Layouts.............................................................................................. G-46 MSP Inquiry Header Record ......................................................................................... G-46 MSP Inquiry Trailer Record .......................................................................................... G-47 MSP Inquiry Detail Record ........................................................................................... G-48 MSP Inquiry Response Detail Record .......................................................................... G-74 G.4 Prescription Drug Inquiry File Layouts .......................................................................... G-79 Prescription Drug Inquiry Header Record ..................................................................... G-79 Prescription Drug Inquiry Trailer Record ....................................................................... G-80 Prescription Drug Inquiry Detail Record........................................................................ G-81 Prescription Drug Inquiry Response Header Record .................................................... G-90 Prescription Drug Inquiry Response Detail Record ....................................................... G-91 Appendix H : Error Codes ........................................................................................ H-1 Appendix I : Frequently Asked Questions (FAQs) ................................................... I-1 I.1 General Issues ................................................................................................................ I-2 What are the operating hours for the ECRS Web application? ........................................ I-2 Do all contractors see the same exact information on ECRS Web, or does it vary from state to state?.................................................................................................................. I-2 Can users print ECRS Web pages? ................................................................................ I-2 I.2 Inquiry and Assistance Request Issues ........................................................................... I-3 Are completed MSP Inquiries, CWF Assistance Requests, Prescription Drug Assistance Requests, and Prescription Drug inquiries purged? ....................................... I-3 Why can I only update or delete an Inquiry or Assistance Request while it is in NW (new) status? ............................................................................................................ I-3 Does a contractor need to send three separate Assistance Requests to delete three auxiliary records for the same beneficiary?............................................................. I-3 In the event a transaction is sent via ECRS Web through both an Assistance Request and an Inquiry option, does ECRS have an edit in place that will find these duplicate records? ........................................................................................................... I-3 If a contractor has multiple contractor numbers, can they choose one to use consistently for Inquiries and Assistance Request transactions? ..................................... I-3 Can contractors delete an Inquiry once it has been entered and is later found to contain an error? ............................................................................................................. I-4 What action code should contractors use when they receive information regarding a termination date for a 77777 or 11102 record that is more than six months from the date of accretion? ............................................................................................................ I-4 Does the BCRC view the Comments fields on the Assistance Request Detail pages and the MSP Inquiry Detail page? ................................................................................... I-4 Appendix J : Acronyms ............................................................................................. J-1 Appendix K : Previous Version Updates ................................................................. K-1
ECRS User Guide Table of Contents vii List of Figures Figure 2-1: IDM Login with Terms and Conditions................................................................... 2-4 Figure 2-2: IDM Login with Multi-Factor Authentication ........................................................... 2-5 Figure 2-3: ECRS Federal Systems Login Warning ................................................................ 2-5 Figure 2-4: Contractor Lookup/Sign In Page ........................................................................... 2-6 Figure 2-5: Main Menu ............................................................................................................ 2-7 Figure 2-6: Completed ECRS Requests and Inquiries........................................................... 2-11 Figure 3-1: CWF Assistance Request Action Requested ........................................................ 3-4 Figure 3-2: HIMR MSP Data List ............................................................................................. 3-5 Figure 3-3: CWF Assistance Request Auxiliary Record Information ........................................ 3-8 Figure 3-4: CWF Assistance Request Informant Information ................................................. 3-11 Figure 3-5: CWF Assistance Request Insurance Information ................................................ 3-13 Figure 3-6: CWF Assistance Request Employment Information ............................................ 3-17 Figure 3-7: CWF Assistance Request Additional Information ................................................ 3-19 Figure 3-8: CWF Assistance Request Additional Information More Diagnosis Codes............ 3-20 Figure 3-9: CWF Assistance Request Comments/Remarks .................................................. 3-21 Figure 3-10: CWF Assistance Request Summary ................................................................. 3-22 Figure 3-11: CWF Assistance Request Search ..................................................................... 3-23 Figure 3-12: CWF Assistance Request Search Listing .......................................................... 3-24 Figure 3-13: CWF Assistance Request Summary ................................................................. 3-26 Figure 4-1: MSP Inquiry Action Requested ............................................................................. 4-2 Figure 4-2: MSP Inquiry MSP Information ............................................................................... 4-4 Figure 4-3: MSP Inquiry Informant Information ........................................................................ 4-7 Figure 4-4: MSP Inquiry Insurance Information ....................................................................... 4-9 Figure 4-5: MSP Inquiry Employment Information ................................................................. 4-12 Figure 4-6: MSP Inquiry Additional Information ..................................................................... 4-13 Figure 4-7: MSP Inquiry Additional Information More Diagnosis Codes ................................ 4-15 Figure 4-8: MSP Inquiry Prescription Drug ............................................................................ 4-16 Figure 4-9: MSP Inquiry Summary ........................................................................................ 4-19 Figure 4-10: MSP Inquiry Search .......................................................................................... 4-20 Figure 4-11: MSP Inquiry Search Listing ............................................................................... 4-21 Figure 4-12: MSP Inquiry Summary ...................................................................................... 4-23 Figure 5-1: Prescription Drug Assistance Request Action Requested ..................................... 5-3 Figure 5-2: Prescription Drug Assistance Request Informant Information................................ 5-9 Figure 5-3: Prescription Drug Assistance Request Insurance Information ............................. 5-11 Figure 5-4: Prescription Drug Assistance Request Employment Information ......................... 5-13 Figure 5-5: Prescription Drug Assistance Request Additional Information ............................. 5-14 Figure 5-6: Prescription Drug Assistance Request Comments and Remarks ........................ 5-15 Figure 5-7: Prescription Drug Assistance Request Summary ................................................ 5-16 Figure 5-8: Prescription Drug Assistance Request Search .................................................... 5-17 Figure 5-9: Prescription Drug Assistance Requests Search Listing ....................................... 5-18 Figure 5-10: Prescription Drug Assistance Request Summary .............................................. 5-20 Figure 6-1: Prescription Drug Inquiry Initial Information ........................................................... 6-2 Figure 6-2: Prescription Drug Inquiry Additional Information.................................................... 6-4 Figure 6-3: Prescription Drug Inquiry Prescription Drug .......................................................... 6-6 Figure 6-4: Prescription Drug Inquiry Summary..................................................................... 6-10 Figure 6-5: Prescription Drug Inquiry Search ........................................................................ 6-12 Figure 6-6: Prescription Drug Inquiry Search Listing ............................................................. 6-13
ECRS User Guide Table of Contents viii Figure 6-7: Prescription Drug Inquiry Summary..................................................................... 6-15 Figure 7-1: Main Menu (Contractor View)................................................................................ 7-1 Figure 7-2: Contractor Workload Tracking............................................................................... 7-2 Figure 7-3: Contractor Workload Tracking Results .................................................................. 7-2 Figure 7-4: Consolidated ECRS Workload Search .................................................................. 7-4 Figure 7-5: Consolidated ECRS Workload Search Results ..................................................... 7-5 Figure 7-6: CMS Workload Tracking ....................................................................................... 7-7 Figure 7-7: CMS Workload Tracking Sample .......................................................................... 7-9 Figure 7-8: QASP Report ...................................................................................................... 7-10 Figure 7-9: QASP Report Listing ........................................................................................... 7-11 Figure 8-1: ECRS File Upload ................................................................................................. 8-2 Figure 8-2: Download Response Files .................................................................................... 8-3 Figure 8-3: Response File Example ........................................................................................ 8-4 Figure 9-1: IDM Login ............................................................................................................. 9-2 Figure 9-2: Step #1: Enter Personal Information ..................................................................... 9-3 Figure 9-3: Step #2: Enter Contact Information ....................................................................... 9-4 Figure 9-4: Step #3: Enter Credentials .................................................................................... 9-5 Figure 9-5: Self-Service Dashboard ........................................................................................ 9-6 Figure 9-6: My Profile .............................................................................................................. 9-7 Figure 9-7: Manage MFA Devices ........................................................................................... 9-8 Figure 9-8: Example Text Message (SMS) Selected ............................................................... 9-8 Figure 9-9: List of MFA Devices .............................................................................................. 9-8 Figure 9-10: Role Request: Application and Role .................................................................... 9-9 Figure 9-11: Role Request: Review....................................................................................... 9-10 Figure 9-12: Role Request: Request ID ................................................................................ 9-10 Figure 9-13: My Requests ..................................................................................................... 9-10 Figure 9-14: Manage My Roles ............................................................................................. 9-11 Figure 9-15: IDM Login Page ................................................................................................ 9-12 Figure 9-16: Forgot Password: User ID ................................................................................. 9-13 Figure 9-17: Forgot Password: Security Question ................................................................. 9-13 Figure 9-18: Forgot Password: New Password and Confirm ................................................. 9-14 Figure 9-19: Forgot Password: Confirmed............................................................................. 9-14 Figure 9-20: Unlock Account: User ID ................................................................................... 9-15 Figure 9-21: Unlock Account: Recovery Method ................................................................... 9-15 Figure 9-22: Unlock Account: Security Question ................................................................... 9-15 Figure 9-23: Unlock Account: Confirmation ........................................................................... 9-16 Figure 9-24: IDM Login Page ................................................................................................ 9-16 Figure 9-25: Forgot User ID: Identification............................................................................. 9-17 Figure 9-26: Forgot User ID: Email Recovery ........................................................................ 9-17 Figure 9-27: Reset Password Page....................................................................................... 9-18 Figure 9-28: RIDP: Process Overview and Terms and Conditions ........................................ 9-20 Figure 9-29: RIDP: Verification Form .................................................................................... 9-21 List of Tables Table 2-1: Navigation .............................................................................................................. 2-6 Table 2-2: Contractor Lookup.................................................................................................. 2-6 Table 2-3: Right Side Bar – Quick Help ................................................................................... 2-7 Table 2-4: Right Side Bar – User ............................................................................................ 2-7
ECRS User Guide Table of Contents ix Table 2-5: Main Menu ............................................................................................................. 2-8 Table 2-6: Navigation .............................................................................................................. 2-9 Table 2-7: Left Side Bar .......................................................................................................... 2-9 Table 2-8: Right Side Bar ........................................................................................................ 2-9 Table 2-9: Completed ECRS Requests and Inquiries ............................................................ 2-11 Table 3-1: MSP Hierarchy Requirements ................................................................................ 3-2 Table 3-2: CWF Assistance Request Action Requested.......................................................... 3-4 Table 3-3: HIMR MSP Data List .............................................................................................. 3-6 Table 3-4: CWF Assistance Request: Pre-Populated Fields.................................................... 3-7 Table 3-5: More on Importing HIMR Records .......................................................................... 3-7 Table 3-6: CWF Assistance Request Auxiliary Record Information ......................................... 3-9 Table 3-7: CWF Assistance Request Informant Information .................................................. 3-11 Table 3-8: CWF Assistance Request Insurance Information ................................................. 3-14 Table 3-9: CWF Assistance Request Employment Information ............................................. 3-18 Table 3-10: CWF Assistance Request Additional Information ............................................... 3-19 Table 3-11: CWF Assistance Request More Diagnosis Codes .............................................. 3-20 Table 3-12: CWF Assistance Request Comments/Remarks ................................................. 3-21 Table 3-13: CWF Assistance Request Search ...................................................................... 3-23 Table 3-14: CWF Assistance Request Search Listing ........................................................... 3-25 Table 4-1: MSP Inquiry Action Requested............................................................................... 4-3 Table 4-2: MSP Inquiry MSP Information ................................................................................ 4-5 Table 4-3: MSP Inquiry Informant Information ......................................................................... 4-7 Table 4-4: MSP Inquiry Insurance Information ...................................................................... 4-10 Table 4-5: MSP Inquiry Employment Information .................................................................. 4-12 Table 4-6: MSP Inquiry Additional Information ...................................................................... 4-14 Table 4-7: MSP Inquiry Additional Information More Diagnosis Codes.................................. 4-15 Table 4-8: MSP Inquiry Prescription Drug ............................................................................. 4-16 Table 4-9: MSP Inquiry Search ............................................................................................. 4-20 Table 4-10: MSP Inquiry Search Listing ................................................................................ 4-21 Table 5-1: Primary and Supplemental Drug Record Hierarchy Requirements ......................... 5-2 Table 5-2: Prescription Drug Assistance Request Action Requested ...................................... 5-4 Table 5-3: Prescription Drug Assistance Request Informant Information ................................. 5-9 Table 5-4: Prescription Drug Assistance Request Insurance Information .............................. 5-11 Table 5-5: Prescription Drug Assistance Request Employment Information .......................... 5-13 Table 5-6: Prescription Drug Assistance Request Additional Information .............................. 5-14 Table 5-7: Prescription Drug Assistance Request Comments and Remarks ......................... 5-15 Table 5-8: Prescription Drug Assistance Request Search ..................................................... 5-17 Table 5-9: Prescription Drug Assistance Requests Search Listing ........................................ 5-19 Table 5-10: Prescription Drug Assistance Request Summary ............................................... 5-21 Table 6-1: Prescription Drug Inquiry Initial Information ............................................................ 6-2 Table 6-2: Prescription Drug Inquiry Additional Information ..................................................... 6-4 Table 6-3: Prescription Drug Inquiry Prescription Drug............................................................ 6-7 Table 6-4: Prescription Drug Inquiry Search Criteria ............................................................. 6-12 Table 6-5: Prescription Drug Inquiry Search Listing .............................................................. 6-13 Table 6-6: Prescription Drug Inquiry Summary ...................................................................... 6-16 Table 7-1: Contractor Workload Tracking Criteria ................................................................... 7-3 Table 7-2: Contractor Workload Tracking Listing..................................................................... 7-3 Table 7-3: Consolidated ECRS Workload Search ................................................................... 7-5 Table 7-4: Consolidated ECRS Workload Search Listing ........................................................ 7-6
ECRS User Guide Table of Contents x Table 7-5: CMS Workload Tracking Selection Criteria............................................................. 7-8 Table 7-6: Reports, Workload Tracking Report Detail ............................................................. 7-9 Table 7-7: QASP Report Selection Criteria ........................................................................... 7-10 Table 7-8: QASP Report Listing ............................................................................................ 7-12 Table 8-1: ECRS File Upload .................................................................................................. 8-2 Table 8-2: Download Response Files...................................................................................... 8-3 Table 9-1: Self-Service Options .............................................................................................. 9-6 Table 9-2: Supported MFA Devices ........................................................................................ 9-7 Table A-1: CWF Assistance Request Required Data: Action Requested................................. A-1 Table A-2: CWF Assistance Request Required Data: CWF Auxiliary Record Data ................. A-1 Table A-3: CWF Assistance Request Required Data: Informant Information ........................... A-2 Table A-4: CWF Assistance Request Required Data: Insurance Information .......................... A-2 Table A-5: CWF Assistance Request Required Data: Employment Information ...................... A-3 Table A-6: CWF Assistance Request Required Data: Additional Information .......................... A-3 Table A-7: CWF Assistance Request Required Data: Comments/Remarks ............................ A-4 Table B-1: MSP Inquiry Required Data: Action Requested ..................................................... B-1 Table B-2: MSP Inquiry Required Data: MSP Information ....................................................... B-1 Table B-3: MSP Inquiry Required Data: Informant Information ................................................ B-2 Table B-4: MSP Inquiry Required Data: Insurance Information ............................................... B-3 Table B-5: MSP Inquiry Required Data: Employment Information ........................................... B-4 Table B-6: MSP Inquiry Required Data: Additional Information ............................................... B-4 Table B-7: MSP Inquiry Required Data: Prescription Coverage .............................................. B-5 Table C-1: Prescription Drug Assistance Request Required Data: Action Requested ............. C-1 Table C-2: Prescription Drug Assistance Request Required Data: Informant Information ....... C-2 Table C-3: Prescription Drug Assistance Request Required Data: Insurance Information ....... C-2 Table C-4: Prescription Drug Assistance Request Required Data: Employment Information ... C-3 Table C-5: Prescription Drug Assistance Request Required Data: Additional Information ....... C-3 Table C-6: Prescription Drug Assistance Request Required Data: Comments/Remarks ......... C-3 Table D-1: Prescription Drug Inquiry Required Data: Initial Information ................................... D-1 Table D-2: Prescription Drug Inquiry Required Data: Additional Information ........................... D-1 Table D-3: Prescription Drug Inquiry Required Data: Prescription Coverage ........................... D-2 Table E-1: Reason Codes ....................................................................................................... E-1 Table E-2: Action Codes (All Transaction Types) .................................................................... E-3 Table E-3: Automated Action Codes ....................................................................................... E-4 Table F-1: Remark Codes ....................................................................................................... F-1 Table G-1: CWF Assistance Request Header Record Layout .................................................G-1 Table G-2: CWF Assistance Request Trailer Record Layout ...................................................G-2 Table G-3: CWF Assistance Request Detail Record Layout ....................................................G-3 Table G-4: CWF Assistance Request Response Header Record Layout ..............................G-24 Table G-5: CWF Assistance Request Response Detail Record Layout .................................G-25 Table G-6: Prescription Drug Assistance Request Header Record Layout ............................G-30 Table G-7: Prescription Drug Assistance Request Trailer Record Layout..............................G-31 Table G-8: Prescription Drug Assistance Request Detail Record Layout...............................G-32 Table G-9: Prescription Drug Assistance Request Response Header Record Layout ...........G-41 Table G-10: Prescription Drug Assistance Request Response Detail Record Layout ............G-42 Table G-11: MSP Inquiry Header Record Layout ..................................................................G-46 Table G-12: MSP Inquiry Trailer Record Layout ....................................................................G-47 Table G-13: MSP Inquiry Detail Record Layout .....................................................................G-48 Table G-14: MSP Inquiry Response Header Record Layout .................................................G-73
ECRS User Guide Table of Contents xi Table G-15: MSP Inquiry Response Detail Record Layout ....................................................G-74 Table G-16: Prescription Drug Inquiry Header Record Layout...............................................G-79 Table G-17: Prescription Drug Inquiry Trailer Record Layout ................................................G-80 Table G-18: Prescription Drug Inquiry Detail Record Layout .................................................G-81 Table G-19: Prescription Drug Inquiry Response Header Record Layout ..............................G-90 Table G-20: Prescription Drug Inquiry Response Detail Record Layout ................................G-91 Table H-1: Header Record Errors ........................................................................................... H-1 Table H-2: Trailer Record Errors ............................................................................................. H-1 Table H-3: Detail Record and File Structure Errors ................................................................. H-1 Table H-4: Response Record Errors ....................................................................................... H-1 Table I-1: Am I Using the Correct Option?................................................................................ I-1 Table J-1: Acronyms ................................................................................................................J-1
ECRS User Guide Chapter 1: Summary of Version 8.0 Updates 1-1 Chapter 1: Summary of Version 8.0 Updates The following updates have been made in Version 8.0 of the Electronic Correspondence Referral System (ECRS) Web User Guide: Effective July 2026: To avoid erroneous rejections, Rx codes BIN, PCN, Rx Group, and Rx ID are not required for Prescription Drug Assistance Requests when the Action is BN – Develop for Prescription BIN Number, GR – Develop for Group Number, or PN – Develop for/add PCN (Section 5.3.1). Effective July 2026: To prevent the creation of records with invalid or missing information, Type and Record Type will be required for Prescription Drug Inquiries (Section 6.4 and Appendix G). Effective July 2026: To reduce the number of records with invalid insurer names, additional insurer names have been added to the rejection lists for Prescription Drug Assistance Requests and Prescription Drug Inquiries (Appendix G). The ECRS login page has been updated (Sections 2.6.2 and 9.4.1).
ECRS Web User Guide Chapter 2: Introduction 2-1 Chapter 2: Introduction This chapter contains an introduction to the Electronic Correspondence Referral System (ECRS) Web User Guide. 2.1 What is ECRS? Note: Please see the Confidentiality and Disclosure of Information statement on the inside of the title page regarding the appropriate handling of information contained in ECRS. ECRS allows authorized users at Medicare contractor sites and authorized CMS Regional Offices (ROs) to fill out various online forms and electronically transmit requests for changes to existing Common Working File (CWF) MSP information, and inquiries concerning possible MSP coverage. Transactions are automatically stored on the Coordination of Benefits (COB) contractor’s system. Each evening, a batch process reads the transactions and processes the requests. The status of each transaction is updated as it moves through the system. Transactions are entered and viewed in ECRS by contractor number. An organization with more than one contractor number must determine how it wants to group its activity. If the organization wants to see all records together, it should use only one contractor number for all ECRS activities. If the organization wants to distinguish the transactions by contract, it should use its different contractor numbers. 2.2 ECRS Web CBTs For access to the ECRS Web CBTs, please send an email to ECRSHelp@bcrcgdit.com with your Enterprise User Administration (EUA) ID. If you are a CMS contractor, please confirm that the Ent_Agile_Tools job code is assigned. Otherwise, please have that code approved prior to requesting access to the ECRS Web CBTs. 2.3 About this Guide This guide was written to help you understand the Electronic Correspondence Referral System (ECRS) for the web. Chapter 1, Summary of User Guide Updates, provides an overview of all significant revisions to this version of the ECRS Web User Guide. Chapter 2: Introduction, is the section you are reading now. It contains information about how to use the guide. It also includes basic information about ECRS. If you are unfamiliar with the system or are not an experienced computer user, read the entire introduction before reading the rest of the guide. Chapter 3: CWF Assistance Request Transactions, contains step-by-step instructions for performing CWF assistance transactions, as well as examples of web pages in ECRS Web, with complete descriptions of the fields. Chapter 4: MSP Inquiry Transactions, contains step-by-step instructions for performing MSP inquiry transactions, as well as examples of web pages in ECRS Web, with complete descriptions of the fields. Chapter 5: Prescription Drug Assistance Request Transactions, contains step-by-step instructions for performing prescription drug assistance transactions, as well as examples of web pages in ECRS Web, with complete descriptions of the fields.
ECRS Web User Guide Chapter 2: Introduction 2-2 Chapter 6: Prescription Coverage Inquiry Transactions, contains step-by-step instructions for performing Prescription Coverage inquiry transactions, as well as examples of web pages in ECRS Web, with complete descriptions of the fields. Chapter 7: Workload Tracking Reports, details how to run and display the tracking report for Medicare contractors, as well as CMS and Regional Office (RO) users. Chapter 8: Uploading & Downloading Files, contains step-by-step instructions for uploading assistance request and inquiry files to ECRS Web, as well as downloading response files. Chapter 9: Remote ID Proofing (RIDP) and Multi-Factor Authentication (MFA), contains step- by-step instructions for completing these identity verification processes. Appendices A, B, C, and D are Required Data Reference tables that provide a quick way to determine the data required for completing assistance requests and inquiries. Appendix E: Reason and Action Codes, lists all possible reason and action codes that are available in ECRS Web. Appendix F: CWF Remark Codes, lists all possible remark codes that can be entered on the first page of CWF assistance requests. Appendix G contains File Layouts, which outlines how files must be formatted to be successfully uploaded to ECRS Web. Appendix H lists all possible error codes that may be returned on a transaction response file, along with their descriptions. Appendix I: Frequently Asked Questions, contains a list of common questions about ECRS Web, along with the corresponding answers. Appendix J: defines terms and acronyms associated with ECRS. Appendix K: describes the changes made to previous releases. 2.4 How to Use the Required Data Reference Tables The reference tables in Appendices A, B, C, and D list the page names associated with completing an assistance request or inquiry. Below each page name are the data fields on the page. Across from each field, there is a Y or N, indicating if the field is required. The Notes column dictates when that field is required, if applicable. If the field is marked as required, and the Notes column is blank, then the field is required in all circumstances. If the field is marked as required, and there is information in the Notes column, that indicates that the field is only required in the situations listed. 2.5 User Guide Conventions This section explains how information appears in the guide. Understanding the conventions will help you to better understand the tasks and web page explanations. Information that links/navigates to other information within the application appears in bold typeface. For example, in the following instruction, “click Continue,” continue is in bold typeface because you must click on that link to go to the next page. System messages appear in CAPITAL LETTERS. For example: The system shows the message, “SSN NOT ENTERED.”
ECRS Web User Guide Chapter 2: Introduction 2-3 Application web page examples are representative of the pages that you see within the ECRS web. The actual information may not be the same, unless otherwise noted in the guide. Pointers throughout the guide can help you locate information. The guide includes a master Table of Contents in the front, and smaller Tables of Contents at the beginning of the chapters. In addition, headers and footers can be used to determine where you are in the guide. 2.6 Basic Functions 2.6.1 IDM Registration and ECRS Access Individuals who require access to the ECRS web must first register and create an account through the CMS Identity Management (IDM) system in the IDM system: https://idm.cms.gov/. Additionally, new users must complete the Remote Identity Proofing (RIDP) process and set up Multi-Factor Authentication (MFA) (see Chapter 9). Once these steps are done, you can then log in and request access to the ECRS application and role. Former EIDM users with an active ECRS account (valid login ID, password, and an application role) and who have completed RIDP can go directly to the IDM system and log in. You will need to authenticate initially (using MFA) by email (system default) and then set up one security question and answer. This allows you access to the self-service account recovery features. See Chapter 9 for details. Note: You must log in to your account at least once every 60 days. If you do not log in within this timeframe, you will have to reset your password the next time you log in. 2.6.2 ECRS Login To log into ECRS, you must have completed registration and the RIDP process as described above. You will also need to have a contractor number and access code. If you have a contractor number but need assistance obtaining an access code, please contact ECRSHelp@bcrcgdit.com. 1. Go to the ECRS URL: https://www.cob.cms.hhs.gov/ECRS The IDM login page appears (Figure 2-1). 2. Enter your user ID and password. 3. Click and read the Terms & Conditions; then click the Agree to our Terms & Conditions checkbox. Note: If you forgot your password or need to unlock your account, see Chapter 9 for details. The MFA verification page appears (Figure 2-2).
ECRS Web User Guide Chapter 2: Introduction 2-4 Figure 2-1: IDM Login with Terms and Conditions
ECRS Web User Guide Chapter 2: Introduction 2-5 Figure 2-2: IDM Login with Multi-Factor Authentication 4. Click the button to send the security code (example: Send me an email). Note: If you have more than one security device registered and you want to verify with a different device, click the Verify with something else link to select another option. Then, send the security code. 5. Enter the code in the text box. 6. Click Verify to continue. The ECRS Federal Systems Login Warning page appears. 7. Read the Federal Systems Login Warning and click I Accept at the bottom of the page. The system displays the ECRS Contractor Sign In page. Figure 2-3: ECRS Federal Systems Login Warning
ECRS Web User Guide Chapter 2: Introduction 2-6 Figure 2-4: Contractor Lookup/Sign In Page Table 2-1: Navigation Link Description HOME Click to return to the Main Menu page. CMS Click to link to the CMS website https://www.cms.gov. Adobe Acrobat Click to open a link to download Acrobat Reader. ECRS User Guide Click to access this user guide. ABOUT Click to see information about the ECRS Web menu options. SIGN OUT Click to leave the ECRS Web application. The system returns you to the CMS Access Management Logon page. Table 2-2: Contractor Lookup Field Description CONTRACTOR NUMBER Unique five-digit identification number assigned to each Medicare contractor by CMS. Required field for contractors. Or BCRC, CMS, or Regional Office (RO) identification number. Required field for BCRC, CMS, and RO users. ACCESS CODE Five-character authorization code assigned by the BCRC. Required field for contractors. Or Five-character authorization code for BCRC, CMS, and RO users. Required field for BCRC, CMS, and RO users. SUBMITTER TYPE Type of submitter. Select “Part C” or “Part D.” Note: This field appears for users who can submit Part C or Part D data, after the CONTRACTOR NUMBER and ACCESS CODE fields have been populated. ECRS MESSAGES Location of messages for ECRS web users to keep them informed of upcoming events, maintenance, or other system-specific information. CONTINUE Command button. Click to navigate to the Main Menu page.
ECRS Web User Guide Chapter 2: Introduction 2-7 Contractor Lookup Page - Right Side Bar The right side bar of the Contractor Lookup Page is divided into two sections: Quick Help and User. 1. Enter the appropriate values in the CONTRACTOR NUMBER and ACCESS CODE fields. For users who can submit Part C or Part D data, the Contractor Sign-In page reappears, with the CONTRACTOR NUMBER and ACCESS CODE fields disabled, with a SUBMITTER TYPE field shown and enabled. 2. Select a Submitter Type. 3. Click the Continue button. The Main Menu page appears (Figure 2-5). Table 2-3: Right Side Bar – Quick Help Quick Help Description Help About This Page Click to see helpful information for completing the page. Table 2-4: Right Side Bar – User Field Description ID User ID of person logged in. (protected field) NAME Name of person associated with the user ID. (protected field) PHONE Phone number associated with the user ID. (protected field) 2.6.3 Main Menu The Main Menu page is the home page for the ECRS Web application. Select the tasks you want to perform from this page. Click on a link to access information in ECRS. The ECRS Main Menu is divided into four sections: Create Requests or Inquiries, Search for Requests or Inquiries, Reports, and Files. Each section includes various navigation links that will direct you to the applicable ECRS web page (Table 2-5). Figure 2-5: Main Menu
ECRS Web User Guide Chapter 2: Introduction 2-8 Table 2-5: Main Menu Link Description CREATE REQUESTS OR INQUIRIES - CWF ASSISTANCE REQUEST Click CWF Assistance Request to enter a new CWF Assistance Request. MSP INQUIRY Click MSP Inquiry to enter a new MSP Inquiry. PRESCRIPTION DRUG ASSISTANCE REQUEST Click Prescription Drug Assistance Request to enter a new Prescription Drug Assistance Request. Note: This field appears for users who can submit Part C or Part D data. PRESCRIPTION DRUG INQUIRY Click Prescription Drug Inquiry to enter a new Prescription Drug Inquiry. SEARCH FOR REQUESTS AND INQUIRIES - CWF ASSISTANCE REQUESTS Click CWF Assistance Requests to enter search criteria to locate a CWF Assistance Request. MSP INQUIRIES Click MSP Inquiries to enter search criteria to locate an MSP Inquiry. PRESCRIPTION DRUG ASSISTANCE REQUESTS Click Prescription Drug Assistance Requests to enter search criteria to locate a Prescription Drug Assistance Request. PRESCRIPTION DRUG INQUIRIES Click Prescription Drug Inquiries to enter search criteria to locate a Prescription Drug Inquiry. REPORTS - CONTRACTOR WORKLOAD TRACKING Click Contractor Workload Tracking to select criteria and view the workload tracking report for your contractor. CONSOLIDATED ECRS WORKLOAD SEARCH Click the Consolidated ECRS Workload Search to enter search criteria to verify receipt and status of all submitted requests. CMS WORKLOAD TRACKING Click CMS Workload Tracking to select criteria and view the workload tracking report for contractors. Note: Restricted to CMS and Regional Offices QUALITY ASSURANCE SURVEILLANCE PLAN (QASP) REPORT Click Quality Assurance Surveillance Plan (QASP) Report to select criteria and view the QASP report. Note: Restricted to CMS and Regional Offices FILES - UPLOAD FILE Click Upload File to upload ECRS transaction files. Note: File Upload and Download are restricted to selected users. Contact the EDI Help Desk at (646) 458-6740 for additional information. DOWNLOAD RESPONSE FILE Click Download Response File to download the ECRS response files. Note: File Upload and Download are restricted to selected users. Contact the EDI Help Desk at (646) 458-6740 for additional information.
ECRS Web User Guide Chapter 2: Introduction 2-9 2.6.4 Navigation Links The following navigation links appear on each page that is opened from the Main Menu. Table 2-6: Navigation Link Description HOME Returns to the Main Menu page. CMS Links to the CMS website https://www.cms.gov/. ABOUT Shows information about the ECRS Web menu options. SIGN OUT Exits the ECRS web application. Table 2-7: Left Side Bar Link Description ACTION REQUESTED Goes to the Action Requested page. CWF AUXILIARY RECORD INFORMATION Goes to the CWF Auxiliary Record Data page. INFORMANT INFORMATION Goes to the Informant Information page. INSURANCE INFORMATION Goes to the Insurance Information page. EMPLOYMENT INFORMATION Goes to the Employment Information page. ADDITIONAL INFORMATION Goes to the Additional Information page. COMMENTS/REMARKS Goes to the Comments/Remarks page. SUMMARY Goes to the Summary page. The right side bar shows four to six sections of links and fields, as well as different link combinations, depending on the page. For some pages, beneficiary and DCN Information is retrieved from the system using the Medicare ID entered on the Action Requested page (Section 3.2). The Medicare ID can be either the Health Insurance Claim Number (HICN) or the Medicare Beneficiary Identifier (MBI). This information is then carried forward on subsequent pages opened from the Main Menu, and it will appear on the right side bar. This information will not be editable. Table 2-8: Right Side Bar Link Description QUICK HELP - Help About This Page Click Help About this Page to see helpful information for completing the page. CHANGE CONTRACTOR - Change Contractor Click the link to change the contractor number and access code on the Contractor Sign In page. Note: You will lose all unsubmitted data for the current contractor. CONTRACTOR - ID Contractor number or CMS ID entered on Contractor Sign In page (protected field). Name Name of contractor associated with the contractor number, or Regional Office associated with the CMS ID (protected field).
ECRS Web User Guide Chapter 2: Introduction 2-10 Link Description USER - ID User ID of person logged in (protected field). Name Name of person associated with user ID (protected field). Phone Phone number associated with the user ID (protected field). BENEFICIARY - Medicare ID HICN or MBI of the beneficiary (protected field). SSN Social Security Number of the beneficiary (protected field). Name Name of the beneficiary (protected field). Address Street address of the beneficiary (protected field). City, State City and State associated with the street address of the beneficiary (protected field). Zip ZIP code associated with street address of beneficiary (protected field). Sex Gender of the beneficiary (protected field). DOB Date of birth of the beneficiary (protected field). DCN - ID Document control number (DCN) assigned by the contractor to correspondence or paperwork associated with a transaction (protected field). Origin Date Date CWF Assistance Request transaction was submitted (protected field). Status Two-character code explaining where the CWF Assistance Request transaction is in the COB system process (protected field). CM: Completed DE: Delete (do not process ECRS CWF Assistance Request) HD: Hold, individual not yet a Medicare beneficiary IP: In process, being edited by COB NW: New, not yet read by COB Note: STATUS will always be NW until the transaction is processed. Reason Two-character code explaining why the CWF Assistance Request is in a particular status (protected field). Note: REASON will always be 01 until the transaction is processed. Alert (Notifications) – Closed Requests and Inquiries Number of transactions of each transaction type completed within the last 30 calendar days, based on the user ID and contractor ID of the submitter. Click any non-zero number to view the Completed ECRS Requests and Inquiries page for that transaction type. Note: Transactions submitted by flat file are not noted here, nor are they shown on the corresponding Completed ECRS Requests and Inquiries page. 2.6.5 Completed ECRS Requests and Inquiries The Completed ECRS Requests and Inquiries page shows transactions put into completed status in the last 30 calendar days, according to the selected transaction type as well as user ID and contractor ID. It does not show transactions submitted by flat file—only those submitted in ECRS. This page is accessible via the Alert (Notifications) – Closed Requests and Inquiries section of the right side bar, available on the Main Menu page. That section of the side bar also appears on this page.
ECRS Web User Guide Chapter 2: Introduction 2-11 Figure 2-6: Completed ECRS Requests and Inquiries Table 2-9: Completed ECRS Requests and Inquiries Column Description DCN Click the Document Control Number for the transaction to view the summary page of the request or inquiry. Status Status of the transaction. Reason Reason code most recently applied to the transaction. Date Date the transaction was put in completed status. Medicare ID Medicare ID (MBI or HICN) for the beneficiary on the transaction. Beneficiary Name Name of the beneficiary on the transaction.
ECRS Web User Guide Chapter 3: CWF Assistance Request Transactions 3-1 Chapter 3: CWF Assistance Request Transactions This chapter provides you with step-by-step instructions to perform a CWF assistance request. Examples and explanations are provided for each page in ECRS. If you are a new user, this chapter can help you use the system as you learn it. You can also use this chapter to determine what information is contained in each field or what you should enter in a field. It can also help you to navigate through the CWF assistance request transaction process if you are lost. If you are an experienced user, you can use the chapter as a quick reference for a web page that you use infrequently. This chapter also includes a discussion regarding the hierarchy requirements for processing MSP records. 3.1 Adding a CWF Assistance Request Transaction Use the CWF Assistance Request link under Create Requests or Inquiries on the Main Menu, to add CWF Assistance Request transactions for existing CWF MSP auxiliary occurrences. To submit an inquiry to the Benefits Coordination & Recovery Center (BCRC) about a new or possible MSP situation not yet documented at CWF, use the MSP Inquiry link on the Main Menu. 3.1.1 Retrieving Beneficiary Information Beneficiary information is automatically retrieved when the Medicare ID (HICN or MBI) and other required data is entered and saved on the first page of the CWF Assistance Request (Action Requested page). The information appears on the right side bar, and is carried forward on the CWF Assistance Request transaction. 3.1.2 About Action Codes Note: See Appendix E for a complete list of available action codes for all transaction types. ECRS uses action codes to determine what information should be updated on the MSP auxiliary occurrence at CWF or what type of special processing should be performed on an MSP auxiliary occurrence. For example, if you type action code EI in the ACTION(S) field, only the information you type in the employer fields (employer name, street, city, ZIP code, EIN, and employee number) will be updated on the MSP auxiliary occurrence at CWF. For CWF Assistance Request transactions, you are required to enter at least one ACTION, but you have the ability to enter a maximum of four codes. For MSP inquiries, you are not required to enter any ACTIONs. If you type information in a field (for example, TERMINATION DATE), but you do not type the corresponding ACTION (for example, TD) in the ACTION field, the system will not update that information on the MSP auxiliary occurrence at CWF. Finally, selected action codes have been automated to prevent you from requesting updates to current records on the CWF Assistance Request Auxiliary Record and the Prescription Drug Assistance Request pages (either via flat file or online data entry), if certain conditions are met. If these codes are used, you will receive an immediate reply and the update request will be denied. See Sections 3.5.1 and 5.3.2.
ECRS Web User Guide Chapter 3: CWF Assistance Request Transactions 3-2 3.2 CMS MSP Hierarchy Requirements The following applies to MSP records only. 3.2.1 MSP Hierarchy Background CMS has ranked all of the possible sources of an update/delete request from the highest level (first) to the lowest level (fifth). When an update or delete transaction is received that matches an existing MSP occurrence, the source of that information and its associated hierarchy ranking will be compared to the source and hierarchy ranking of the existing occurrence. The following table illustrates the hierarchy rank associated to each source. When an update/delete transaction is received, the BCRC will compare the source of the incoming transaction to the source of the existing transaction. The decision to apply the update or delete will be based on the hierarchy ranking of each source. If the hierarchy ranking of the source on the incoming transaction is greater than or equal to the hierarchy ranking of the source on the existing transaction, the update/delete transaction will be allowed. If the hierarchy ranking of the source on the incoming transaction is lower than the hierarchy ranking of the source on the existing transaction, the update/delete transaction will NOT be allowed. These access guidelines will not allow multiple changes to any record field, including the patient relationship field, for example. The patient relationship field is meant to identify the policy holder and that is unlikely to change from claim to claim. MSP hierarchy requirements apply to MSP occurrences. For details related to prescription drugs, see Section 5.2. 3.2.2 MSP Hierarchy Requirements The following describes the MSP hierarchy rules. Table 3-1: MSP Hierarchy Requirements Hierarchy Ranking Source of Update/Delete Request First BCRC Analyst (11100) Note: The BCRC Analyst will have the authority to manually lock an MSP occurrence from any subsequent changes except those made by the BCRC. Second • BCRC Call Center/BCRC CSR (11110) • Beneficiary Call Center (1-800-Medicare) (11140) • CRC GHP Recovery (ECRS - 11139) • CRC ORM Recovery (ECRS - 11142) Third • Section 111 GHP RREs (11121) • Section 111 NGHP RREs (11122) • Medicare Advantage (MA)/(Part C Plan) (11143) Fourth • Employer Voluntary Data Sharing Agreements (VDSAs) (11105) • Employer response to IRS/SSA/CMS Data Match Questionnaire Fifth • Medicare Administrative Contractors (MACs) • Other Medicare Contractors • All others
ECRS Web User Guide Chapter 3: CWF Assistance Request Transactions 3-3 3.3 About Matching Criteria for Inquiries and Transactions When submitting inquiries or update transactions, how the CWF retrieves records depends on the criteria entered, or not entered. In some cases, depending on the type of request, your submission may be considered a duplicate, which will be rejected or closed. The following are examples of when this may occur: Example #1: A contractor submits an MSP Inquiry request but the contractor does not provide an MSP effective date of coverage. In this case, the system will attempt to create an MSP record using the Medicare Part A date as the effective date. If a record already exists with an effective date that matches the Part A date, the request will be rejected as a duplicate. Example #2: A contractor receives a claim with a paying Explanation of Benefits (EOB) from another insurance company for a date of service of 8/15/2021. The contractor submits an inquiry but does not know the new insurance effective date. The system will attempt to create the record using the Part A entitlement date. Since a record already exists, the request will be rejected as a duplicate. Example #3: A contractor submits a CWF assistance request on 10/11/2021 to change an insurance policy number. The contractor receives additional correspondence that indicates the insurance name is different. They submit a new request on 10/17/2021 to change the insurance name. The request is rejected as a duplicate because of the previous request has not completed processing. Note: The insurer name and address are not a matching field to CWF, therefore an additional field needs to be different for the CWF to not match an existing ECRS record. 3.4 Action Requested Page The Action Requested page is the first page to appear when adding a new CWF Assistance Request. The information entered on this page determines required information on subsequent pages. 1. From the Main Menu page, click the CWF Assistance Request link under Create Requests or Inquiries. The Action Requested page and navigation links appear (Figure 3-1). 2. Type/select data in all of the required fields on the Action Requested page, and click the Continue button. Required fields are noted with a red asterisk (*) and are as follows: • DCN • MEDICARE ID • ACTIVITY CODE • ACTION • SOURCE Notes: For information on importing HIMR MSP Data for CWF Assistance Requests, see Figure 3-2. If beneficiary information is not found for the Medicare ID you have entered, you will not be able to continue the CWF Assistance Request. 3. After all relevant fields have been entered, click Continue to go to the CWF Auxiliary Record Data page, or select a page link from the left side bar. 4. If you selected to import HIMR MSP data, clicking Continue shows the HIMR MSP Data List (Figure 3-2). 5. To exit the CWF Assistance Request Detail pages, click the Home link to return to the Main Menu or click Sign Out to exit the application.
ECRS Web User Guide Chapter 3: CWF Assistance Request Transactions 3-4 Figure 3-1: CWF Assistance Request Action Requested Table 3-2: CWF Assistance Request Action Requested Field Description DCN DCN assigned by the contractor to correspondence and/or paperwork associated with transaction (required field). The system auto-generates the DCN, but it can be changed by the user. MEDICARE ID Medicare Beneficiary Identifier (MBI) or Health Insurance Claim Number (HICN) of the beneficiary (required field). Enter the ID without dashes, spaces, or other special characters. ACTIVITY CODE Activity of the contractor (required field). Valid values are: C Claims (Pre-Payment) D Debt Collection/Referral G Group Health Plan I General Inquiries N Liability, No Fault, Workers’ Compensation, and Federal Tort Claim Act ACTION Two-character code defining the action to take on the MSP auxiliary occurrence at CWF (required field). See Appendix E for a complete list of action codes and definitions. Notes: Enter up to four Actions unless the CWF Assistance Request is to: • Mark Occurrence for Deletion (DO) • Investigate Closed or Deleted Record (DR) • Investigate/Possible Duplicate for Deletion (ID) • Update A Record For A Vow Of Poverty (VP) • Develop for Employer Information (DE) • Develop for Insurer Information (DI) You cannot combine these six Actions with any other Actions. Action MT only applies when supplemental type is Primary. Note: DE and DI Actions are developed to the beneficiary only.
ECRS Web User Guide Chapter 3: CWF Assistance Request Transactions 3-5 Field Description SOURCE Four-character code identifying source of the information (required field). Valid values are: CHEK = Unsolicited check LTTR = Letter PHON = Phone call SCLM = Claim submitted to Medicare contractor for secondary payment SRVY = Survey IMPORT HIMR MSP DATA Defaults to Yes, but can be changed to No. See the next section for more information. CONTINUE Command button. Click to go to the next page. Note: All required fields must be populated before clicking Continue. CANCEL Command button. Click to return to the Main Menu. 3.4.1 Importing HIMR MSP Information for CWF Assistance Requests Importing HIMR MSP data allows you to retrieve HIMR BENA and MSPD screens at each host site. The system then transfers that information to the CWF Assistance Request Detail pages and populates the associated fields. Follow the steps below to import HIMR MSP data for a new CWF Assistance Request. Note: The HIMR application may be inconsistent after 5 p.m. EST. 1. From the Action Requested page, which is the first page of the CWF Assistance Request, type/select all relevant fields, set Import HIMR MSP Data to “Yes,” and click Continue. The system retrieves all aux record numbers associated with the Medicare ID, and shows their MSP data on the HIMR MSP Data List. 2. To select HIMR MSP data and transfer it to the CWF Assistance Request Detail pages, click the AUX REC # link next to that record. Note: Only records with a validity indicator of Y can be selected. Deleted and invalid records are sorted to the bottom of the list. The system pre-populates certain fields through the CWF assistance request process. Figure 3-2: HIMR MSP Data List
ECRS Web User Guide Chapter 3: CWF Assistance Request Transactions 3-6 Table 3-3: HIMR MSP Data List Field Description AUX REC # Record number of the MSP auxiliary occurrence in CWF. Click to select the record and transfer the data to the CWF Auxiliary Record Data page. MSP TYPE Description of the MSP coverage type. Valid values are: A Working Aged B ESRD C Conditional Payment D Automobile Insurance, No Fault E Workers’ Compensation F Federal (Public) G Disabled H Black Lung I Veterans L Liability W Workers’ Compensation Medicare Set Aside EFFECTIVE DATE Effective date of the MSP coverage. TERM DATE Termination date of the MSP coverage. ORIGINAL CONTRACTOR Contractor number of the contractor that created the original MSP occurrence at CWF. DELETE INDICATOR Indicates if the record has been deleted. Valid values are: D Deleted Blank Not Deleted VALIDITY INDICATOR Indicates if the record is active. Valid values are: I Under Development Y MSP Coverage Confirmed N No MSP Coverage UPDATING CONTRACTOR Contractor number of the contractor that most recently updated the MSP occurrence. DATE OF ACCRETION Accretion date of MSP coverage in MMDDCCYY format. CANCEL Command button. Click to return to the Main Menu.
ECRS Web User Guide Chapter 3: CWF Assistance Request Transactions 3-7 Table 3-4: CWF Assistance Request: Pre-Populated Fields Page Pre-Populated Fields CWF AUXILIARY RECORD DATA MSP Type Patient Relationship Auxiliary Record # Originating Contractor Effective Date Termination Date Accretion Date INSURANCE INFORMATION Insurance Company Name Address City State ZIP Insurance Type Group Number Policy Number Subscriber Name ADDITIONAL INFORMATION Diagnosis Codes Refer to the following for additional actions: Table 3-5: More on Importing HIMR Records If you… Follow these steps: Don’t get a list of HIMR records 1. Check to make sure the Medicare ID entered is correct. 2. Check the time. The HIMR application may be unavailable before 8 a.m. and after 5 p.m. EST. Want to use this imported information 1. Change information in any of the fields by typing the correct information over the imported information, if necessary. 2. Continue the CWF assistance request process. Want to select a different MSP record for the beneficiary if you have already transferred HIMR data to the CWF Auxiliary Record Data page From the CWF Auxiliary Record Data page, click Back To List, and click the Aux Rec # link, next to the record you want to select. Do not want to use this imported information, but want to look up a new beneficiary 1. Enter the new beneficiary’s Medicare ID in the Medicare ID field on the Action Requested page. 2. Set Import HIMR MSP Data to “Yes”. 3. Click the Continue button to show the HIMR MSP Data List. 4. Click the AUX REC # link next to the record you want to select. Want to return to the CWF Assistance Request Action Requested page without selecting data Click Cancel.
ECRS Web User Guide Chapter 3: CWF Assistance Request Transactions 3-8 3.5 CWF Auxiliary Record Information Page 1. Enter/select information on the CWF Auxiliary Record Information page that associates the assistance request with an MSP auxiliary record. Note: Some ICD-9 and ICD-10 diagnosis codes cannot be submitted when the MSP record type is “D-Automobile Insurance, No Fault.” If you attempt to submit these codes, the following error message appears: “Diagnosis code [number] is invalid with insurer type of No-Fault.” For a listing of diagnosis codes that are invalid with insurer type of No-Fault, go to CMS.gov at: https://www.cms.gov/medicare/coordination-benefits-recovery/overview/icd-code-lists. 2. After all relevant fields have been entered, click the Continue button to go to the Informant Information page, or select a page link from the left side bar. Figure 3-3: CWF Assistance Request Auxiliary Record Information
ECRS Web User Guide Chapter 3: CWF Assistance Request Transactions 3-9 Table 3-6: CWF Assistance Request Auxiliary Record Information Field Description MSP TYPE One-character code identifying the type of MSP coverage (required field). Description of code appears next to value. Valid values are: A Working Aged B ESRD C Conditional Payment D Automobile Insurance, No Fault E Workers’ Compensation F Federal (Public) G Disabled H Black Lung L Liability W Workers’ Compensation Medicare Set Aside NEW MSP TYPE One-character code identifying the type of new MSP coverage. Description of code appears next to value. Required field when ACTION is MT. PATIENT RELATIONSHIP Patient relationship between the policyholder and the beneficiary (required field). Description of code appears next to value. Valid values are: 01 Self; Patient is policyholder 02 Spouse 03 Child 04 Other 20 Domestic partner Note: All patient relationship values accepted for MSP Types B and G. MSP Type A will accept 01 and 02. MSP Types D, E, L, H, W, S, and T will only accept 01. NEW PATIENT RELATIONSHIP New patient relationship between the policyholder and the beneficiary. Description of code appears next to value. Required field when ACTION is PR. Valid values are: 01 Self; Patient is policyholder 02 Spouse 03 Child 04 Other 20 Domestic partner Note: All patient relationship values accepted for MSP Types B and G. MSP Type A will accept 01 and 02. MSP Types D, E, L, H, W, S, and T will only accept 01. AUXILIARY RECORD # Record number of the MSP auxiliary occurrence in CWF (required field). Note: Part D contractors must enter ‘001’ when aux number is unknown. ORIGINATING CONTRACTOR Contractor number of contractor that created the original MSP occurrence at CWF (required field).
ECRS Web User Guide Chapter 3: CWF Assistance Request Transactions 3-10 Field Description EFFECTIVE DATE Effective date of MSP coverage in MMDDCCYY format (required field). Notes: This field accepts dates up to three months from the current date: For GHP records (MSP Types A, B, and G): The Effective Date can be in the future for currently entitled beneficiaries (i.e., enrolled in Medicare), or for beneficiaries who will be entitled starting up to three months in the future. For NGHP records (MSP Types D, E, L, H, and W): The Effective Date can be in the future for beneficiaries as long as their entitlement start date is in the future. The future Effective Date must be equal to the entitlement start date. (NGHP MSP occurrences for beneficiaries who are currently entitled cannot have future MSP Effective Dates.) NEW EFFECTIVE DATE New effective date of MSP coverage in MMDDCCYY format. Required field when ACTION is ED. Notes: This field accepts dates up to three months from the current date: For GHP records (MSP Types A, B, and G): The Effective Date can be in the future for currently entitled beneficiaries (i.e., enrolled in Medicare), or for beneficiaries who will be entitled starting up to three months in the future. For NGHP records (MSP Types D, E, L, H, and W): The New Effective Date can be in the future for beneficiaries as long as their entitlement start date is in the future. The future New Effective Date must be equal to the entitlement start date. (NGHP MSP occurrences for beneficiaries who are currently entitled cannot have future MSP Effective Dates.) TERMINATION DATE Termination date of MSP coverage in MMDDCCYY format. Required when ACTION is TD or CT. REMOVE EXISTING TERMINATION DATE Check to remove an existing termination date. ACCRETION DATE Accretion date of MSP coverage in MMDDCCYY format. ORM Indicator for Ongoing Responsibility for Medicals. This field is read-only. Available values are Y (“Yes” ORM exists) or a “Space” (ORM does not exist, or existence of ORM is unknown). Notes: Once ORM is reported as Y, then even after ORM has terminated, the record will continue to show an indicator of “Y.” If you did not select the Import HIMR Data option, you will not see an ORM indicator on this screen. CONTINUE Command button. Click to go to the Informant Information page. CANCEL Command button. Click to return to the Main Menu. 3.5.1 Automated Action Code Impacts Automated action codes are codes that are processed automatically when entered. See Appendix E for a complete list. Your updates to current records on the CWF Assistance Request Auxiliary Record Information page will be denied if these conditions are found or when you use automated action codes. • Submitting contractor’s hierarchy permission level is lower than that of the updating contractor of the existing record • Record not found • Same policy number or group number entered (AP: Add Policy and/or Group Number)
ECRS Web User Guide Chapter 3: CWF Assistance Request Transactions 3-11 • Record previously termed, or termed but same term date entered (TD: Add Termination Date) • Record not previously termed (CT: Change Termination Date) • Same patient relationship entered (PR: Change Patient Relationship) • Record is deleted (DO: Mark for deletion) • Pre-paid health plan date not provided (PH: Add Pre-Paid Health Plan (PHP) Date) • Insurer information not provided (II: Change Insurer Information) (Note: Partially automated for BCRC and CRC recovery users only.) Note: When processing valid Assistance Requests submitted with automated action codes, the system will search for matching existing MSP records. 3.6 Informant Information Page 1. Enter information on the Informant Information page regarding the person who informed you of the change in MSP coverage. 2. After all relevant fields have been entered, click the Continue button to go to the Insurance Information page, or select a page link from the left side bar. Figure 3-4: CWF Assistance Request Informant Information Table 3-7: CWF Assistance Request Informant Information Field Description FIRST NAME First name of the person informing the contractor of the change in MSP coverage. • Required for all ACTIONs when SOURCE is CHEK, LTTR, or PHON. • Required for all SOURCEs when ACTION is AI. MIDDLE INITIAL First initial of the middle name of the person informing the contractor of the change in MSP coverage.
ECRS Web User Guide Chapter 3: CWF Assistance Request Transactions 3-12 Field Description LAST NAME Last name of the person informing the contractor of the change in MSP coverage. • Required for all ACTIONs when SOURCE is CHEK, LTTR, or PHON. • Required for all SOURCEs when ACTION is AI. ADDRESS Informant’s street address. • Required for all ACTIONs when SOURCE is CHEK, LTTR, or PHON. • Required for all SOURCEs when ACTION is AI. CITY Informant’s city. • Required for all ACTIONs when SOURCE is CHEK, LTTR, or PHON. • Required for all SOURCEs when ACTION is AI. STATE Informant’s state. • Required for all ACTIONs when SOURCE is CHEK, LTTR, or PHON. • Required for all SOURCEs when ACTION is AI. ZIP Informant’s ZIP code. • Required for all ACTIONs when SOURCE is CHEK, LTTR, or PHON. • Required for all SOURCEs when ACTION is AI. PHONE Informant’s telephone number RELATIONSHIP One-character code indicating the relationship of the informant to the beneficiary. Valid values are: A Attorney representing beneficiary B Beneficiary C Child D Defendant’s attorney E Employer F Father I Insurer M Mother N Non-relative O Other relative P Provider R Beneficiary representative (other than attorney) S Spouse U Unknown W Pharmacy Required for: • All ACTIONs when SOURCE is CHEK, LTTR, or PHON. • Defaults to A when ACTION is AI. CONTINUE Command button. Click to go to Insurance Information page. CANCEL Command button. Click to return to the Main Menu.
ECRS Web User Guide Chapter 3: CWF Assistance Request Transactions 3-13 3.7 Insurance Information Page 1. Enter information on the Insurance Information page about the insurance type associated with the MSP coverage. To modify insurer information at CWF, you must enter Action II on the Action Requested page. Type data in all fields to update insurer information. Leave all fields blank to delete insurer information. 2. After all relevant fields have been entered, click Continue to go to the Employment Information page, or select a page link from the left side bar. Note: If you enter Action II and leave any of the following fields blank, the system deletes the previous value at CWF: ADDRESS, CITY, STATE, ZIP, GROUP NUMBER, POLICY NUMBER, and SUBSCRIBER NAME. Figure 3-5: CWF Assistance Request Insurance Information
ECRS Web User Guide Chapter 3: CWF Assistance Request Transactions 3-14 Table 3-8: CWF Assistance Request Insurance Information Field Description INSURANCE COMPANY NAME Name of the insurance carrier for MSP coverage. Required field when ACTION is II. If the Insurance Company Name entered is less than two characters or contains one of the following values, then it is considered an error: • ATTORNEY • BC • BCBS • BCBX • BCRC • BENEFITS COORDINATION & RECOVERY • BENEFITS COORDINATION & RECOVERY CENTER • BENEFITS COORDINATION AND RECOVE • BENEFITS COORDINATION AND RECOVERY CENTER • BLUE CROSS • BLUE SHIELD • BS • BX • CMS • COB • COBC • COORDINATION OF BENEFITS CONTRAC • COORDINATION OF BENEFITS CONTRACTOR • HCFA • INSURER • MEDICARE • MISC • MISCELLANEOUS • N/A • NA • NO • NO FAULT • NO-FAULT • NONE • SUPPLEMENT • SUPPLEMENTAL • UN • UNK • UNKNOWN • XX ADDRESS First line of the insurance carrier’s street address. CITY City associated with the insurance carrier’s street address.
ECRS Web User Guide Chapter 3: CWF Assistance Request Transactions 3-15 Field Description STATE State associated with the insurance carrier’s street address. ZIP ZIP code associated with the insurance carrier’s street address. INSURANCE TYPE One-character code for the type of insurance. Valid values are: A Insurance or Indemnity (OTHER TYPES) B Group Health Organization (GHO) C Preferred Provider Organization (PPO) D Third Party Administrator arrangement under an Administrative Service Only (ASO) contract without stop loss from any entity (TPA/ASO) E Third Party Administrator arrangement with stop loss insurance issued from any entity (STOP LOSS TPA) F Self-Insured/Self-Administered (SELF-INSURED) G Collectively-Bargained Health and Welfare Fund (HEALTH/WELFAR) H Multiple Employer Health Plan with at least one employer who has 100 or more full- and/or part-time employees (EMPLOYER+100) I Multiple Employer Health Plan with at least one employer who has more 20 or more full- and/or part-time employees (EMPLOYER+20) J Hospitalization Only Plan covering inpatient hospital services (HOSPITAL ONLY) K Medical Services Only Plan covering only non-inpatient medical services (MEDICAL ONLY) M Medicare Supplemental Plan, Medicare Wraparound Plan or Medicare Carve Out Plan (SUPPLEMENTAL) R GHP Health Reimbursement Arrangement S GHP Health Savings Account Blank Unknown (UNKNOWN); defaults to A Required field when ACTION is AI (Attorney information should be entered on the Informant Information page) or ACTION is II and INSURANCE COMPANY NAME is entered. ACTION types are TD, CT, AP and PR. NEW INSURANCE TYPE Select a one-character code for the new type of insurance. Valid values are: A Insurance or Indemnity (OTHER TYPES) J Hospitalization Only Plan covering inpatient hospital services (HOSPITAL ONLY) K Medical Services Only Plan covering only non-inpatient medical services (MEDICAL ONLY) R GHP Health Reimbursement Arrangement Required field when ACTION is IT.
ECRS Web User Guide Chapter 3: CWF Assistance Request Transactions 3-16 Field Description POLICY NUMBER Policy number of insurance coverage. • Required field when ACTION is AP and MSP TYPE is NOT D, E, L, or W. • Required field when INSURANCE COMPANY NAME is entered. Note: If GROUP NUMBER is entered, POLICY NUMBER is not required. GROUP NUMBER Group number of insurance coverage • Required field when ACTION is AP and MSP TYPE is NOT D, E, L, or W. • Required field when ACTION is CD and MSP TYPE IS D, E, L or W. • Required field when INSURANCE COMPANY NAME is entered. Note: If POLICY NUMBER is entered, GROUP NUMBER is not required. SUBSCRIBER FIRST NAME First name of individual covered by this insurance. SUBSCRIBER MIDDLE INITIAL First letter of the middle name of the individual covered by this insurance. SUBSCRIBER LAST NAME Last name of the individual covered by this insurance. CONTINUE Command button. Click to go to the Employment Information page. CANCEL Command button. Click to return to the Main Menu. 3.8 Employment Information Page 1. Enter employment information associated with the MSP coverage on the Employment Information page. 2. After all relevant fields have been entered, click Continue to go to the Additional Information page, or select a page link from the left side bar.
ECRS Web User Guide Chapter 3: CWF Assistance Request Transactions 3-17 Figure 3-6: CWF Assistance Request Employment Information
ECRS Web User Guide Chapter 3: CWF Assistance Request Transactions 3-18 Table 3-9: CWF Assistance Request Employment Information Field Description EMPLOYER NAME Name of the employer providing group health insurance under which the beneficiary is covered. Required field when ACTION is EA or EI. ADDRESS First line of the employer’s street address. Required field when ACTION is EI. ADDRESS 2 Second line of the employer’s street address. Optional field. CITY City associated with the employer’s street address. Required field when ACTION is EI. STATE State associated with the employer’s street address. Required field when ACTION is EI. ZIP ZIP code associated with the employer’s street address. Required field when ACTION is EI. PHONE Phone number of the employer. EIN Employer Identification Number. EMPLOYEE # Employee number of policyholder CONTINUE Command button. Click to go to the Additional Information page. CANCEL Command button. Click to return to the Main Menu. 3.9 Additional Information Page 1. Enter check and beneficiary information on the CWF Assistance Additional Information page. This information is used in conjunction with the action and source codes selected on the CWF Assistance Request, Action Requested page. 2. After all relevant fields have been entered, click Continue to go to the Comments/Remarks page, or select a page link from the left side bar. If you need to enter more than 5 diagnosis codes, click the More Diagnosis Codes button. The More Diagnosis Codes page will appear (Figure 3-8).
ECRS Web User Guide Chapter 3: CWF Assistance Request Transactions 3-19 Figure 3-7: CWF Assistance Request Additional Information Table 3-10: CWF Assistance Request Additional Information Field Description CHECK NUMBER Number of check received. Required field if SOURCE is CHEK. CHECK DATE Date of check received. Required field if SOURCE is CHEK. You cannot future-date this field. CHECK AMOUNT Amount of check received. Required field if SOURCE is CHEK. Note: The amount will always appear with two decimal places. PRE-PAID HEALTH PLAN DATE Pre-paid Health Plan date in MMDDCCYY Required field if ACTION is PH. SOCIAL SECURITY NUMBER Corrected Social Security Number when Medicare ID and SSN do not match CWF. Required field if ACTION is MX. DIAGNOSIS CODES Five-to-seven-digit diagnosis code that applies to this MSP occurrence. Enter up to five diagnosis codes on this page. Up to 15 additional diagnosis codes may be entered on the More Diagnosis Codes page. To enter more than 5 diagnosis codes, click the More Diagnosis Codes button. The More Diagnosis Codes page will appear (Figure 3-8). Required when ACTION is DX. ICD Indicator Type of diagnosis code. Select “ICD-9” or “ICD-10.” Required if corresponding Diagnosis Code is submitted. More Diagnosis Codes Command button. Click to go to the More Diagnosis Codes page. CONTINUE Command button. Click to go to the Comments/Remarks page. CANCEL Command button. Click to return to the Main Menu.
ECRS Web User Guide Chapter 3: CWF Assistance Request Transactions 3-20 Figure 3-8: CWF Assistance Request Additional Information More Diagnosis Codes Table 3-11: CWF Assistance Request More Diagnosis Codes Field Description DIAGNOSIS CODES Five-to-seven-digit diagnosis code that applies to this MSP occurrence. Enter up to 15 diagnosis codes. ICD Indicator Type of diagnosis code. Select “ICD-9” or “ICD-10.” Required if corresponding Diagnosis Code is submitted. CONTINUE Command button. Click to go to the Comments and Remarks page. CANCEL Command button. Click to return to the Main Menu. 3.10 Comments and Remarks Page 1. Enter comments on the CWF Assistance Request Comments and Remarks page. All comments entered are viewable by the BCRC. Refer to Appendix F for the complete list of remark codes. Notes: • Remarks are only shown on the Comments and Remarks page when the ACTION is AR. • Comments by the BCRC are not provided for auto-processed requests. 2. After all relevant fields have been entered, click Continue to go to the Summary page, or select a page link from the left side bar.
ECRS Web User Guide Chapter 3: CWF Assistance Request Transactions 3-21 Figure 3-9: CWF Assistance Request Comments/Remarks Table 3-12: CWF Assistance Request Comments/Remarks Field Description COMMENTS Free-form, optional, text field, where Medicare contractors type data to send notes to the BCRC. (Protected field when the BCRC adds a comment.) Notes: Use this field to provide additional context or details that cannot be provided in other fields. There is no need, for example, to repeat action code descriptions. The BCRC does not provide comments on auto-processed requests as the action requested has been completed. REMARKS Enter at least one remark code, explaining the reason for the transaction. Enter up to three remark codes. See Appendix F for more information. Required field when ACTION is AR. CONTINUE Command button. Click to go to the Summary page. CANCEL Command button. Click to return to the Main Menu. 3.11 Summary Page The Summary page shows a summary of all information entered for the assistance request before submission (Figure 3-10). After entering or selecting data in all relevant fields on the previous CWF Assistance Request pages, review the Summary page and then click Submit. The system shows the Submit Confirmation page. At this point, the assistance request is submitted and you can print the confirmation page.
ECRS Web User Guide Chapter 3: CWF Assistance Request Transactions 3-22 Figure 3-10: CWF Assistance Request Summary
ECRS Web User Guide Chapter 3: CWF Assistance Request Transactions 3-23 3.12 Viewing, Updating, and Deleting CWF Assistance Request Transactions Follow the steps below to search for and view a list of CWF Assistance Request transactions. Note: You can only update or delete CWF assistance request transactions in NW status. Any user with the same contractor number can update or delete a transaction in NW status. However, if the COB system has started processing the information you cannot request an update or delete. From the Main Menu page, click the CWF Assistance Request link under Search for Requests or Inquiries. The CWF Assistance Request Search page appears. Figure 3-11: CWF Assistance Request Search Table 3-13: CWF Assistance Request Search Field Description CONTRACTOR # If you are a Medicare contractor, this field will be pre-filled with the contractor number entered during contractor sign-in. (protected field) If you are a regional office (RO) or a CMS user, this field will be pre-filled with the CMS ID/RO number entered during contractor sign-in. Note: This field is updateable with any Medicare contractor number, but only the CMS ID/RO number entered during contractor sign-in can be used. MEDICARE ID Enter a Medicare ID (HICN or MBI). Note: If searching by Medicare ID, do not enter an SSN or DCN. SSN Enter a Social Security Number. Note: If searching by SSN, do not enter a Medicare ID or DCN. STATUS Enter a status code. To view all in-process CWF Assistance Request transactions, select IP in the Status field. REASON Select a reason code. (See Appendix E for the complete list of codes.) USER ID Enter a user ID. ACTION CODE Select an action code, if applicable. Action codes appear according to the action type. (See Appendix E for a list of action codes.) ORIGIN DATE FROM Enter a starting date for the date range, if applicable. Note: MMDDCCYY format.
ECRS Web User Guide Chapter 3: CWF Assistance Request Transactions 3-24 Field Description ORIGIN DATE TO Enter an ending date for the date range. Note: The dates in the Origin Date From and To fields default to the date 31 calendar days prior to the current date and the current date but can be changed to any calendar day range, as long as it is not more than 6 months. DCN Enter a DCN. Note: If searching by DCN, do not enter a Medicare ID or SSN. SUBMIT Command button. Click to show search results. RESET Command button. Click to clear search results. CANCEL Command button. Click to return to the Main Menu. 3.12.1 View Transactions 1. Type search criteria in the appropriate fields and click the Submit button. • To create a list of all CWF Assistance Requests for a specific Medicare ID, enter the Medicare ID in the search criteria and leave the CONTRACTOR NUMBER field blank. • When searching by origin date, user ID, status, reason, and/or action code, you must also enter a DCN, Medicare ID, SSN, or contractor number. The system shows a list of CWF Assistance Requests. There are up to 500 items per page; scroll through the records or use the First, Previous, Next, and Last navigation at the top of the list to view other transactions on other pages. 2. Change or delete search criteria and click the Submit button to initiate a new search. Figure 3-12: CWF Assistance Request Search Listing
ECRS Web User Guide Chapter 3: CWF Assistance Request Transactions 3-25 Table 3-14: CWF Assistance Request Search Listing Field Description DISPLAY RANGE Select a range to filter the records in the search results by a defined range. Note: This field is only visible if a search has been completed. The range in the DISPLAY RANGE field defaults to 1-500. Total Records Found Total number of records found. Current Display Range Defined display range for the records found. Note: This field defaults to 1-500. DELETE Click the delete [X] link to mark a transaction for deletion. MEDICARE ID Medicare ID (HICN or MBI) for the CWF Assistance Request transaction (protected field). Click the Medicare ID link to view the Summary page. CONTRACTOR Contractor number (protected field). DCN DCN assigned to the CWF Assistance Request transaction by the Medicare contractor (protected field). STATUS Status of the CWF Assistance Request transaction (protected field). REASON Two-character code explaining why the CWF Assistance Request is in a particular status (protected field). Note: See Appendix E for a complete list of reason codes and definitions. ORIGIN DATE Originating date in MMDDCCYY format (protected field). LAST UPDATE Date the CWF Assistance Request transaction was last changed in MMDDCCYY format (protected field). USER ID User ID of the operator who entered CWF Assistance Request transaction (protected field). ACTION CODE Action code for the CWF Assistance Request transaction (protected field). Export options Click the link to export search results in the given format. Note: You may export all results returned, up to 500 records at a time, based on the records currently shown. 3.12.2 Update Transactions 1. To update information on a CWF Assistance Request transaction, click the Medicare ID link for the transaction. The system shows the Summary page for the selected transaction, along with page links to the information, to allow for updates (Figure 3-13). 2. To leave the Summary page without making any changes, click the Cancel or Return buttons to return to the Search Page Listing. If you do need to update the transaction, access the appropriate page and navigate back to the Summary page. 3. After you have made all updates, click Submit to confirm updates, or Cancel to return to the CWF Assistance Request Search Page Listing.
ECRS Web User Guide Chapter 3: CWF Assistance Request Transactions 3-26 Figure 3-13: CWF Assistance Request Summary
ECRS Web User Guide Chapter 3: CWF Assistance Request Transactions 3-27 3.12.3 Delete Transactions 1. To mark a CWF Assistance Request transaction for deletion, click the delete [X] icon next to the Medicare ID and when the Confirmation page appears, click Continue to confirm or click Cancel to decline. 2. To exit the CWF Assistance Request Search page, click Home to return to the Main Menu. The system does not retain search criteria.
ECRS Web User Guide Chapter 4: MSP Inquiry Transactions 4-1 Chapter 4: MSP Inquiry Transactions This chapter provides you with step-by-step instructions to perform an MSP Inquiry transaction. Examples and explanations are provided for each page in ECRS. If you are a new user, this chapter can help you use the system as you learn it. You can also use this chapter to determine what information is contained in each field or what you should enter in a field. It can also help you to navigate through the MSP inquiry transaction process if you are lost. If you are an experienced user, you can use the chapter as a quick reference for a web page that you use infrequently. 4.1 Adding an MSP Inquiry Transaction Use the MSP Inquiry link under Create Requests or Inquiries on the Main Menu, to add MSP Inquiry transactions for new or possible MSP situations not yet documented at CWF. See Section 3.2 for information on CMS’ MSP Hierarchy rules. To enter CWF Assistance Request transactions for changes to existing CWF MSP auxiliary occurrences, use the CWF Assistance Request Detail transaction. 4.1.1 Retrieving Beneficiary Information Beneficiary information is automatically retrieved when Medicare ID (HICN or MBI) and other required data is entered and saved on the first page of the MSP Inquiry (Action Requested page). The information appears on the right side bar, and is carried forward on the MSP Inquiry transaction. 4.1.2 Common MSP Sources Common sources that provide contractors with MSP information, followed by the associated source code, are: • Letters from beneficiaries or other informants (LTTR) • Phone calls (PHON) • Checks (CHEK) • Secondary claims (SCLM) 4.2 Action Requested Page From the Main Menu page, click MSP Inquiry under Create Requests or Inquiries. The system shows the Action Requested page, the first page of the MSP Inquiry. The information entered on this page determines required information on subsequent pages.
ECRS Web User Guide Chapter 4: MSP Inquiry Transactions 4-2 Figure 4-1: MSP Inquiry Action Requested 4.2.1 Navigation Links Several basic navigation links appear on every Main Menu page. See Section 2.6.4 for descriptions of the heading bar links and the right side bar links and fields. 1. Enter data in all required fields on the Action Requested page, and then click the Continue button. The required fields on this web page are noted with a red asterisk (*) and are as follows: • DCN • MEDICARE ID • ACTIVITY CODE • SOURCE Note: If beneficiary information is not found for the Medicare ID you have entered you will receive a warning message, but will still be able to continue with the MSP Inquiry. 2. After all relevant fields have been entered, click Continue to go to the MSP Information page, or select a page link from the left side bar. 3. To exit the MSP Inquiry Detail pages, click the Home link to return to the Main Menu or Sign Out to exit the application.
ECRS Web User Guide Chapter 4: MSP Inquiry Transactions 4-3 Table 4-1: MSP Inquiry Action Requested Field Description DCN DCN assigned by the contractor to correspondence and/or paperwork associated with the transaction. Required field. The system auto-generates the DCN, but it can be changed by the user. MEDICARE ID Medicare ID (HICN or MBI) of the beneficiary. Required field. Enter the ID without dashes, spaces, or other special characters. Note: The system looks up the Medicare ID to ensure all related Medicare IDs are returned. Results show the Medicare ID you entered. ACTIVITY CODE Activity of contractor. Required field. Valid values are: C Claims (Pre-Payment) D Debt Collection/Referral G Group Health Plan I General Inquiries N Liability, No-Fault, Workers’ Compensation, and Federal Tort Claim Act ACTION Two-character code indicating the type of special processing to perform on the MSP Inquiry record. See Appendix E for a complete list of action codes and definitions. Note: You can use CA and CL together. Valid values are: CA Class Action Suit Note: This action code assigns the designated lead contractor according to the type of class action suit. The system does not send the beneficiary an MSP confirmation letter. CL Closed or Settled Case Note: This action code is only valid for closed and settled cases. This action code suppresses the lead contractor assignment. The system does not send the beneficiary an MSP confirmation letter. SOURCE Four-character code identifying the source of the MSP Inquiry information. Required field. Valid values are: CHEK Unsolicited check LTTR Letter PHON Phone call SCLM Claim submitted to Medicare contractor for secondary payment SRVY Survey CONTINUE Command button. Click to go to the MSP Information page. Note: Required fields must be typed/selected before clicking Continue. CANCEL Command button. Click to return to the Main Menu.
ECRS Web User Guide Chapter 4: MSP Inquiry Transactions 4-4 4.3 MSP Information Page 1. Enter information associated with the MSP coverage on this page. 2. After all relevant fields have been entered, click Continue to go to the Informant Information page, or select a page link from the left side bar. Note: Some ICD-9 and ICD-10 diagnosis codes cannot be submitted when the MSP record type is “D-Automobile Insurance, No Fault.” If you attempt to submit these codes, the following error message appears: “Diagnosis code [number] is invalid with insurer type of No- Fault.” For a listing of diagnosis codes that are invalid with insurer type of No-Fault, go to CMS.gov at: https://www.cms.gov/medicare/coordination-benefits-recovery/overview/icd-code-lists. Figure 4-2: MSP Inquiry MSP Information
ECRS Web User Guide Chapter 4: MSP Inquiry Transactions 4-5 Table 4-2: MSP Inquiry MSP Information Field Description MSP TYPE One-character code identifying the type of MSP coverage. Valid values are: A Working Aged B ESRD D Automobile Insurance, No-Fault E Workers’ Compensation F Federal (Public) G Disabled H Black Lung L Liability W Workers’ Compensation Medicare Set Aside Required field: • When SOURCE is PHON. • When ACTION is CA or CL. (MSP TYPE must be D, E, or L when ACTION is CL.) PATIENT RELATIONSHIP Patient relationship between the policyholder and the beneficiary. Required field when: ACTION is Blank and MSP TYPE is F ACTION is CA and MSP TYPE is L ACTION is CL and MSP TYPE is D, E, or L Valid values are: 01 Self; Patient is policyholder 02 Spouse 03 Child 04 Other 20 Domestic partner Note: All patient relationship values accepted for MSP Types B and G. MSP Type A will accept 01 and 02. MSP Types D, E, L, H, W, S, and T will only accept 01. EFFECTIVE DATE Effective date of MSP coverage. Required field when: • ACTION is CA and MSP TYPE is L • ACTION is CL and MSP TYPE is D, E, or L Notes: EFFECTIVE DATE cannot be the same as TERMINATION DATE. This field accepts dates up to three months from the current date: For GHP records (MSP Types A, B, and G): The Effective Date can be in the future for currently entitled beneficiaries (i.e., enrolled in Medicare), or for beneficiaries who will be entitled starting up to three months in the future. For NGHP records (MSP Types D, E, L, H, and W): Effective Date can be in the future for beneficiaries as long as their entitlement start date is in the future. The future Effective Date must be equal to the entitlement start date. (NGHP MSP occurrences for beneficiaries who are currently entitled cannot have future MSP Effective Dates.)
ECRS Web User Guide Chapter 4: MSP Inquiry Transactions 4-6 Field Description TERMINATION DATE Termination date of MSP coverage. TERMINATION DATE can be all zeroes for open ended coverage. Required field when ACTION is CL and MSP TYPE is D, E, or L. Note: TERMINATION DATE cannot be the same as EFFECTIVE DATE. CMS GROUPING CODE CMS Grouping Code. Required field when ACTION is CA and MSP TYPE is L. Valid values are: 01 Gel Implants (TrailBlazers, 00400) 02 Gel Implants (Alabama, 00010) 03 Bone Screw Recoveries (United Government Services, 00454) 04 Diet Drug Recoveries (Cahaba BCBS Alabama, 00010) 05 Sulzer Inter-Op Acetabular Shells for Hip Implant Recoveries (Chisholm Administrative Services, 00340) 06 Sulzer Orthopedic and Defective Knee Replacement Recoveries (Chisholm Administrative Services, 00340) 07 Baycol Litigation 08 Dexatrim (90000) 09 Rhode Island Receivership Recoveries (00180) 10 Propulsid (00010) 11 Asbestos Exposure 12 Garretson Asbestos Cases 13 Fleet Phosphate 14 Accutane 15 Garretson - Trasylol 16 Zelnorm 17 Total Body Supplements - TBS 18 Hormone Replacement Therapy - HRT 19 Keugl Mesh DIALYSIS TRAIN DATE Date the beneficiary received self-dialysis training. BLACK LUNG BENEFITS Yes or No field indicating whether the beneficiary receives benefits under the Black Lung Program. BLACK LUNG EFFECTIVE DATE Date the beneficiary began receiving benefits under the Black Lung Program. This field is only enabled when BLACK LUNG BENEFITS is Yes. SEND TO CWF Indicates whether to send the MSP inquiry to CWF. Select Yes or No. Note: SEND TO CWF defaults to No unless ACTION is blank and MSP TYPE is blank or F. CONTINUE Command button. Click to go to the Informant Information page. CANCEL Command button. Click to return to the Main Menu. 4.4 Informant Information Page 1. On this page, enter information about the person who informed you of the change in MSP coverage. 2. After all relevant fields have been entered, click Continue to go to the Insurance Information page, or select a page link from the left side bar.
ECRS Web User Guide Chapter 4: MSP Inquiry Transactions 4-7 Figure 4-3: MSP Inquiry Informant Information Table 4-3: MSP Inquiry Informant Information Field Description FIRST NAME First name of the person informing the contractor of the change in MSP coverage. Required field when: • SOURCE is CHEK, LTTR or PHON. • ACTION is CA or CL, unless Insurance Company Address will be entered. MIDDLE INITIAL First initial of the middle name of the person informing the contractor of the change in MSP coverage. LAST NAME Last name of the person informing the contractor of the change in MSP coverage. Required field when • SOURCE is CHEK, LTTR or PHON. • ACTION is CA or CL, unless Insurance Company Address will be entered. ADDRESS Informant’s street address. Required field when: • SOURCE is CHEK, LTTR or PHON. • ACTION is CA or CL, unless Insurance Company Address will be entered. CITY Informant’s city. Required field when: • SOURCE is CHEK, LTTR or PHON. • ACTION is CA or CL, unless Insurance Company City will be entered.
ECRS Web User Guide Chapter 4: MSP Inquiry Transactions 4-8 Field Description STATE Informant’s state. Required field when: • SOURCE is CHEK, LTTR or PHON. • ACTION is CA or CL, unless Insurance Company State will be entered. ZIP Informant’s ZIP code. Required field when: • SOURCE is CHEK, LTTR or PHON. • ACTION is CA or CL, unless Insurance Company ZIP will be entered. PHONE Informant’s telephone number. RELATIONSHIP One-character code indicating the relationship of the informant to the beneficiary. Valid values are: A Attorney representing beneficiary B Beneficiary C Child D Defendant’s attorney E Employer F Father I Insurer M Mother N Non-relative O Other relative P Provider R Beneficiary representative (other than attorney) S Spouse U Unknown W Pharmacy Notes: • Required field when SOURCE is CHEK, LTTR or PHON. • Must be A if ACTION is CA or CL and informant information is entered. CONTINUE Command button. Click to go to the Insurance Information page. CANCEL Command button. Click to return to the Main Menu. 4.5 Insurance Information Page 1. Enter information about the type of insurance associated with the MSP coverage on this page. 2. After all relevant fields have been entered, click Continue to go to the Employment Information page, or select a page link from the left side bar.
ECRS Web User Guide Chapter 4: MSP Inquiry Transactions 4-9 Figure 4-4: MSP Inquiry Insurance Information
ECRS Web User Guide Chapter 4: MSP Inquiry Transactions 4-10 Table 4-4: MSP Inquiry Insurance Information Field Description INSURANCE COMPANY NAME Name of the insurance carrier for MSP coverage. If the Insurance Company Name entered is less than two characters or contains one of the following values, then it is considered an error: • ATTORNEY • BC • BCBS • BCBX • BCRC • BENEFITS COORDINATION & RECOVERY • BENEFITS COORDINATION & RECOVERY CENTER • BENEFITS COORDINATION AND RECOVE • BENEFITS COORDINATION AND RECOVERY CENTER • BLUE CROSS • BLUE SHIELD • BS • BX • CMS • COB • COBC • COORDINATION OF BENEFITS CONTRAC • COORDINATION OF BENEFITS CONTRACTOR • HCFA • INSURER • MEDICARE • MISC • MISCELLANEOUS • N/A • NA • NO • NO FAULT • NO-FAULT • NONE • SUPPLEMENT • SUPPLEMENTAL • UN • UNK • UNKNOWN • XX
ECRS Web User Guide Chapter 4: MSP Inquiry Transactions 4-11 Field Description ADDRESS LINE 1 First Line of insurance carrier’s street address. Required field when: • INSURANCE COMPANY NAME is entered • ACTION is CA or CL, unless Informant Name and Address were entered. ADDRESS LINE 2 Second Line of insurance carrier’s street address. CITY City associated with the insurance carrier’s street address. Required field when: • INSURANCE COMPANY NAME is entered • ACTION is CA or CL, unless Informant City was entered. STATE State associated with the insurance carrier’s street address. Required field when: • INSURANCE COMPANY NAME is entered • ACTION is CA or CL, unless Informant State was entered. ZIP ZIP code associated with the insurance carrier’s street address. Required field when: • INSURANCE COMPANY NAME is entered • ACTION is CA or CL, unless Informant ZIP was entered. INSURANCE TYPE One-character code for the type of insurance. (Required field) Valid values are: A Insurance or Indemnity (OTHER TYPES) J Hospitalization Only Plan covering inpatient hospital services (HOSPITAL ONLY) K Medical Services Only Plan covering only non-inpatient medical services (MEDICAL ONLY) R GHP Health Reimbursement Arrangement S GHP Health Savings Account Blank Unknown (UNKNOWN); defaults to A. POLICY NUMBER Policy number of the insurance coverage. If you enter a POLICY NUMBER, you do not have to enter a GROUP NUMBER. GROUP NUMBER Group number of the insurance coverage. If you enter a GROUP NUMBER, you do not have to enter a POLICY NUMBER. SUBSCRIBER FIRST NAME First name of individual covered by this insurance. SUBSCRIBER MIDDLE INITIAL First initial of the middle name of the individual covered by this insurance. SUBSCRIBER LAST NAME Last name of the individual covered by this insurance. SUBSCRIBER SSN Social Security Number of the individual covered by this insurance. CONTINUE Command button. Click to go to the Employment Information page. CANCEL Command button. Click to return to the Main Menu.
ECRS Web User Guide Chapter 4: MSP Inquiry Transactions 4-12 4.6 Employment Information Page 1. Enter employment information associated with the MSP coverage on this page (Figure 4-5). 2. After all relevant fields have been entered, click Continue to go to the Additional Information page, or select a page link from the left side bar. Figure 4-5: MSP Inquiry Employment Information Table 4-5: MSP Inquiry Employment Information Field Description EMPLOYER NAME Name of the employer providing group health insurance under which the beneficiary is covered. Required field when: • MSP TYPE is F and SEND TO CWF is Yes ADDRESS First line of the employer’s street address. Required field when: • MSP TYPE is F and SEND TO CWF is Yes ADDRESS 2 Second line of the employer’s street address. Optional field. CITY City associated with the employer’s street address. Required field when: • MSP TYPE is F and SEND TO CWF is Yes STATE State associated with the employer’s street address. Required field when: • MSP TYPE is F and SEND TO CWF is Yes
ECRS Web User Guide Chapter 4: MSP Inquiry Transactions 4-13 Field Description ZIP ZIP code associated with the employer’s street address. Required field when: • MSP TYPE is F and SEND TO CWF is Yes PHONE Phone Number of the employer. EIN Employer Identification Number. EMPLOYEE # Employee number of policyholder. CONTINUE Command button. Click to go to the Additional Information page. CANCEL Command button. Click to return to the Main Menu. 4.7 Additional Information Page 1. Enter check and beneficiary information on this page. This information is used in conjunction with the ACTION(s) and SOURCE(s) selected on the MSP Inquiry, Action Requested page. 2. After all relevant fields have been entered, click Continue to go to the Prescription Drug page, or select a page link from the left side bar. If you need to enter more than 5 diagnosis codes, click the More Diagnosis Codes button. The More Diagnosis Codes page will appear (Figure 4-7). Figure 4-6: MSP Inquiry Additional Information
ECRS Web User Guide Chapter 4: MSP Inquiry Transactions 4-14 Table 4-6: MSP Inquiry Additional Information Field Description CHECK NUMBER Number of check received. Required field if SOURCE is CHEK. CHECK DATE Date of check received. Required field if SOURCE is CHEK. Note: You cannot future-date this field. CHECK AMOUNT Amount of check received. Required field if SOURCE is CHEK. Note: The amount will always appear with two decimal places. DIAGNOSIS CODES Five-to-seven-digit diagnosis code that applies to this MSP occurrence. Enter up to five diagnosis codes on this page. Up to 15 additional diagnosis codes may be entered on the More Diagnosis Codes page. To enter more than 5 diagnosis codes, click the More Diagnosis Codes button. The More Diagnosis Codes page will appear (Figure 4-7). Note: Enter at least one DIAGNOSIS CODE when the ACTION is CA or CL. NGHP MSP types will require a valid diagnosis code to be entered. A message will appear stating that the diagnosis code will be required if one is not entered. The user will not be allowed to continue until a valid code is entered into the field. Note: Diagnosis Codes cannot be entered on an MSP Inquiry when the MSP Type is A (Working Aged), B (ESRD), or G (Disabled). ICD INDICATOR Type of diagnosis code. Select “ICD-9” or “ICD-10”. Required if corresponding Diagnosis Code is submitted. MORE DIAGNOSIS CODES Command button. Click to go to the More Diagnosis Codes page. ILLNESS/INJURY DATE Date the illness or injury occurred. TYPE One-character code indicating the type of relationship between the beneficiary and his or her representative. Valid values are: A Attorney R Bene Rep (individual not acting as attorney) NAME Name of individual representing a beneficiary’s medical affairs or estate. Type name in first name/middle initial/last name format. ADDRESS Beneficiary representative’s street. CITY Beneficiary representative’s city. STATE Beneficiary representative’s state. ZIP Beneficiary representative’s ZIP code. CONTINUE Command button. Click to go to the Prescription Coverage page. CANCEL Command button. Click to return to the Main Menu.
ECRS Web User Guide Chapter 4: MSP Inquiry Transactions 4-15 Figure 4-7: MSP Inquiry Additional Information More Diagnosis Codes Table 4-7: MSP Inquiry Additional Information More Diagnosis Codes Field Description DIAGNOSIS CODES Five-to-seven-digit diagnosis code that applies to this MSP occurrence. Enter up to 15 diagnosis codes. ICD Indicator Type of diagnosis code. Select “ICD-9” or “ICD-10”. Required if corresponding Diagnosis Code is submitted. CONTINUE Command button. Click to go to the Prescription Coverage page. CANCEL Command button. Click to return to the Main Menu. 4.8 Prescription Drug Page 1. On this page, enter Prescription Coverage information associated with the MSP Inquiry Part D coverage. 2. After all relevant fields have been entered, click Continue to go to the Summary page, or select a page link from the left side bar. Note: If an NGHP MSP Type (D, E, H, L, or W) is selected on the MSP Inquiry MSP Information page, the MSP Inquiry Prescription Drug page is disabled.
ECRS Web User Guide Chapter 4: MSP Inquiry Transactions 4-16 Figure 4-8: MSP Inquiry Prescription Drug Table 4-8: MSP Inquiry Prescription Drug Field Description INSURANCE COMPANY NAME Name of the insurance carrier for MSP coverage. Note: If the Insurance Company Name entered is less than two characters or contains one of the following values, then it is considered an error: ADAP, ASSISTANCE PROGRAM, ATTORNEY, BC, BCBS, BCBX, BCRC, BENEFITS COORDINATION & RECOVERY, BENEFITS COORDINATION & RECOVERY CENTER, BENEFITS COORDINATION AND RECOVE, BENEFITS COORDINATION AND RECOVERY CENTER, BLUE CROSS, BLUE SHIELD, BS, BX, CMS, COB, COBC, COORDINATION OF BENEFITS CONTRAC, COORDINATION OF BENEFITS CONTRACTOR, HCFA, INSURER, MEDICAID, MEDICARE, MISC, MISCELLANEOUS, N/A, NA, NO, NO FAULT, NO-FAULT, NONE, PAP, QSP, QUALIFIED STATE PROGRAM, SPAP, SUPPLEMENT, SUPPLEMENTAL, TRICARE, UN, UNK, UNKNOWN, and XX. ADDRESS LINE 1 First Line of the insurance carrier’s street address. Required field when NAME and ADDRESS were entered. ADDRESS LINE 2 Second Line of the insurance carrier’s street address. CITY City associated with the insurance carrier’s street address. STATE State associated with the insurance carrier’s street address. ZIP ZIP code associated with the insurance carrier’s street address. POLICY NUMBER Policy number of the insurance coverage.
ECRS Web User Guide Chapter 4: MSP Inquiry Transactions 4-17 Field Description EFFECTIVE DATE Effective date of the MSP coverage. Notes: EFFECTIVE DATE cannot be the same as the TERMINATION DATE. This field accepts dates up to three months from the current date: For GHP records (MSP Types A, B, and G: The Effective Date can be in the future for beneficiaries who are currently enrolled in Part D, or for beneficiaries who will be enrolled starting up to three months in the future. TERMINATION DATE Termination date of MSP coverage. TERMINATION DATE can be all zeroes for open ended coverage. Note: TERMINATION DATE cannot be the same as the EFFECTIVE DATE. RECORD TYPE Prescription Coverage Record Type. Valid values are: PRI Primary SUP Supplemental Note: RECORD TYPE must be SUP when SUPPLEMENTAL TYPE is L. COVERAGE TYPE Prescription Coverage type of insurance. Valid values are: U Drug Network V Drug Non-network Z Health account (such as a flexible spending account provided by other party to pay prescription drug costs or premiums) Required field. BIN Prescription Drug BIN number. Must be six digits and cannot be all the same number if COVERAGE TYPE is U. Required field when COVERAGE TYPE is U. Group, BIN, or PCN is required with Action Code CX. PCN Prescription Drug PCN number. Must not contain special characters. Populate with spaces if not available. Cannot have special characters, except for a non-leading dash, and no leading space. Group, BIN, or PCN is required with Action Code CX. GROUP Prescription Drug group number. Must not contain special characters. Group, BIN, or PCN is required with Action Code CX. ID Prescription Drug ID number. Must not contain special characters. Required field when COVERAGE TYPE is U. Cannot be blank or all zeros if COVERAGE TYPE is U. SUPPLEMENTAL TYPE Prescription Drug Coverage policy type. Valid values are: L - Supplemental N - Non-qualified State Program R – Charity T – Federal Government Programs 3 – Major Medical
ECRS Web User Guide Chapter 4: MSP Inquiry Transactions 4-18 Field Description PERSON CODE Person Code. Plan specific relationship assigned plan administrator at the plan level. Required field when RECORD TYPE is Supplemental. Valid values are: 001 Self 002 Spouse 003 Other CONTINUE Command button. Click to go to the Summary page. CANCEL Command button. Click to return to the Main Menu. 4.9 Summary Page The Summary page shows a summary of all information entered for the MSP inquiry before submission (Figure 4-9). After typing/selecting data in all relevant fields on the previous MSP Inquiry pages, review the Summary page and click the Submit button. The system shows the Submit Confirmation page. At this point, the MSP inquiry is submitted and you can print the confirmation page.
ECRS Web User Guide Chapter 4: MSP Inquiry Transactions 4-19 Figure 4-9: MSP Inquiry Summary
ECRS Web User Guide Chapter 4: MSP Inquiry Transactions 4-20 4.10 Viewing, Updating, and Deleting MSP Inquiry Transactions Follow the steps below to search for and view a list of MSP Inquiry transactions. Note: You can only update or delete MSP Inquiry transactions in NW status. Any user with the same contractor number can update or delete a transaction in NW status. However, if the COB system has started processing the information you cannot request an update or delete. From the Main Menu page, click MSP Inquiries under Search for Requests or Inquiries. The MSP Inquiry Search page appears. Figure 4-10: MSP Inquiry Search Table 4-9: MSP Inquiry Search Field Description CONTRACTOR # If you are a Medicare contractor, this field will be pre-filled with the contractor number entered during contractor sign-in (protected field). If you are a Regional Office or CMS user, this field will be pre-filled with the CMS ID/RO number entered during contractor sign-in. Note: You can update this field with any Medicare contractor number, but only the CMS ID/RO number entered during contractor sign-in can be used. MEDICARE ID Enter a Medicare ID (HICN or MBI). Note: If searching by Medicare ID, do not enter an SSN or DCN. SSN Enter a Social Security Number. Note: If searching by SSN, do not enter a Medicare ID or DCN. STATUS Enter a status code. To view all in-process MSP Inquiry transactions, select IP in the STATUS field. REASON Select a reason code. (See Appendix E for the complete list of codes.) USER ID Enter a user ID. ACTION CODE Select an action code, if applicable. Action codes appear according to the action type. (See Appendix E for a list of action codes.) ORIGIN DATE FROM Enter a starting date for the date range, if applicable. Note: MMDDCCYY format. ORIGIN DATE TO Enter an ending date for the date range. Note: The dates in the ORIGIN DATE FROM and TO fields default to the date 31 calendar days prior to the current date and the current date but can be changed to any calendar day range, as long as it is not more than 6 months.
ECRS Web User Guide Chapter 4: MSP Inquiry Transactions 4-21 Field Description DCN Enter a DCN. Note: If searching by DCN, do not enter a Medicare ID or SSN. SUBMIT Command button. Click to view search results. RESET Command button. Click to clear search results. CANCEL Command button. Click to return to the Main Menu. 4.10.1 View Transactions 1. Type search criteria in the appropriate fields and click Submit. • To create a list of all MSP Inquiries for a specific Medicare ID, enter the Medicare ID in the search criteria and leave the CONTRACTOR NUMBER field blank. • When searching by origin date, user ID, status, and/or reason, you must also enter a DCN, Medicare ID, SSN, or contractor number. The system shows a list of MSP Inquiries (Figure 4-11). There are up to 500 items per page; scroll through the records or use the First, Previous, Next, and Last navigation at the top of the list to view other transactions on other pages. Note: If the beneficiary is deceased, and there is no representative payee on file, then the inquiry will be closed with Reason Code 65: Deceased, used with CM status. 2. Change or delete search criteria to initiate a new search. Figure 4-11: MSP Inquiry Search Listing Table 4-10: MSP Inquiry Search Listing Field Description Display Range Select a range to filter the records in the search results by a defined range. Note: This field is only visible if a search has been completed. The range in the Display Range field defaults to 1-500. Total Records Found Total number of records found.
ECRS Web User Guide Chapter 4: MSP Inquiry Transactions 4-22 Field Description Current Display Range Defined display range for the records found. Note: This field defaults to 1-500. Delete Click the delete [X] link to mark a transaction for deletion. Medicare ID Medicare ID (HICN or MBI) for the MSP Inquiry transaction (protected field). Click the link to view the Summary page. Contractor Contractor number (protected field). DCN DCN assigned to the MSP Inquiry transaction by the Medicare contractor (protected field). Action Code Action code for the MSP Inquiry transaction (protected field). Status Status of the MSP Inquiry transaction (protected field). Reason Reason for the MSP Inquiry transaction (protected field). Note: See Appendix E for a complete list of reason codes and definitions. Origin Date Originating date in MMDDCCYY format (protected field). Last Update Date the MSP Inquiry transaction was last changed in MMDDCCYY format (protected field). User ID User ID of the operator who entered the MSP Inquiry transaction (protected field). Export options Click the link to export search results in the given format. Note: You may export all results returned, up to 500 records at a time, based on the records currently shown. 4.10.2 Update Transactions 1. To update information on an MSP Inquiry transaction, click the Medicare ID link for the transaction and the system shows the Summary page for the selected transaction, along with page links to the information, to allow for updates (Figure 4-12). 2. To leave the Summary page without making any changes, click Cancel or Return to return to the Search Page Listing. If you do need to update the transaction, access the appropriate page and navigate back to the Summary page. After you have made all updates, click Submit to confirm updates, or click Cancel to return to the MSP Inquiry Search Page Listing.
ECRS Web User Guide Chapter 4: MSP Inquiry Transactions 4-23 Figure 4-12: MSP Inquiry Summary
ECRS Web User Guide Chapter 4: MSP Inquiry Transactions 4-24 4.10.3 Delete Transactions 1. To mark an MSP Inquiry transaction for deletion, click the delete [X] icon next to the Medicare ID and when the Confirmation page appears, click Continue to confirm, or click Cancel to decline. 2. To exit the MSP Inquiry Search page, click Home to return to the Main Menu. The system does not retain search criteria.
ECRS Web User Guide Chapter 5: Prescription Drug Assistance Request Transactions 5-1 Chapter 5: Prescription Drug Assistance Request Transactions This chapter provides you with step-by-step instructions to perform a Prescription Drug assistance request. Examples and explanations are provided for each page in ECRS Web. This chapter also includes a discussion regarding the hierarchy rules and logic for processing primary and supplemental Part D prescription drug records (effective April 2023). If you are a new user, this chapter can help you use the system as you learn it. You can also use this chapter to determine what information is contained in each field or what you should enter in a field. It can also help you to navigate through the Prescription Drug assistance request transaction process if you are lost. If you are an experienced user, you can use the chapter as a quick reference for a web page that you use infrequently. 5.1 Adding a Prescription Drug Assistance Request Transaction Use the Prescription Drug Assistance Request link under Create Requests or Inquiries on the Main Menu, to add Prescription Drug Assistance Request transactions for Part D records. Note: Prescription Drug Assistance Requests are only available to Part C and Part D submitters. 5.1.1 Retrieving Beneficiary Information Beneficiary information is automatically retrieved when Medicare ID (HICN or MBI) and other required data is entered and saved on the first page of the Prescription Drug Assistance Request (Action Requested). The information appears on the right side bar, and carried forward on the Prescription Drug Assistance Request transaction. 5.2 Prescription Drug Hierarchy Requirements Hierarchy rules and processing logic, similar to those governing MSP occurrences (Section 3.2), are applied when processing primary and supplemental Part D prescription drug records. 5.2.1 Prescription Drug Hierarchy Background Because of the large volume of duplicate reporting of prescription drug records by various contractors, hierarchy business rules are applied to Part D primary and supplemental prescription drug transactions. Previously, updating drug transactions was limited to the reporter, to reduce conflicting information or flip-flopping of drug record information. Unfortunately, this resulted in a high volume of duplicate drug records. To prevent further duplicates, updating is no longer limited to the reporter. Instead, hierarchy rules will be applied to drug records. This will allow higher hierarchy levels to update drug records based on the new matching criteria. 5.2.2 Prescription Drug Hierarchy Requirements Table 5-1 describes the hierarchy rules for Part D primary and supplemental drug records. The main differences between the drug and the MSP hierarchy rules are as follows:
ECRS Web User Guide Chapter 5: Prescription Drug Assistance Request Transactions 5-2 Primary Drug Records • Section 111 NGHP RREs, CRC GHP or ORM Recovery, and MACs will not be included (not a source for drug records). • The third tier will include automated ECRS PDAR/ARs (11143). • The fourth tier will include ECRS PDIs (11109) and all other contractor IDs • The fifth tier will only include VDSAs. Supplemental Drug Records The hierarchy rules for supplemental are the same as for primary drug records except for the following: • PAPs, SPAPs, ADAPs, Tricare, and Medicaid can only update their own records. • Records from these contractors cannot be updated by any other source except the BCRC Analyst. • The third tier will include the COBA contractor (11120). Table 5-1: Primary and Supplemental Drug Record Hierarchy Requirements Hierarchy Ranking Source of Update/Delete Request First BCRC Analyst (11100) Note: The BCRC Analyst will have the authority to manually lock a drug occurrence from any subsequent changes except those made by the BCRC. Second • BCRC Call Center/BCRC CSR (11110) • Beneficiary Call Center (1-800-Medicare) (11140) • SPD/PDC questionnaires (11110) Third • Section 111 GHP RREs (11121) • Part C/D Plans – PDP Medicare Advantage (MAPD) (11143) automated PDARs • Part D Plan – PDP automated PDARs • COBA Contractor (11120) – Supplemental only Fourth • PDIs (11109) • WCMSA Contractor (11119) • All other contractor IDs Fifth • VDSAs (11105) 5.3 Action Requested Page From the Main Menu page, click Prescription Drug Assistance Request under Create Requests or Inquiries. The system shows the Action Requested page (Figure 5-1). The Action Requested page is the first page to appear when adding a new Prescription Drug Assistance Request. The information entered on this page determines required information on subsequent pages. 5.3.1 Navigation Links Several basic navigation links are shown on every Main Menu page. See Section 2.6.4 for descriptions of the heading bar links and the right side bar links and fields. 1. Type/select data in all of the required fields on the Action Requested page, and click Continue. Required fields are noted with a red asterisk (*) and are as follows:
ECRS Web User Guide Chapter 5: Prescription Drug Assistance Request Transactions 5-3 • DCN • MEDICARE ID • ACTIVITY CODE • ACTION • SOURCE • RECORD TYPE • PATIENT RELATIONSHIP • PERSON CODE • ORIGINATING CONTRACTOR • EFFECTIVE DATE Note: If beneficiary information is not found for the Medicare ID you have entered, you will not be able to continue the Prescription Drug Assistance Request. 2. After all relevant fields have been entered, click Continue to go to the Prescription Drug Assistance Request Informant Information page, or select a page link from the left side bar. 3. To exit the Prescription Drug Assistance Request Detail pages, click Home to return to the Main Menu or Sign Out to exit the application. Figure 5-1: Prescription Drug Assistance Request Action Requested
ECRS Web User Guide Chapter 5: Prescription Drug Assistance Request Transactions 5-4 Table 5-2: Prescription Drug Assistance Request Action Requested Field Description DCN DCN assigned by the contractor to correspondence and/or paperwork associated with transaction. Required field. The system auto-generates the DCN, but it can be changed by the user. MEDICARE ID Medicare ID (HICN or MBI) of the beneficiary. Required field. Enter the ID without dashes, spaces, or other special characters. ACTIVITY CODE Activity of contractor. Required field. Valid values are: C Claims (Pre-Payment) D Debt Collection/Referral G Group Health Plan I General Inquiries
ECRS Web User Guide Chapter 5: Prescription Drug Assistance Request Transactions 5-5 Field Description ACTION Two-character code defining action to take on Prescription Drug record. Required field. See Appendix E for a complete list of action codes and definitions. Valid values are: AP Add Policy and/or Group Number BN Develop for Prescription BIN CT Change Termination Date CX Change Prescription Values (BIN, Group, PCN) DO Mark Occurrence for Deletion DR Investigate Closed or Deleted Record EA Change Employer Address ED Change Effective Date EI Change Employer Information GR Develop for Group Number II Change Insurer Information IT Change Insurance Type MT Change MSP Type OH Change Effective Date of Other Drug Coverage PC Update Prescription Person Code PN Develop for/add PCN PR Change Patient Relationship TD Add Termination Date Notes: Action code II cannot be used with action code DO. Action code DR cannot be used with any other action codes. The following Actions can be combined together, but not with any other Actions: BN Develop for Prescription BIN GR Develop for Group Number PN Develop for/add PCN The BIN field is not required when the action code is “BN.” The following Actions do not require the 4 Rx codes (BIN, PCN, Rx Group, or Rx ID) (Effective July 2026): BN Develop for Prescription BIN GR Develop for Group Number PN Develop for/add PCN
ECRS Web User Guide Chapter 5: Prescription Drug Assistance Request Transactions 5-6 Field Description SOURCE Four-character code identifying the source of the Prescription Drug Assistance Request information. Required field. Valid values are: CHEK = Unsolicited check LTTR = Letter PHON = Phone call SCLM = Claim submitted to Medicare contractor for secondary payment SRVY = Survey MSP TYPE One-character code identifying type of MSP coverage. Description of code appears next to value. Valid values are: A Working Aged B ESRD C Conditional Payment F Federal (Public) G Disabled Required field when ACTION is MT or the RECORD TYPE is Primary and the ACTION is DR. NEW MSP TYPE One-character code identifying type of new MSP coverage. Description of code appears next to value. Required field when ACTION is MT. RECORD TYPE Prescription coverage record type Required field. Valid values are: PRI Primary SUP Supplemental Note: RECORD TYPE must be PRI when ACTION is MT. PATIENT RELATIONSHIP Patient relationship between the policyholder and the beneficiary (required field). Description of code appears next to value. Valid values are: 01 Self; Patient is policyholder 02 Spouse 03 Child 04 Other 20 Domestic partner If MSP Type is A, B or G, or Record Type is Primary, Patient Relationship is required. Note: All patient relationship values accepted for MSP Types B and G. MSP Type A will accept 01 and 02.
ECRS Web User Guide Chapter 5: Prescription Drug Assistance Request Transactions 5-7 Field Description NEW PATIENT RELATIONSHIP New patient relationship between policyholder and beneficiary. Description of code appears next to value Required field when ACTION is PR. Valid values are: 01 Self; Patient is policyholder 02 Spouse 03 Child 04 Other 20 Domestic partner Note: All patient relationship values accepted for MSP Types B and G. MSP Type A will accept 01 and 02. PERSON CODE Plan-specific person code. Values are: 001 Self 002 Spouse 003 Other Required field when: RECORD TYPE is Supplemental ORIGINATING CONTRACTOR Contractor number of the contractor that created the original Prescription Drug record at MBD. Required field. COB EFFECTIVE DATE COB effective date of drug coverage in MMDDCCYY format. Required field. Notes: For GHP MSP records (MSP Types A, B, and G) it identifies the start date. This field accepts dates up to three months from the current date for primary coverage: For GHP records (MSP Types A, B, and G): The COB Effective Date can be in the future for beneficiaries who are currently enrolled in Part D, or for beneficiaries who will be enrolled starting up to three months in the future. NEW COB EFFECTIVE DATE New COB effective date of drug coverage in MMDDCCYY format. Required field when ACTION is ED. Notes: This field accepts dates up to three months from the current date for primary coverage: For GHP records (MSP Types A, B, and G): The New COB Effective Date can be in the future for beneficiaries who are currently enrolled in Part D, or for beneficiaries who will be enrolled starting up to three months in the future. EFFECTIVE DATE OF OTHER DRUG COVERAGE Effective date of the other drug insurance coverage provided by the other insurance (Other Health Information) in MMDDCCYY format. Note: Use this date for coordination of benefits. The Part D sponsor should compare this Date of Service (DOS) to both the Part D effective period and the other coverage effective period to determine if coordination of benefits is necessary. NEW EFFECTIVE DATE OF OTHER DRUG COVERAGE New effective date of the other drug coverage provided by the other insurance (Other Health Information) in MMDDCCYY format. Required field when ACTION is OH.
ECRS Web User Guide Chapter 5: Prescription Drug Assistance Request Transactions 5-8 Field Description TERMINATION DATE Medicare Secondary Payer (MSP) termination date of drug coverage in MMDDCCYY format. This is the MSP end date, which identifies whether or not the primary insurance is terminated. If the insurance is open, the field is populated with all zeroes. Required field when ACTION is TD or CT. SUBMITTER TYPE Indicates the submitter type. Select either Part C or Part D. REMOVE EXISTING TERMINATION DATE checkbox Check to remove an existing termination date. CONTINUE Command button. Click to go to the Informant Information page. Note: All required fields must be populated before clicking Continue. CANCEL Command button. Click to return to the Main Menu. 5.3.2 Automated Action Code Impacts Automated action codes are codes that are processed automatically when entered. See Appendix E for a complete list. Your updates to current records on the Prescription Drug Assistance Request Detail page will be denied if these conditions are found or when you use automated action codes. • Submitting contractor’s hierarchy permission level is lower than that of the updating contractor of the existing record • Record not found • Same Policy Number or Group Number entered (AP: Add Policy and/or Group Number) • Record previously termed, termed but same Term Date entered (TD: Add Termination Date) • Record not previously termed (CT: Change Termination Date) • Same BIN, Group, or PCN entered (CX: Change Prescription Values (BIN, Group, PCN)) • Same patient relationship entered (PR: Change Patient Relationship) • Record is deleted (DO: Mark for deletion) • Insurer information not provided (II: Change Insurer Information) (Note: Partially automated for BCRC and CRC recovery users only.) Notes: For the automated action codes indicated, ECRS will also deny an update if it conflicts with a current supplemental drug record (PAP, ADAP, SPAP, Medicaid, or Tricare). Additionally, when processing valid PDARs submitted with automated action codes, the system will search for matching existing drug coverage records using either the MSP Effective Date provided on the input file or the Other Health Information (OHI) Effective Date submitted when the drug record was created. 5.4 Informant Information Page 1. Enter information on the Informant Information page regarding the person who informed you of the change in the Part D coverage. 2. After all relevant fields have been entered, click Continue to go to the Insurance Information page, or select a page link from the left side bar.
ECRS Web User Guide Chapter 5: Prescription Drug Assistance Request Transactions 5-9 Figure 5-2: Prescription Drug Assistance Request Informant Information Table 5-3: Prescription Drug Assistance Request Informant Information Field Description FIRST NAME Given or first name of person informing contractor of change in Part D coverage. Required field for all ACTIONs when SOURCE is CHEK, LTTR, or PHON. MIDDLE INITIAL Middle initial of person informing contractor of change in Part D coverage. LAST NAME Surname of person informing contractor of change in Part D coverage. Required field for all ACTIONs when SOURCE is CHEK, LTTR, or PHON. ADDRESS Informant’s street address. Required field for all ACTIONs when SOURCE is CHEK, LTTR, or PHON. CITY Informant’s city. Required field for all ACTIONs when SOURCE is CHEK, LTTR, or PHON. STATE Informant’s state. Required field for all ACTIONs when SOURCE is CHEK, LTTR, or PHON. ZIP Informant’s ZIP code. Required field for all ACTIONs when SOURCE is CHEK, LTTR, or PHON. PHONE Informant’s telephone number.
ECRS Web User Guide Chapter 5: Prescription Drug Assistance Request Transactions 5-10 Field Description RELATIONSHIP One-character code indicating relationship of informant to beneficiary. Valid values are: A Attorney representing beneficiary B Beneficiary C Child D Defendant’s attorney E Employer F Father I Insurer M Mother N Non-relative O Other relative P Provider R Beneficiary representative (other than attorney) S Spouse U Unknown W Pharmacy Required field for all ACTIONs when SOURCE is CHEK, LTTR, or PHON. CONTINUE Command button. Click to go to Insurance Information page. CANCEL Command button. Click to return to the Main Menu. 5.5 Insurance Information Page 1. Enter information on the Insurance Information page about the insurance type associated with the Part D record. 2. Type data in all fields that need to be revised. Note: Action II can be used by BCRC and CRC recovery users to automatically update insurer information.
ECRS Web User Guide Chapter 5: Prescription Drug Assistance Request Transactions 5-11 Figure 5-3: Prescription Drug Assistance Request Insurance Information Table 5-4: Prescription Drug Assistance Request Insurance Information Field Description INSURANCE COMPANY NAME Name of prescription drug insurance carrier. Required field when ACTION CODE is II. Notes: Action code II cannot be used with action code DO. When action code II is included, a valid insurance company name must be provided. The following are invalid entries: ADAP, ASSISTANCE PROGRAM, ATTORNEY, BC, BCBS, BCBX, BCRC, BENEFITS COORDINATION & RECOVERY, BENEFITS COORDINATION & RECOVERY CENTER, BENEFITS COORDINATION AND RECOVE, BENEFITS COORDINATION AND RECOVERY CENTER, BLUE CROSS, BLUE SHIELD, BS, BX, CMS, COB, COBC, COORDINATION OF BENEFITS CONTRAC, COORDINATION OF BENEFITS CONTRACTOR, HCFA, INSURER, MEDICAID, MEDICARE, MISC, MISCELLANEOUS, N/A, NA, NO, NO FAULT, NO-FAULT, NONE, PAP, QSP, QUALIFIED STATE PROGRAM, SPAP, SUPPLEMENT, SUPPLEMENTAL, TRICARE, UN, UNK, UNKNOWN, and XX. ADDRESS First line of the insurance carrier’s street address. (ADDRESS 2) Unlabeled field. Second line of the insurance carrier’s street address. CITY City associated with the insurance carrier’s street address. STATE State associated with the insurance carrier’s street address. ZIP ZIP code associated with the insurance carrier’s street address. INSURANCE TYPE One-character code for the type of insurance. Not used for Prescription Drug records. NEW INSURANCE TYPE Select a one-character code for the new type of insurance.
ECRS Web User Guide Chapter 5: Prescription Drug Assistance Request Transactions 5-12 Field Description COVERAGE TYPE Prescription coverage type of insurance. Valid values are: U Drug network V Drug non-network Z Health account (such as a flexible spending account provided by other party to pay prescription drug costs or premiums) Required field for all ACTION types (for primary and supplemental records). POLICY NUMBER Policy number of insurance coverage. Required field when ACTION is AP. Note: If GROUP NUMBER is entered, the POLICY NUMBER is not required. GROUP NUMBER Group number of insurance coverage Group, BIN, or PCN is required with Action Code CX. BIN Prescription Drug BIN number. Must be six digits and cannot be all the same number if COVERAGE TYPE is U.. Required field if COVERAGE TYPE is U and ACTION CODE is NOT BN. Group, BIN, or PCN is required with Action Code CX. PCN Prescription Drug PCN number. Cannot have special characters, except for a non-leading dash, and no leading space. Group, BIN, or PCN is required with Action Code CX. ID Prescription Drug ID number. Must not contain special characters. Required field if COVERAGE TYPE is U. Cannot be blank or all zeros if COVERAGE TYPE is U. SUPPLEMENTAL TYPE Prescription Drug policy type. Valid values are: L Supplemental N Non-Qualified State Program P PAP R Charity T Federal Government Programs 1 Medicaid 2 Tricare 3 Major Medical CONTINUE Command button. Click to go to the Employment Information page. CANCEL Command button. Click to return to the Main Menu.
ECRS Web User Guide Chapter 5: Prescription Drug Assistance Request Transactions 5-13 5.6 Employment Information Page 1. Enter employment information associated with the Part D record on the Employment Information page. 2. After all relevant fields have been entered, click Continue to go to the Additional Information page, or select a page link from the left side bar. Figure 5-4: Prescription Drug Assistance Request Employment Information Table 5-5: Prescription Drug Assistance Request Employment Information Field Description EMPLOYER NAME Name of employer providing the group health insurance the beneficiary is covered under. Required field when ACTION is EA or EI. ADDRESS First line of the employer’s street address. Required field when ACTION is EI. (ADDRESS 2) Unlabeled field. Second line of the employer’s street address. CITY City associated with the employer’s street address. Required field when ACTION is EI. STATE State associated with the employer’s street address. Required field when ACTION is EI. ZIP ZIP code associated with the employer’s street address. Required field when ACTION is EI. PHONE Phone number of the employer EIN Employer identification number. EMPLOYEE # Employee number of the policyholder.
ECRS Web User Guide Chapter 5: Prescription Drug Assistance Request Transactions 5-14 Field Description CONTINUE Command button. Click to go to the Additional Information page. CANCEL Command button. Click to return to the Main Menu. 5.7 Additional Information Page 1. Enter check information on this page. 2. After all relevant fields have been entered, click Continue to go to the Comments/Remarks page, or select a page link from the left side bar. Figure 5-5: Prescription Drug Assistance Request Additional Information Table 5-6: Prescription Drug Assistance Request Additional Information Field Description CHECK NUMBER Number of check received. Required field if SOURCE is CHEK. CHECK DATE Date of check received. Required field if SOURCE is CHEK. You cannot future- date this field. CHECK AMOUNT Amount of check received. Required field if SOURCE is CHEK. Note: The amount will always appear with two decimal places. CONTINUE Command button. Click to go to the Comments/Remarks page. CANCEL Command button. Click to return to the Main Menu.
ECRS Web User Guide Chapter 5: Prescription Drug Assistance Request Transactions 5-15 5.8 Comments and Remarks Page 1. Enter comments on the Comments and Remarks page. All comments entered are viewable by the BCRC. Refer to Appendix F for the complete list of remark codes. Note: Remarks are only shown on the Comments/Remarks page when the ACTION is AR. 2. After all relevant fields have been entered, click Continue to go to the Summary page, or select a page link from the left side bar. Figure 5-6: Prescription Drug Assistance Request Comments and Remarks Table 5-7: Prescription Drug Assistance Request Comments and Remarks Field Description COMMENTS Free-form, optional, text field, where Medicare contractors type data to send notes to the BCRC. Protected field when the BCRC adds a comment. Notes: Use this field to provide additional context or details that cannot be provided in other fields. There is no need, for example, to repeat action code descriptions. The BCRC does not provide comments on auto-processed requests as the action requested has been completed. REMARKS Enter at least one remark code, explaining the reason for the transaction. Enter up to three remark codes. See Appendix F for more information. CONTINUE Command button. Click to go to the Summary page. CANCEL Command button. Click to return to the Main Menu. 5.9 Summary Page The Summary page shows a summary of all information entered for the assistance request before submission (Figure 5-7).
ECRS Web User Guide Chapter 5: Prescription Drug Assistance Request Transactions 5-16 After typing/selecting data in all relevant fields on the previous Prescription Drug Assistance Request pages, review the Summary page and click Submit. The system shows the Submit Confirmation page. At this point, the assistance request is submitted and you can print the confirmation page. Figure 5-7: Prescription Drug Assistance Request Summary
ECRS Web User Guide Chapter 5: Prescription Drug Assistance Request Transactions 5-17 5.10 Viewing, Updating, and Deleting Prescription Drug Assistance Request Transactions Follow the steps below to search for and view a list of Prescription Drug Assistance Request transactions. Note: You can only update or delete Prescription Drug assistance request transactions in NW status. Any user with the same contractor number can update or delete a transaction in NW status. However, if the COB system has started processing the information you cannot request an update or delete. From the Main Menu page, click the Prescription Drug Assistance Requests link under Search for Requests or Inquiries. The Prescription Drug Assistance Request Search page appears. Figure 5-8: Prescription Drug Assistance Request Search Table 5-8: Prescription Drug Assistance Request Search Field Description CONTRACTOR # If you are a Medicare contractor, this field will be pre-filled with the contractor number entered during contractor sign-in (protected field). If you are a Regional Office or CMS user, this field will be pre-filled with the CMS ID/RO number entered during contractor sign-in. Note: This field is updateable with any Medicare contractor number, but only the CMS ID/RO number entered during contractor sign-in can be used. MEDICARE ID Enter a Medicare ID. Note: If searching by Medicare ID, do not enter an SSN or DCN. SSN Enter a Social Security Number. Note: If searching by SSN, do not enter a Medicare ID or DCN. STATUS Enter a status code. To view all in-process Prescription Drug Assistance Request transactions, select IP in the Status field. REASON Select a reason code to search for. (See Appendix E for the complete list of codes.) USER ID Enter a user ID. ACTION CODE Select an action code, if applicable. Action codes appear according to the action type. (See Appendix E for a list of action codes.) ORIGIN DATE FROM Enter a starting date for the date range you wish to search for, if applicable. Note: MMDDCCYY format.
ECRS Web User Guide Chapter 5: Prescription Drug Assistance Request Transactions 5-18 Field Description ORIGIN DATE TO Enter an ending date for the date range. Note: The dates in the Origin Date From and To fields default to the date 31 calendar days prior to the current date and the current date but can be changed to any calendar day range, as long as it is not more than 6 months. DCN Enter a DCN. Note: If searching by DCN, do not enter a Medicare ID or SSN. SEARCH Command button. Click to show search results. RESET Command button. Click to clear search results. CANCEL Click to return to the Main Menu. 5.10.1 View Transactions 1. Type search criteria in the appropriate fields and click Submit. • To create a list of all Prescription Drug Assistance Requests for a specific Medicare ID, enter the Medicare ID in the search criteria and leave the CONTRACTOR NUMBER field blank. • When searching by origin date, user ID, status, and/or reason, you must also enter a DCN, Medicare ID, SSN, or contractor number. The system shows a list of Prescription Drug Assistance Requests. There are up to 500 items per page; scroll through the records or use the First, Previous, Next, and Last navigation at the top of the list to view other transactions on other pages. 2. Change or delete search criteria to initiate a new search. Figure 5-9: Prescription Drug Assistance Requests Search Listing
ECRS Web User Guide Chapter 5: Prescription Drug Assistance Request Transactions 5-19 Table 5-9: Prescription Drug Assistance Requests Search Listing Field Description DISPLAY RANGE Select a range to filter the records in the search results by a defined range. Note: This field is only visible if a search has been completed. The range defaults to 1-500. Total Records Found Total number of records found. Current Display Range Defined display range for the records found. Note: This field defaults to 1-500. Delete Click the delete [X] icon to mark a transaction for deletion. MEDICARE ID Medicare ID (HICN or MBI) for the Prescription Drug Assistance Request transaction (protected field). Click the Medicare ID link to view the Summary page. CONTRACTOR Contractor number (protected field). DCN DCN assigned to the Prescription Drug Assistance Request transaction by Medicare contractor (protected field). ACTION CODE Action code for the Prescription Drug Assistance Request transaction (protected field). STATUS Status of the Prescription Drug Assistance Request transaction (protected field). REASON Two-character code explaining why the Prescription Drug Assistance Request is in a particular status (protected field). (See Appendix E for the complete list of codes.) ORIGIN DATE Originating date in MM-DD-CCYY format (protected field). LAST UPDATE Date Prescription Drug Assistance Request transaction was last changed in MMDDCCYY format (protected field). USER ID User ID of operator who entered the Prescription Drug Assistance Request transaction (protected field). Export options Click the link to export search results in the given format. Note: You may export all results returned, up to 500 records at a time, based on the records currently shown. 5.10.2 Update Transactions 1. To update information on a Prescription Drug Assistance Request transaction, click the Medicare ID link for the transaction and the system shows the Summary page for the selected transaction, along with page links to the information, to allow for updates (Figure 5-10). 2. To leave the Summary page without making any changes, click Cancel or Return to return to the Search Page Listing. If you do need to update the transaction, access the appropriate page and navigate back to the Summary page. 3. After you have made all updates, click Submit to confirm updates, or Cancel to return to the Prescription Drug Assistance Request Search Page Listing.
ECRS Web User Guide Chapter 5: Prescription Drug Assistance Request Transactions 5-20 Figure 5-10: Prescription Drug Assistance Request Summary
ECRS Web User Guide Chapter 5: Prescription Drug Assistance Request Transactions 5-21 Table 5-10: Prescription Drug Assistance Request Summary Field Description ACTION REQUESTED Shows information that was previously entered on the Action Requested page. INFORMANT INFORMATION Shows information that was previously entered on the Informant Information page. INSURANCE INFORMATION Shows information that was previously entered on the Insurance Information page. EMPLOYMENT INFORMATION Shows information that was previously entered on the Employment Information page. ADDITIONAL INFORMATION Shows information that was previously entered on the Additional Information page. COMMENTS/REMARKS Shows information that was previously entered on the Comments/Remarks page. COB RESPONSE INFORMATION Appears for records that are not in NW status. See below for more information. COB COMMENTS Free-form text field, where the BCRC’s comments appear. USER ID User ID of the person who entered the BCRC comment. DEVELOPMENT RESPONSE INDICATOR Development response indicator. Valid values are: A Attorney B Beneficiary E Employer I Insurer P Provider R Beneficiary Representative N No Response DEVELOPED TO (INITIAL) Development source code indicating where the initial development letter was sent. Valid values are: A Attorney B Beneficiary E Employer I Insurer P Provider R Beneficiary Representative (other than attorney) DEVELOPED TO (SUBSEQUENT) Development source code indicating where the subsequent development letter was sent. Valid values are: A Attorney B Beneficiary E Employer I Insurer P Provider R Beneficiary Representative (other than attorney)
ECRS Web User Guide Chapter 5: Prescription Drug Assistance Request Transactions 5-22 Field Description RETURN Command button. Click to return to the Prescription Drug Assistance Request Search Page Listing without making any updates to the transaction. Appears for records in all statuses except NW. SUBMIT Command button. Click to save updates. Appears for records in NW status. CANCEL Command button. Click to return to the Search Page Listing without making any updates to the transaction. Appears for records in NW status. 5.10.3 Delete Transactions 1. To mark a Prescription Drug Assistance Request transaction for deletion, click the delete [X] icon next to the Medicare ID and when the Confirmation page appears, click Continue to confirm, or click Cancel to decline. 2. To exit the Prescription Drug Assistance Request Search page, click Home to return to the Main Menu. The system does not retain search criteria.
ECRS Web User Guide Chapter 6: Prescription Drug Inquiry Transactions 6-1 Chapter 6: Prescription Drug Inquiry Transactions This chapter provides you with step-by-step instructions to perform a prescription drug inquiry. Examples and explanations are provided for each page in ECRS. If you are a new user, this chapter can help you use the system as you learn it. You can also use this chapter to determine what information is contained in each field or what you should enter in a field. It can also help you to navigate through the prescription coverage inquiry transaction process if you are lost. If you are an experienced user, you can use the chapter as a quick reference for a web page that you use infrequently. 6.1 Adding a Prescription Drug Inquiry Transaction There are two ways to enter a Prescription Drug Inquiry: From an MSP Inquiry This option allows you to see Prescription Drug information associated with an MSP Inquiry. • From the Main Menu, click MSP Inquiry under the heading Create Requests or Inquiries. The system shows the first page of the MSP Inquiry. • Follow instructions for Adding an MSP Inquiry and enter Prescription Drug information on the Prescription Coverage page. From the Main Menu This option allows you to enter a Prescription Drug inquiry independent of an MSP inquiry. Follow the steps in Section 6.4. See Section 5.2 for information on CMS’ Prescription Drug Hierarchy rules. 6.1.1 Retrieving Beneficiary Information Beneficiary information is automatically retrieved when the Medicare ID (HICN or MBI) and other required data is entered on the first page of the Prescription Drug Inquiry (Initial Information) and you click Continue. The information appears on the right side bar, and is carried forward on the Prescription Drug Inquiry transaction. 6.1.2 Common Prescription Drug Sources The following are common sources that provide contractors with prescription drug information, followed by the associated source code: • Survey (SRVY) • Letters from beneficiaries or other informants (LTTR) • Phone calls (PHON) • Checks (CHEK) • Secondary claims (SCLM) 6.2 Initial Information Page From the Main Menu, click Prescription Drug Inquiry under Create Requests or Inquiries.
ECRS Web User Guide Chapter 6: Prescription Drug Inquiry Transactions 6-2 The Initial Information page appears. This is the first page you see when adding a new Prescription Drug Inquiry. The information entered on this page determines required information on subsequent pages. Figure 6-1: Prescription Drug Inquiry Initial Information 6.2.1 Navigation Links Several basic navigation links appear on every Main Menu page. See Section 2.6.4 for descriptions of the heading bar links and the right side bar links and fields. 1. Enter data in all fields and click Continue to go to the Additional Information page, or select a page link from the left side bar. Note: If beneficiary information is not found for the Medicare ID (HICN or MBI) you have entered, you will receive a warning message but will still be able to continue with the Prescription Drug Inquiry. 2. To exit the Prescription Drug Inquiry Detail pages, click Home to return to the Main Menu or Sign Out to exit the application. Table 6-1: Prescription Drug Inquiry Initial Information Field Description DCN DCN assigned by the contractor to correspondence and/or paperwork associated with the transaction. Required field. The system auto-generates the DCN, but it can be changed by the user. MEDICARE ID Medicare ID (HICN or MBI) of the beneficiary. Enter the ID without dashes, spaces, or other special characters. Required field. ACTIVITY CODE Activity of contractor. Required field. Valid values are: C Claims (Pre-Payment) D Debt Collection/Referral G Group Health Plan I General Inquiries
ECRS Web User Guide Chapter 6: Prescription Drug Inquiry Transactions 6-3 Field Description SOURCE Four-character code identifying source of the Prescription Drug Inquiry information. Required field. Valid values are: CHEK = Unsolicited check LTTR = Letter PHON = Phone call SCLM = Claim submitted to Medicare contractor for secondary payment SRVY = Survey MSP TYPE One-character code identifying type of MSP coverage. Required field. Valid values are: A Working Aged B ESRD C Conditional Payment F Federal (Public) G Disabled Note: The MSP Type cannot be selected when Prescription Drug Record Type is supplemental. PATIENT RELATIONSHIP Patient relationship between the policyholder and the beneficiary. Required field. Valid values are: 01 Self; Patient is policyholder 02 Spouse 03 Child 04 Other 20 Domestic partner Note: All patient relationship values accepted for MSP Types B and G. MSP Type A will accept 01 and 02. SEND TO MDB Indicates whether to send the Prescription Drug inquiry to MBD. Required field. Valid values are: YES Send to MBD (default) NO Do not send to MBD CONTINUE Command button. Click to go to the Additional Information page. You must enter data in required fields before clicking Continue. CANCEL Command button. Click to return to the Main Menu. 6.3 Additional Information Page On this page, enter additional information needed for the prescription drug inquiry.
ECRS Web User Guide Chapter 6: Prescription Drug Inquiry Transactions 6-4 Figure 6-2: Prescription Drug Inquiry Additional Information After all relevant fields have been entered, click Continue to go to the Prescription Coverage page, or select a page link from the left side bar. Table 6-2: Prescription Drug Inquiry Additional Information Field Description CHECK NUMBER Number of check received. Required field when SOURCE is CHEK. CHECK DATE Date of check received. You cannot future-date this field. Required field when SOURCE is CHEK. CHECK AMOUNT Amount of check received. Required field when SOURCE is CHEK. FIRST NAME First name of person informing contractor of change in Prescription Drug coverage. Required field when SOURCE is CHEK, LTTR or PHON. MIDDLE INITIAL First initial of middle name of the person informing the contractor of the change in Prescription Drug coverage. LAST NAME Last name of the person informing the contractor of the change in Prescription Drug coverage. Required field when SOURCE is CHEK, LTTR or PHON. ADDRESS Informant’s street address. Required field when SOURCE is CHEK, LTTR or PHON.
ECRS Web User Guide Chapter 6: Prescription Drug Inquiry Transactions 6-5 Field Description CITY Informant’s city. Required field when SOURCE is CHEK, LTTR or PHON. STATE Informant’s state. Required field when SOURCE is CHEK, LTTR or PHON. ZIP Informant’s ZIP code. Required field when SOURCE is CHEK, LTTR or PHON. PHONE Informant’s telephone number. RELATIONSHIP One-character code indicating the relationship of the informant to the beneficiary. Required field when SOURCE is CHEK, LTTR or PHON. Valid values are: A Attorney representing beneficiary B Beneficiary C Child D Defendant’s attorney E Employer F Father I Insurer M Mother N Non-relative O Other relative P Provider R Beneficiary representative (other than attorney) S Spouse U Unknown W Pharmacy EMPLOYER NAME Name of employer providing the group health insurance the beneficiary is covered under. ADDRESS First line of the employer’s street address. ADDRESS 2 Second line of the employer’s street address. CITY City associated with the employer’s street address. STATE State associated with the employer’s street address. ZIP ZIP code associated with the employer’s street address. PHONE Phone number of the employer. EIN Employer Identification Number. EMPLOYEE # Employee number of the policyholder. CONTINUE Command button. Click to go to the Prescription Coverage page. CANCEL Command button. Click to return to the Main Menu.
ECRS Web User Guide Chapter 6: Prescription Drug Inquiry Transactions 6-6 6.4 Prescription Drug Inquiry Prescription Drug Page Type/select Prescription Drug information associated with the Part D coverage on this page. • If the insurance company name is not entered, you will receive the following error message: “Please enter Insurance Company Name.” • If the insurance company name matches any of the values listed in Table 6-3, you will receive the following error message: “Insurance Company Name not a valid name.” Figure 6-3: Prescription Drug Inquiry Prescription Drug
ECRS Web User Guide Chapter 6: Prescription Drug Inquiry Transactions 6-7 Table 6-3: Prescription Drug Inquiry Prescription Drug Field Description INSURANCE COMPANY NAME Name of the insurance carrier for prescription drug coverage. Required field. Note: If the Insurance Company Name entered is less than two characters or contains one of the following values, then it is considered an error: ADAP, ASSISTANCE PROGRAM, ATTORNEY, BC, BCBS, BCBX, BCRC, BENEFITS COORDINATION & RECOVERY, BENEFITS COORDINATION & RECOVERY CENTER, BENEFITS COORDINATION AND RECOVE, BENEFITS COORDINATION AND RECOVERY CENTER, BLUE CROSS, BLUE SHIELD, BS, BX, CMS, COB, COBC, COORDINATION OF BENEFITS CONTRAC, COORDINATION OF BENEFITS CONTRACTOR, HCFA, INSURER, MEDICAID, MEDICARE, MISC, MISCELLANEOUS, N/A, NA, NO, NO FAULT, NO-FAULT, NONE, PAP, QSP, QUALIFIED STATE PROGRAM, SPAP, SUPPLEMENT, SUPPLEMENTAL, TRICARE, UN, UNK, UNKNOWN, and XX. ADDRESS LINE 1 First line of the insurance carrier’s street address. ADDRESS LINE 2 Second line of the insurance carrier’s street address. CITY City associated with the insurance carrier’s street address. STATE State associated with the insurance carrier’s street address. ZIP ZIP code associated with the insurance carrier’s street address. EFFECTIVE DATE Effective date of the drug coverage. Required field. Notes: The EFFECTIVE DATE cannot be the same as the TERMINATION DATE. This field accepts dates up to three months from the current date for primary coverage: For GHP records (MSP Types A, B, and G): The Effective Date can be in the future for beneficiaries who are currently enrolled in Part D, or for beneficiaries who will be enrolled starting up to three months in the future. If the effective date or termination date for an incoming primary or supplemental drug record falls within or overlaps an existing record’s effective date or termination date, and the submitter of the new record matches the existing record, the record will be rejected. If the submitter of the new record does not match the submitter of the existing record, the new record will be accepted. TERMINATION DATE Termination date of the drug coverage. TERMINATION DATE can be all zeroes for open ended coverage. Note: TERMINATION DATE cannot be the same as the EFFECTIVE DATE. An open-ended TERMINATION DATE is automatically populated when COVERAGE TYPE is U. If the effective date or termination date for an incoming primary or supplemental drug record falls within or overlaps an existing record’s effective date or termination date, and the submitter of the new record matches the existing record, the record will be rejected. If the submitter of the new record does not match the submitter of the existing record, the new record will be accepted.
ECRS Web User Guide Chapter 6: Prescription Drug Inquiry Transactions 6-8 Field Description RECORD TYPE Prescription Drug Record Type. Valid values are: PRI Primary SUP Supplemental Required field (effective July 2026) Note: Record Type must be SUP when Supplemental Type is L. COVERAGE TYPE Prescription Drug Coverage type of insurance. Valid values are: U Drug Network V Drug Non-Network Z Health account (such as a flexible spending account provided by other party to pay prescription drug costs or premiums) Required field. BIN Prescription Drug BIN number. Must be six digits and cannot be all the same number if COVERAGE TYPE is U. Required field if COVERAGE TYPE is U. BIN will not be edited for formats when the ACTION CODE is BN. Group, BIN, or PCN is required with Action Code CX. PCN Prescription Drug PCN number. Must not contain special characters. Cannot have special characters, except for a non-leading dash, and no leading space. Group, BIN, or PCN is required with Action Code CX. POLICY NUMBER Policy number of insurance coverage. GROUP Prescription Drug group number. Must not contain special characters. Group, BIN, or PCN is required with Action Code CX. ID Prescription Drug ID number. Must not contain special characters. Required field if COVERAGE TYPE is U. Cannot be blank or all zeros if COVERAGE TYPE is U. SUPPLEMENTAL TYPE Prescription Drug Coverage policy type. Valid values are: L - Supplemental N - Non-qualified State Program R – Charity T – Federal Government Programs 3 – Major Medical PERSON CODE Plan-specific person code. Required field when RECORD TYPE is Supplemental or RECORD TYPE is blank and SUPPLEMENTAL TYPE is L. Values are: 001 Self 002 Spouse 003 Other CONTINUE Command button. Click to go to the Summary page.
ECRS Web User Guide Chapter 6: Prescription Drug Inquiry Transactions 6-9 Field Description CANCEL Command button. Click to return to the Main Menu. 6.5 Summary Page The Prescription Drug Inquiry Summary page (Figure 6-4) shows a summary of all information entered for the Prescription Drug inquiry before submission. After typing/selecting data in all relevant fields on the previous Prescription Drug Inquiry pages, review the Summary page and click Submit. The Submit Confirmation page appears. At this point, the Prescription Drug inquiry is submitted and you can print the confirmation page. Note: You may click Cancel to return to the Main Menu.
ECRS Web User Guide Chapter 6: Prescription Drug Inquiry Transactions 6-10 Figure 6-4: Prescription Drug Inquiry Summary
ECRS Web User Guide Chapter 6: Prescription Drug Inquiry Transactions 6-11 6.6 Viewing, Updating, and Deleting Prescription Drug Inquiries Follow the steps below to search for and view a list of Prescription Drug Inquiry transactions. Note: You can only update or delete Prescription Drug Inquiry transactions in NW status. Any user with the same contractor number can update or delete a transaction in NW status. There are two ways to access Prescription Drug Inquiries: From an MSP Inquiry This option allows you to see Prescription Drug information associated with an MSP Inquiry. From the COB ECRS Main Menu web page: 1. Click MSP Inquiries under the heading Search for Requests or Inquiries. 2. Enter the search criteria in the appropriate fields. 3. Click Search. From a Stand-Alone ECRS Prescription Drug Coverage Inquiry This option allows you to see Prescription Drug information independent of an MSP inquiry. From the COB ECRS Main Menu web page: 1. Click Prescription Drug Inquiries under the heading Search for Requests or Inquiries. 2. Enter the search criteria in the appropriate fields. 3. Click Search. 6.6.1 Tracking Prescription Drug Inquiries When Prescription Drug information is entered in conjunction with an MSP inquiry, no additional tracking of status and reason is performed on the Prescription Drug information. Status and reason codes are tracked on the MSP inquiry only. When Prescription Drug information is entered as a stand-alone inquiry, the following status/reason code combinations are used to track the inquiry: • NW01 Not yet read by COB • DE01 Deleted by Medicare Contractor • CM15 Update Sent to MBD • CM53 Duplicate ECRS Request • CM60 Invalid Medicare ID • CM92 Change of Venue not allowed after 90 days Note: CM92 refers to a request to change the lead contractor more than 90 days after the initial assignment; this request will be rejected.
ECRS Web User Guide Chapter 6: Prescription Drug Inquiry Transactions 6-12 Figure 6-5: Prescription Drug Inquiry Search Table 6-4: Prescription Drug Inquiry Search Criteria Field Description CONTRACTOR If you are a Medicare contractor, this field will be pre-filled with the contractor number entered during contractor sign-in (protected field). If you are a Regional Office or CMS user, this field will be prefilled with the CMS ID/RO number entered during contractor sign-in. Note: This field is updateable with any Medicare contractor number, but only the CMS ID/RO number entered during contractor sign-in can be used. MEDICARE ID Enter a Medicare ID (HICN or MBI). Note: If searching by Medicare ID, do not enter an SSN or DCN. SSN Enter a Social Security Number. Note: If searching by SSN, do not enter a Medicare ID or DCN. STATUS Enter a status code. To view all in-process Prescription Drug Inquiry transactions, select IP in the STATUS field. REASON Select a reason code. (See Appendix E for the complete list of codes.) USER ID Enter a user ID. ORIGIN DATE FROM Enter a starting date for the date range, if applicable. Note: MMDDCCYY format. ORIGIN DATE TO Enter an ending date for the date range. Note: The dates in the ORIGIN DATE FROM and TO fields default to the date 31 calendar days prior to the current date and the current date but can be changed to any calendar day range, as long as it is not more than 6 months. DCN Enter a DCN. Note: If searching by DCN, do not enter a Medicare ID or SSN. SUBMIT Click Submit to view search results. RESET Click Reset to clear search results. CANCEL Click Cancel to return to the Main Menu.
ECRS Web User Guide Chapter 6: Prescription Drug Inquiry Transactions 6-13 6.6.2 View Transactions 1. Type search criteria in the appropriate fields and click Submit. • To create a list of all Prescription Drug Inquiries for a specific Medicare ID, enter the Medicare ID in the search criteria and leave the CONTRACTOR NUMBER field blank. • When searching by origin date, user ID, status, and/or reason, you must also enter a DCN, Medicare ID, SSN, or contractor number. A list of Prescription Drug Inquiries appears. There are up to 500 items per page; scroll through the records or use the First, Previous, Next, and Last navigation at the top of the list to view other transactions on other pages. 2. Change or delete search criteria to initiate a new search. Figure 6-6: Prescription Drug Inquiry Search Listing Table 6-5: Prescription Drug Inquiry Search Listing Field Description DISPLAY RANGE Select a range to filter the records in the search results by a defined range. Note: This field is only visible if a search has been completed. The range in the Display Range field defaults to 1–500. Total Records Found Total number of records found. Current Display Range Defined display range for the records found. Note: This field defaults to 1–500. DELETE Click the delete [X] link to mark a transaction for deletion
ECRS Web User Guide Chapter 6: Prescription Drug Inquiry Transactions 6-14 Field Description MEDICARE ID Medicare ID (HICN or MBI) for Prescription Drug Inquiry transaction (protected field). Click the Medicare ID link to view the Summary page CONTRACTOR Contractor number (protected field). DCN DCN assigned to the Prescription Drug Inquiry transaction by the Medicare contractor (protected field). STATUS Status of the Prescription Drug Inquiry transaction (protected field). REASON Two-character code explaining why the Prescription Drug Inquiry is in a particular status (protected field). (See Appendix E for the complete list of codes.) ORIGIN DATE Originating date in MM-DD-CCYY format (protected field). LAST UPDATE Date the Prescription Drug Inquiry transaction was last changed in MMDDCCYY format (protected field). USER ID User ID of the operator who entered the Prescription Drug Inquiry transaction (protected field). Export options Click the link to export search results. Note: You may export all results returned, up to 500 records at a time, based on the records currently shown. 6.6.3 Update Transactions 1. To update information on a Prescription Drug Inquiry transaction, click the Medicare ID link for the transaction. The Summary page for the selected transaction appears, along with page links to the information, to allow for updates (Figure 6-7). 2. To leave the Summary page without making any changes, click Cancel or Return to return to the Search Page Listing. If you do need to update the transaction, access the appropriate page and navigate back to the Summary page. 3. After you have made all updates, click Submit to confirm updates, or Cancel to return to the Prescription Drug Inquiry Search Page Listing.
ECRS Web User Guide Chapter 6: Prescription Drug Inquiry Transactions 6-15 Figure 6-7: Prescription Drug Inquiry Summary
ECRS Web User Guide Chapter 6: Prescription Drug Inquiry Transactions 6-16 Table 6-6: Prescription Drug Inquiry Summary Field Description INITIAL INFORMATION Shows information that was previously entered on the Initial Information page. ADDITIONAL INFORMATION Shows information that was previously entered on the Additional Information page. PRESCRIPTION COVERAGE Appears information that was previously entered on the Prescription Coverage page. COB RESPONSE INFORMATION Appears for records that are not in NW status. See below for more information. DEVELOPMENT RESPONSE INDICATOR Development response indicator. Values are: A Attorney B Beneficiary E Employer I Insurer P Provider R Beneficiary Representative N No Response DEVELOPED TO (INITIAL) Development source indicating where the initial development letter was sent. Valid values are: Attorney Beneficiary Employer Insurer Provider Beneficiary Representative (other than attorney) DEVELOPED TO (SUBSEQUENT) Development source indicating where subsequent development letter was sent. Valid values are: Attorney Beneficiary Employer Insurer Provider Beneficiary Representative (other than attorney) RETURN Command button. Click to return to the Prescription Drug Inquiry Search Page Listing without making any updates to the transaction. Appears for records in all statuses except NW. SUBMIT Command button. Click to save updates. Appears for records in NW status. CANCEL Command button. Click to return to the Search Page Listing without making any updates to the transaction. Appears for records in NW status.
ECRS Web User Guide Chapter 6: Prescription Drug Inquiry Transactions 6-17 6.6.4 Delete Transactions To mark a Prescription Drug Inquiry transaction for deletion, click the delete [X] icon next to the Medicare ID and when the Confirmation page appears, click Continue to confirm, or click Cancel to decline. To exit the Prescription Drug Inquiry Search page, click Home to return to the Main Menu. The system does not retain search criteria.
ECRS Web User Guide Chapter 7: Reports 7-1 Chapter 7: Reports This chapter provides details regarding the reporting functions that are available within the ECRS application. The following sections provide step-by-step instructions for generating and creating each report. It should be noted access to reports may be limited based on the user locations. 7.1 Navigation Links Several basic navigation links appear on every Main Menu page. See Section 2.6.4 for descriptions of the heading bar links and the right side bar links and fields. Figure 7-1: Main Menu (Contractor View) 7.2 Contractor Workload Tracking Report The Contractor Workload Tracking report provides Medicare contractors with statistics on the number of CWF Assistance Requests, MSP Inquiries, Prescription Drug Assistance Requests, and Prescription Drug Inquiries that your contractor site submitted during a date range you specify. Statistics also include the number of CWF Assistance Requests, MSP Inquiries, Prescription Drug Assistance Requests, and Prescription Drug Inquiries that were rejected, as well as gross and net totals. The report is sorted by activity code. To create a workload tracking report: 1. From the Main Menu, click the Contractor Workload Tracking link in the Reports section. The Contractor Workload Tracking page appears (Figure 7-2).
ECRS Web User Guide Chapter 7: Reports 7-2 2. Enter the desired criteria in the search fields and click Search. The search page reappears with the results shown. 3. To change the search criteria, click Reset to clear all search criteria and results. Then enter new search criteria and click Search. 4. Print the report by clicking the Print This Page link or export the report to a file by clicking the Export Options link. 5. To exit the Contractor Workload Tracking page, click the Home link in the upper navigation bar to return you to the Main Menu. Figure 7-2: Contractor Workload Tracking Figure 7-3: Contractor Workload Tracking Results
ECRS Web User Guide Chapter 7: Reports 7-3 Table 7-1: Contractor Workload Tracking Criteria Field Description Date From Enter a start date for the reporting period. Defaults to the first day of the previous month. Date To Enter an end date for the reporting period. Defaults to the last day of the previous month. Status Select a two-character status code. Values include: NW – New CM – Completed IP – In Process Default is all statuses if none are selected. Reason Select a reason code from the drop-down menu. (See Appendix E for the complete list of codes.) Activity Code Select a single-character activity code from drop-down menu. Refer to the Appendix for a complete list of reason codes. C – Claims (Pre-Payment) D – Debt Collection/Referral G – Group Health Plan I – General Inquiries N – Liability, No Fault, Workers’ Compensation, and Federal Tort Claim Act Blank – Prescription Drug Inquiries Default value is ALL if none are selected. Search Command button. Click to create the report using the selected criteria. Reset Command button. Click to clear search criteria and results. Cancel Command button. Click to go to the Main Menu. Table 7-2: Contractor Workload Tracking Listing Field Description Contractor Five-digit contractor number sorted in ascending order. Activity Code (AC) Activity code counts sorted in ascending order. Assistance Requests Number of CWF Assistance Requests and PD Assistance Requests submitted by contractor for each activity code (protected field). Assistance Requests Rejects Number of duplicate CWF Assistance Requests and PD Assistance Requests submitted by contractor for each activity code (CM53) (protected field). Inquiries Number of MSP Inquiries and Prescription Drug Inquiries submitted by contractor for each activity code (protected field). Inquiries Rejects Number of duplicate MSP Inquiries and PD Inquiries submitted by contractor for each activity code (CM53), combined with number of MSP Inquiries submitted by contractor that should have been a CWF Assistance Request (CM87) (protected field). Net Total Net total number of CWF Assistance Requests, MSP Inquiries, PD Assistance Requests, and PD Inquiries submitted by contractor for each activity code, excluding duplicates (protected field).
ECRS Web User Guide Chapter 7: Reports 7-4 Field Description Gross Total Gross total number of CWF Assistance Requests, MSP Inquiries, PD Assistance Requests, and PD Inquiries submitted by contractor for each activity code, including duplicates (protected field). Export Options Click to launch the File Save dialog. Print Report/Export Data Click to launch the Print dialog. 7.3 Consolidated ECRS Workload Search The Consolidated ECRS Workload Search feature allows Medicare contractors to select and verify the receipt and status of all submitted requests (MSP Inquiries, CWF Assistance Requests, Prescription Drug Inquiries, and Prescription Drug Assistance Requests). Up to 500 records will appear in the results. Note: This feature is not available for RO and CMS users. To conduct a search: 1. Click the Consolidated ECRS Workload Search link under the Reports section. The Consolidated ECRS Workload Search page appears. 2. Enter the desired criteria in the search fields and click Search. The search page reappears with the results shown at the bottom of the page (Figure 7-5). 3. To change the search criteria, click Reset to clear all search criteria and results. Then enter new search criteria and click Search. 4. Print the report by clicking the Print This Page link or export the report to a file by clicking the Export Options link. 5. To exit the Consolidated ECRS Workload Search page, click the Home link in the upper navigation bar. This returns you to the Main Menu. Figure 7-4: Consolidated ECRS Workload Search
ECRS Web User Guide Chapter 7: Reports 7-5 Figure 7-5: Consolidated ECRS Workload Search Results Table 7-3: Consolidated ECRS Workload Search Field Description Date From Enter a start date for the submission period (format: MM/DD/YYYY) (required field). Note: The date defaults to the last day of the previous month. The range is limited to 31 days. Date To Enter an end date for the submission (format: MM/DD/YYYY) (required field). Status Select a two-character code. Values include: NW – New CM – Completed IP – In Process Default is ALL statuses if none are selected. Reason Select a two-character numeric code from the drop-down menu. Note: See Appendix E for a complete list of reason codes and definitions. Contractor ID Select one or more contractor IDs from the drop-down menu (required field). Note: This menu lists all contractor IDs associated with your login. The default value is ALL if you have more than one contractor ID. Activity Code Select a single-character activity code from the drop-down menu. Refer to the Appendix for a complete list of reason codes. C – Claims (Pre-Payment) D – Debt Collection/Referral G – Group Health Plan I – General Inquiries N – Liability, No Fault, Workers’ Compensation, and Federal Tort Claim Act Blank – Prescription Drug Inquiries Default value is ALL if none are selected.
ECRS Web User Guide Chapter 7: Reports 7-6 Field Description Search Click Search to create the report with the selected criteria. Reset Click Reset to clear all search criteria and results. Cancel Click Cancel to return to the Main Menu without saving changes. Table 7-4: Consolidated ECRS Workload Search Listing Field Description Contractor Shows the selected five-digit contractor IDs associated with the contractor who submitted the request. Request Type Shows the request type: MSP Inquiry, CWF Assistance Request, Prescription Drug Inquiry, or Prescription Drug Assistance Request (protected field). Medicare ID Shows the masked HICN or MBI associated with the request (protected field). DCN Shows the Medicare contractor-assigned DCN associated with the request (protected field). Status Shows either NW, CM, or IP (protected field). Reason Shows the reason code associated with the request (protected field). See Appendix E for the complete list of codes. Activity Code Activity of the contractor (protected field). Valid values include: C Claims (Pre-Payment) D Debt Collection/Referral G Group Health Plan I General Inquiries N Liability, No Fault, Workers’ Compensation, and Federal Tort Claim Act Blank Prescription Drug Inquiries User ID Shows the user ID associated with the contractor that submitted the request (protected field). Last Update Date Shows the date the request was last updated (protected field). Total Inquiries Shows the total number of MSP Inquiries and Prescription Drug Inquiries (protected field). Total Assistance Requests Shows the total number of CWF Assistance Requests and Prescription Drug Assistance Requests (protected field). Export Data/Export Options Click to launch the File Save dialog. Print Report/Export Data Click to launch the Print dialog.
ECRS Web User Guide Chapter 7: Reports 7-7 7.4 CMS Workload Tracking Report The CMS Workload Tracking report provides CMS and RO users with statistics on the number of CWF Assistance Requests, MSP Inquiries, Prescription Drug Assistance Requests, and Prescription Drug Inquiries that contractor sites submitted during a date range you specify. Statistics also include information about the number of CWF Assistance Requests, MSP Inquiries, Prescription Drug Assistance Requests, and Prescription Drug Inquiries that were rejected, as well as gross and net totals. The report is sorted by activity code. Follow the steps below to review the workload for selected contractor sites. 1. From the Main Menu, click the CMS Workload Tracking link in the Reports section. The CMS Workload Tracking page appears. 2. Enter the desired criteria in the search fields and click Search. The CMS Workload Tracking page appears, with report details shown at the bottom of the page (Figure 7-7). 3. Print the report by clicking the Print This Page link or export the report to a file by clicking the Export Data link. 4. Change the search criteria and click Search to re-create the report using the revised criteria. Click Reset to clear all search criteria. 5. To exit the CMS Workload Tracking web page, click the Home link in the upper navigation bar to return you to the Main Menu. Figure 7-6: CMS Workload Tracking
ECRS Web User Guide Chapter 7: Reports 7-8 Table 7-5: CMS Workload Tracking Selection Criteria Field Description Date From Enter a start date for the reporting period. Defaults to the first day of the previous month. Date To Enter an end date for the reporting period. Defaults to the last day of the previous month. Status Select a two-character code. Values include: NW – New CM – Completed IP – In Process Default is all statuses if none are selected. Reason Select a reason code from the dropdown list. (See Appendix E for the complete list of codes.) Contractor ID Enter a contractor number to view its associated CMS workload statistics. Leave the field blank to show results for all contractors. Activity Code Select a single-character activity code from the drop-down menu. Refer to the Appendix for a complete list of reason codes. C – Claims (Pre-Payment) D – Debt Collection/Referral G – Group Health Plan I – General Inquiries N – Liability, No Fault, Workers’ Compensation, and Federal Tort Claim Act Blank – Prescription Drug Inquiries Default value is ALL if none are selected. Search Click Search to create the report with the selected criteria. Reset Click Reset to clear all search criteria and results. Cancel Click Cancel to return to the Main Menu without saving changes.
ECRS Web User Guide Chapter 7: Reports 7-9 Figure 7-7: CMS Workload Tracking Sample Table 7-6: Reports, Workload Tracking Report Detail Field Description Contractor Five-digit contractor number sorted in ascending order. Activity Code (AC) Activity code counts for each individual ECRS contractor, sorted in ascending order for each contractor. Assistance Requests Number of CWF Assistance Requests and PD Assistance Requests submitted by contractor for each activity code (protected field). Assistance Requests Rejects Number of duplicate CWF Assistance Requests and PD Assistance Requests submitted by contractor for each activity code (CM53) (protected field). Inquiries Number of MSP Inquiries Prescription Drug Inquiries submitted by contractor for each activity code (protected field). Inquiries Rejects Number of duplicate MSP Inquiries and PD Inquiries submitted by contractor for each activity code (CM53), combined with number of MSP Inquiries submitted by contractor that should have been a CWF Assistance Request (CM87) (protected field). Net Total Net total number of CWF Assistance Requests, MSP Inquiries, PD Assistance Requests, and PD Inquiries submitted by contractor for each activity code, excluding duplicates (protected field). Gross Totals Gross total number of CWF Assistance Requests, MSP Inquiries, PD Assistance Requests, and PD Inquiries submitted by contractor for each activity code, including duplicates (protected field). Export Data/Export Options Click to launch the File Save dialog. Print Report/Export Data Click to launch the Print dialog.
ECRS Web User Guide Chapter 7: Reports 7-10 7.5 QASP Report The Quality Assurance Surveillance Plan (QASP) report provides CMS and RO users with statistics on the number of ECRS Inquiries and Assistance Requests that contractor sites submitted during a date range you specify. The report is sorted by contractor number. Note: Search results are limited to 3000 transactions, sorted by the most recent origination date. If more than 3000 transactions are returned, revise your search criteria. Follow the steps below to review ECRS Inquiry and Assistance Request statistics for selected contractor sites. 1. From the Main Menu, click the Quality Assurance Surveillance Plan (QASP) Report link in the Reports section. The QASP Report page appears. 2. Enter the desired criteria in the search fields and click Submit. The QASP Report page appears, with report details shown at the bottom of the page (Figure 7-9). 3. Export the report to a file by clicking the Export Data link. 4. Change the search criteria and click Submit to re-create the report using the revised criteria. Click Reset to clear all search criteria. 5. To exit the QASP Report page, click the Home link in the upper navigation bar to return you to the Main Menu. Figure 7-8: QASP Report Table 7-7: QASP Report Selection Criteria Field Description Transaction Type Select a transaction type. Options are: M MSP Inquiry R CWF Assistance Request P Prescription Drug Inquiries D Prescription Drug Assistance Requests To search for all transaction types, leave this field blank.
ECRS Web User Guide Chapter 7: Reports 7-11 Field Description Source Codes Select a source. Options are: CHEK LTTR SCLM SRVY To search for all sources, leave this field blank. Origin Date From Enter a start date for the reporting period. Defaults to the first day of the previous month. Origin Date To Enter an end date for the reporting period. Defaults to the last day of the previous month. The origination date range cannot be greater than 6 months. Contractor # Enter a contractor number to view its associated CMS workload statistics. Leave the field blank to view results for all contractors. Enter at least one, but no more than ten, contractor numbers. Export Data Link. Click to launch the File Save dialog. Submit Click Submit to create the report with the selected criteria. Reset Click Reset to clear all search criteria and results. Cancel Click Cancel to return to the Main Menu without saving changes. Figure 7-9: QASP Report Listing
ECRS Web User Guide Chapter 7: Reports 7-12 Table 7-8: QASP Report Listing Field Description Contractor Unique five-digit contractor numbers assigned to Medicare contractors by CMS. Used to identify Medicare contractors. Medicare ID Medicare ID (HICN or MBI) of the beneficiary associated with the record or transaction. Beneficiary Name Name of the beneficiary associated with the record or transaction. Transaction Type Type of record or transaction. Source Code Source of the record or transaction. Date Origination date of the record or transaction.
ECRS Web User Guide Chapter 8: Uploading and Downloading Files 8-1 Chapter 8: Uploading and Downloading Files Users with upload and download authority will see Upload File and Download Response File links on the Main Menu. Most users have upload/download authority for a single Medicare contractor, but some users have the authority to upload and download files for multiple contractors. Users with upload/download authority for multiple contractors must have upload/download authority for each contractor on the file. See Appendix G for transaction file and response file layouts. Note: The file layouts included in this manual should be utilized for all transmission methods. The authority for users to upload and download Assistance Request and Inquiry files resides in the EDI application. Before users can upload Assistance Request and Inquiry files (or download the corresponding response files), they must first be granted permission in the EDI application. To request permission for upload/download authority, call the EDI Department at 646-458-6740. 8.1 Navigation Links Several basic navigation links appear on every Main Menu page. See Section 2.6.4 for descriptions of the heading bar links and the right side bar links and fields. 8.2 Upload Assistance Request and Inquiry Files Use the Upload File link under the Files section on the Main Menu to access the Upload File page. The Upload File page allows you to browse, select, and upload transaction files stored on your system. In addition to allowing a user to upload a new file, the Upload File page also shows a listing of the ten most recently uploaded files. Note: You can upload multiple files separately or upload a single file containing a combination of all requests and inquiries (i.e., a single file with CWF Assistance Requests, MSP Inquiries, Prescription Drug Inquiries, and Prescription Drug Assistance Requests). The combined file must be separated by header and trailer records and grouped by Transaction Type and Contractor Number. Follow the steps below to upload Assistance Request and Inquiry files. 1. From the Main Menu, click the Upload File link in the Files section. The File Upload page appears (Figure 8-1). 2. Enter the file path in the FILE TO UPLOAD field; or click the Browse button and select the file to upload. 3. Click Continue. The system uploads the file and the Upload File Confirmation page appears. The page contains the file name and date/time of the upload. 4. Print the Confirmation page by clicking the Print Confirmation link, or return to the Main Menu by clicking the Home link in the navigation bar at the top of the page.
ECRS Web User Guide Chapter 8: Uploading and Downloading Files 8-2 Figure 8-1: ECRS File Upload Table 8-1: ECRS File Upload Field Description FILE TO UPLOAD File path of the file to upload to the ECRS system. BROWSE Command button. Click to launch the Choose File dialog. CONTINUE Command button. Click to upload the file entered in the File to Upload field. CANCEL Command button. Click to return to the Main Menu. FILE NAME File name of previously uploaded file. UPLOAD DATE Date the file was uploaded. USER ID User ID of the person who uploaded the file. 8.3 Download Assistance Request and Inquiry Response Files Use the Download Response File link under the Files section on the Main Menu to access the Download Response File page. The Download Response File page shows a list of response files available for download. Users with upload/download authority for several contractors can view a list of all response file types for any contractor they have the authority for, regardless of which contractor ID they signed in with. They can also filter this list by contractor ID. Note: Only transactions that have been uploaded using ECRS Web will have response files available for download.
ECRS Web User Guide Chapter 8: Uploading and Downloading Files 8-3 Follow these steps to download Assistance Request and Inquiry Response files. 1. From the Main Menu, click the Download Response File link in the Files section. The Download Response Files page appears. 2. Click a file name link to download the file. The system downloads and shows the detail records from the selected response file (Figure 8-3). 3. Return to the Main Menu by clicking the Cancel link in the navigation bar at the top of the page. Figure 8-2: Download Response Files Table 8-2: Download Response Files Field Description Contractor ID Select an ID from the drop-down menu to filter the list of response files shown by contractor ID. Submit Command button. Click to apply the contractor ID filter. Reset Command button. Click to clear the contractor ID filter. Cancel Command button. Click to return to the Main Menu. File Name List of response files available for download. Click the individual file name to download the response file Date Date the response files were processed. Contractor ID ID of the contractor associated with the listed response file.
ECRS Web User Guide Chapter 8: Uploading and Downloading Files 8-4 Figure 8-3: Response File Example 8.4 Alternative File Submission Options We highly recommend that ECRS users use the features of ECRS Web as it is the most effective of the options, but if it is necessary, there are two additional options for communicating with ECRS. You can use the CMS Electronic File Transfer (EFT) protocol, or you can choose to send these files using a Secure FTP/Gentran Mailbox already established with CMS. The file naming conventions are different for the CMS EFT than they are for the Gentran Mailbox. For the CMS EFT, the naming conventions are as follows: Production or Test Files Input Files: P#/T#EFT.ON.NDM.ECRS.INPUT.Dyymmdd.Thhmmsst Response Files (sent ECRS Plans) Response Files: HLQ.RXnnnn.ECRS.RESP.Dyymmdd.Thhmmsst Notes: • P/T = Production or Test • HLQ = Customer-defined high-level qualifier, one for production and one for test • RXnnnn = “R” plus five-digit ECRS Plan ID (one alpha + four numeric) • Dyymmdd.Thhmmsst = Current date and time If you decide to use your Gentran Mailbox to submit, the naming convention is different. In the following dataset name, complete the information as you normally would to send a file, but in the APPID node you will enter ECRS. GUID.RACFID.APPID.X.UNIQUEID.FUTURE.P Note: You may not submit files in .zip format with the Gentran Mailbox.
ECRS Web User Guide Chapter 8: Uploading and Downloading Files 8-5 8.5 File Submission Errors If you upload a file with an error in the Header or Trailer, that contains incorrect or invalid characters, or that has an incorrect record length, ECRS will show an error code and message (see Appendix H) on the File Upload page. When an upload error occurs, you will see the following message: “Please make corrections and resubmit your file.”
ECRS Web User Guide Chapter 9: IDM Registration, RIDP, and MFA 9-1 Chapter 9: Identification Management (IDM) Registration, Remote Identity Proofing (RIDP), and Multi-Factor Authentication (MFA) 9.1 Introduction This section provides step-by-step instructions for active EIDM ECRS users whose accounts were migrated from the EIDM to the IDM process and for new users registering on the CMS IDM system for the first time. If you were a former EIDM ECRS user with an active account: valid login ID and password, and an application role, and who completed the Remote Identify Proofing (RIDP) verification process, you can now go to the IDM page and log in. When logging in for the first time, your initial (default) security authentication will be by email, and you will also be asked to set up one security question and answer. After you complete this step, should you ever forget your password, or if your account is locked, you can use the IDM self-service features to regain access (Section 9.5). If you have never registered or created an account previously, you will need to complete the account registration process in the IDM system (Section 9.5.3), and the RIDP verification process (Section 9.7). These steps are part of requesting access to the ECRS application and a user role. Whether you are a former active EIDM user or a new user, the default multi-factor authentication (MFA) method assigned to your IDM account is email. However, once you log in to the IDM system, you can then set up other authentication devices (See Manage MFA Devices). 9.2 About RIDP and MFA RIDP is an identity verification process that requires you to provide personally identifiable information (PII) to Experian® (an external credit service agency) that is sufficient to prove your identity. MFA is a security authentication process that requires you to enter a unique security code either through your email, or through another registered authentication device (such as a phone application) to complete your login. You only need to complete the RIDP setup process once. You will not need to repeat this process when requesting access and roles for other applications managed through the IDM system. You can set up alternate MFA devices at any time. 9.3 EIDM Users If you were an active EIDM ECRS user, your account information has been migrated to use the IDM process. Active accounts must have a valid login ID and password, and have current access to ECRS with an application role. You must also have completed the RIDP process. If this is your case, go directly to the IDM system and log in (Section 9.3.1). Otherwise, contact the ECRS Help Desk at 646- 458-6740. When logging in to the IDM system for the first time, your default security authentication will be by email. However, once logged in, you can set up additional authentication devices through your profile (Section 9.4.1).
ECRS Web User Guide Chapter 9: IDM Registration, RIDP, and MFA 9-2 Note: You must log in to your account at least once every 60 days. If you do not log in within this timeframe, you will have to reset your password the next time you log in. 9.3.1 Login Process See Section 2.6.2 for login steps for current ECRS users, including migrated EIDM users. 9.4 New Users Follow these steps to register and log in if you are a new user on the IDM system. All new registrations and requests for ECRS access and roles are done through the IDM system. See Section 9.5.3 for requesting access to ECRS. 9.4.1 Login Process 1. Go to https://idm.cms.gov/. The IDM login page appears. 2. Click IDM User Registration. Figure 9-1: IDM Login
ECRS Web User Guide Chapter 9: IDM Registration, RIDP, and MFA 9-3 3. Complete your personal information. Check the box to indicate that you agree to the terms and conditions (Figure 9-2). 4. Enter your contact details, and then click Next (Figure 9-3). If your address in not within the U.S., click Foreign Address when you answer the question “Is your Address a US or Foreign Address?” Note: If you live overseas, you will not be able to complete the RIDP process (see Section 9.7.2 for details regarding manual ID proofing). Figure 9-2: Step #1: Enter Personal Information
ECRS Web User Guide Chapter 9: IDM Registration, RIDP, and MFA 9-4 Figure 9-3: Step #2: Enter Contact Information
ECRS Web User Guide Chapter 9: IDM Registration, RIDP, and MFA 9-5 Figure 9-4: Step #3: Enter Credentials 5. Create a user ID and password, and select your security question and answer. Then click Submit. A Confirmation appears. When successful, you will automatically be transferred to the IDM login page. Otherwise, correct your errors and then resubmit. 9.5 Self-Service Dashboard and Features Once you log in, the self-service dashboard becomes your “home” page. Dashboard options include: • Manage your profile information (My Profile) Click My Profile to manage your MFA devices. • Request applications and roles (Role Request) This option will also initiate the RIDP process if have not already completed it. • Manage existing roles (Manage My Roles) • Manage role requests (My Requests) Other self-service features include the forgot password and unlock account, which are links available on the IDM login page (but not the ECRS login page). By default, the forgot password and unlock account features work by sending a security code to the email you set up during new user registration or, if you are a legacy EIDM user, the email that was included when your EIDM account was migrated to IDM. Note: The only recovery methods you can use to reset a forgotten password or to unlock your account are email, SMS (text message), and IVR (interactive voice response). You cannot use a phone application (i.e., Google Authenticator or OKTA Verify).
ECRS Web User Guide Chapter 9: IDM Registration, RIDP, and MFA 9-6 IDM also provides a way to retrieve a forgotten user ID (Section 9.5.8) and to update expired passwords (Section 9.6). Figure 9-5: Self-Service Dashboard Table 9-1: Self-Service Options Option Description My Profile This option allows you to view and edit your profile, as well as add and manage your MFA devices. Role Request This option allows you to request access to a new application and role. You will also go through the RIDP process if you have not already done so for another application (Section 9.7). Manage My Roles This option allows you to access existing roles. You may view, add, edit, or remove those roles. My Requests This option allows you to access your pending requests. You may view or cancel requests. 9.5.1 My Profile My Profile allows you to change the following information through your account profile: • My Information • Personal Contact Information • Business Contact Information • Change Password • Manage MFA Devices Most options are self-explanatory, requiring you to update information in the shown fields. You will also receive an email confirmation after submitting any changes.
ECRS Web User Guide Chapter 9: IDM Registration, RIDP, and MFA 9-7 Figure 9-6: My Profile 9.5.2 Manage MFA Devices Adding and managing MFA devices is done by clicking Manage MFA Devices under My Profile. When you first log into ECRS, the default authentication option assigned to your account is email (which cannot be removed). However, you can add, or register, additional authentication devices. You are responsible for managing the MFA devices that are associated with their account. Help desk users can only view devices and cannot assist you directly with device management. The supported MFA devices in IDM are listed in the following table. Table 9-2: Supported MFA Devices MFA Device Actions Email Edit only SMS (text message) Activate, Edit, Remove IVR (Interactive Voice Response) Activate, Edit, Remove Google Authenticator (phone app) Add, Remove OKTA Verify (phone app) Add, Remove How to Add an MFA Device 1. After login, select My Profile under your username. 2. Select Manage MFA Devices and click Register a Device. Note: You have two attempts to register a device. If you are unable to do so, log out and log back in to try again. 3. From the drop-down menu, select a device. 4. Follow the screen prompts to set up the device. Once you select and set up a device, you will be prompted to send a security code. When you receive the verification code on your mobile device, enter the verification code in the Code field and click Send MFA Code (or like button). The device will appear in the device table.
ECRS Web User Guide Chapter 9: IDM Registration, RIDP, and MFA 9-8 Notes: If you add all the device options to your account, the table will display the devices, and the Register a Device button will disappear. You can only have one of each type of device. You can add the same phone number for both IVR and text, but if you delete one of those options, it will also delete the other. Figure 9-7: Manage MFA Devices Figure 9-8: Example Text Message (SMS) Selected Figure 9-9: List of MFA Devices
ECRS Web User Guide Chapter 9: IDM Registration, RIDP, and MFA 9-9 9.5.3 (Application and) Role Requests Role Request allows you to request access to a new application and role for which you do not currently have access. 1. Select an application from the drop-down menu (Figure 9-10). 2. Review the role details and enter a reason for the request (Figure 9-11). 3. Click Submit Role Request. A page appears showing your Request ID (Figure 9-12). Once submitted, the role request is forwarded to the approver of record who will make the final approval determination. Figure 9-10: Role Request: Application and Role
ECRS Web User Guide Chapter 9: IDM Registration, RIDP, and MFA 9-10 Figure 9-11: Role Request: Review Figure 9-12: Role Request: Request ID 9.5.4 My Requests My Requests allows you to view or cancel pending application and role requests. Once approved, these are no longer shown. Figure 9-13: My Requests
ECRS Web User Guide Chapter 9: IDM Registration, RIDP, and MFA 9-11 9.5.5 Manage My Roles Manage My Roles allows you to manage roles for an application to which you currently have access, including viewing, adding, and removing roles. Hover over the icons to select an action. Note: Removing a role does not require approval from the ECRS Help Desk. Role removal takes place the moment that the IDM system accepts the request. Figure 9-14: Manage My Roles 9.5.6 Forgot Password Follow these steps if you have forgotten your password. 1. Go to https://idm.cms.gov/. The IDM login page appears (Figure 9-15). 2. On the IDM login page click the Forgot Password link. The Reset Password page appears (Figure 9-16). 3. Enter your user ID and select a recovery method (SMS, voice call, or email) (Figure 9-16). You can only select those recovery methods that have been added as MFA devices. You will receive instructions from the system. If using email, click the Reset Password link in the email. 4. When the screen appears, enter the answer to your security question and click Reset Password (Figure 9-17). 5. Enter, and confirm, the new password and click Reset Password (Figure 9-18). A Confirmation page appears confirming your password change (Figure 9-19). Click Back to Sign In to return to the login page.
ECRS Web User Guide Chapter 9: IDM Registration, RIDP, and MFA 9-12 Figure 9-15: IDM Login Page
ECRS Web User Guide Chapter 9: IDM Registration, RIDP, and MFA 9-13 Figure 9-16: Forgot Password: User ID Figure 9-17: Forgot Password: Security Question
ECRS Web User Guide Chapter 9: IDM Registration, RIDP, and MFA 9-14 Figure 9-18: Forgot Password: New Password and Confirm Figure 9-19: Forgot Password: Confirmed 9.5.7 Unlock Account For security purposes, the IDM will lock your account after three failed login attempts, and you will get an email notice confirming the lock. If your account is locked and you attempt to log in, you will be redirected to the Unlock Account page. 1. Enter your user ID in the Unlock Account page and select a recovery method (SMS, voice call, or email) (Figure 9-20). You can only select those recovery methods that have been added as MFA devices. You will receive instructions from the system. If using email, click the Unlock Account link in your email. 2. Enter the answer to your security question click Unlock Account (Figure 9-22 ). A confirmation page appears onscreen stating that your account is now unlocked (Figure 9-23). Click Back to Sign In to return to the login page.
ECRS Web User Guide Chapter 9: IDM Registration, RIDP, and MFA 9-15 Figure 9-20: Unlock Account: User ID Figure 9-21: Unlock Account: Recovery Method Figure 9-22: Unlock Account: Security Question
ECRS Web User Guide Chapter 9: IDM Registration, RIDP, and MFA 9-16 Figure 9-23: Unlock Account: Confirmation 9.5.8 Forgot User ID 1. Follow these steps if you have forgotten your user ID. 2. Go to https://idm.cms.gov/. The IDM login page appears. 3. On the IDM login page click the Forgot your User ID link. The Forgot User ID page appears (Figure 9-25). 4. Enter the requested information and click Submit. You will receive an email from the system. 5. Click the link in the email or the Back to Sign In button to return to the login page (Figure 9-26). Figure 9-24: IDM Login Page
ECRS Web User Guide Chapter 9: IDM Registration, RIDP, and MFA 9-17 Figure 9-25: Forgot User ID: Identification Figure 9-26: Forgot User ID: Email Recovery
ECRS Web User Guide Chapter 9: IDM Registration, RIDP, and MFA 9-18 9.6 Expired Passwords Passwords in IDM are permanent as long as you log in at least once every 60 days. If you do not log in within 60 days, your password will expire. On your next login attempt, you will be notified that your password has expired and be redirected to an Reset Password page so you can change it. Follow these steps to reset an expired password: 1. On the Reset Password page, enter, then re-enter, your new password. 2. Click Reset Password. You will see a confirmation message that your password has been updated, and you will receive an email confirmation. Figure 9-27: Reset Password Page
ECRS Web User Guide Chapter 9: IDM Registration, RIDP, and MFA 9-19 9.7 Completing Remote Identity Proofing (RIDP) The RIDP process is part of the IDM Role Request process for requesting access to an application and role (Section 9.5.3). This process is an important component of the CMS IDM system. It provides application owners with a basis to establish a high Identity Assurance Level (IAL) that a user is, in fact, who they claim to be. If you have already completed the RIDP process successfully through another IDM application, including those accessed via the CMS Portal, you will not be required to complete it again for ECRS. For new users requesting access to ECRS, the system will automatically take you through the RIDP process to verify your identity. RIDP makes use of a web service and data provided by Experian®, a consumer credit reporting company. To complete the identity verification process, you will be required to enter PII, such as your social security number (required), full legal name, primary phone number (mobile preferred), date of birth, personal email address, and current home address. RIDP is used by CMS only to verify your identity. Since verification is done through Experian®, you may see an entry on your credit report called a “soft” inquiry that is only visible to you. Completing RIDP does not affect your credit score, and the inquiry will not incur any charges. Follow these steps to complete the RIDP process: 1. Once you select the ECRS application and a role, click Next. The Remote Identity Proofing overview page appears, along with the terms and conditions (Figure 9-28). 2. After reading, check the I agree to the terms and conditions checkbox. 3. Click Next. (Note: This button is enabled only after you check the I Agree checkbox.) The Remote Identity Proofing verification form appears (Figure 9-29). 4. Complete the ID verification form. For many users, all fields are required except for the Zip Code Extension. If you make a mistake entering your personal information, the system will respond requesting a correction. If the correction is valid, you can proceed with the process; otherwise, you will be directed to contact Experian® (See Section 9.7.1 for details). Tips for Completing Personally Identifiable Information • Use your full legal name. Refer to your driver’s license or financial account information to ensure it matches the information you supply in the RIDP process. If you have a two-part name, enter the second part in the middle name field. Do not use nicknames. • Enter your current residential address. Do not use a business address. If you have a recent change in address, try to identity proof with a prior address. Do not enter extraneous symbols. Note: If you reside at a foreign address you will not be able to complete the identity verification process online using this form. In this case, write down the Review Reference Code and contact the EDI Help Desk at (646) 458-6740. • Enter a personal mobile phone number (if you have one). (A landline can be used, but a mobile cell phone is preferred.) • You will be asked to give consent to verify your identity information from your credit report.
ECRS Web User Guide Chapter 9: IDM Registration, RIDP, and MFA 9-20 • The information is used for purposes of identity proofing only. • The consent for using the information does post as a soft inquiry on your credit report. The soft inquiry is visible only to you. • The consent/soft inquiry does not affect your credit score or incur any charges or fees. • If you are incorrectly listed as deceased on the Social Security Administration’s Death Master File, you will not be able to complete the identity proofing process. Contact Social Security at 1- 800-269-0271. 5. Click Submit. The combination of your first name, last name, email address, and SSN must be unique in IDM. If no error message is displayed, then Experian has been able to identify you based on the information you provided. You will see the message, “Remote Identity Proofing has been completed successfully.” Then click (green) OK. You will return to the self-service dashboard. If an error message is displayed, write down the error message and the Reference Number that is displayed. Click (red) Close and then contact the EDI Help Desk at 646-458-6740. Figure 9-28: RIDP: Process Overview and Terms and Conditions
ECRS Web User Guide Chapter 9: IDM Registration, RIDP, and MFA 9-21 Figure 9-29: RIDP: Verification Form 9.7.1 Problems with Verification? If Experian® was unable to verify your identity, or if you timed out with the questions, contact the EDI Help Desk at 646-458-6740 for assistance. Likely, they will ask you to contact the Experian® Verification Support Services Help Desk. This call center is focused on supporting individuals who have failed online identity proofing while attempting to obtain a role through IDM. The system will provide you with a Reference Number to track your case. The Experian® Verification Support Services Help Desk cannot assist you if you do not have the reference number. To contact the Experian® Verification Support Services Help Desk, call 1-866-578-5409 and provide them with the case reference code. The help desk is open Monday through Friday from 8:30 a.m. to 10:00 p.m., Saturday from 10:00 a.m. to 8:00 p.m., and Sunday from 11:00 a.m. to 8:00 p.m., Eastern Standard Time. 9.7.2 Manual Identity Proofing If Experian® is unsuccessful with verifying your identity by phone, or you live overseas, please contact the EDI hotline either by email at ECRSHelp@bcrcgdit.com, or by phone at 646-458-6740, to get instructions for completing the identity-proofing process manually.
ECRS Web User Guide Appendix A: CWF Assistance Request Required Data Reference A-1 Appendix A: CWF Assistance Request Required Data Reference For information on how to use these tables, please see Section 2.4 of the user guide. Table A-1: CWF Assistance Request Required Data: Action Requested Field Required? DCN Y MEDICARE ID Y ACTIVITY CODE Y ACTION(S) Y SOURCE Y IMPORT HIMR MSP DATA Y Table A-2: CWF Assistance Request Required Data: CWF Auxiliary Record Data Field Required? Notes MSP TYPE Y N/A NEW MSP TYPE Y Required when ACTION is MT. PATIENT RELATIONSHIP Y N/A NEW PATIENT RELATIONSHIP Y Required when ACTION is PR. AUXILIARY RECORD # Y Part D contractors must enter 001when the Auxiliary Record Number is unknown. Must contain 3 digits. ORIGINATING CONTRACTOR Y N/A EFFECTIVE DATE Y N/A NEW EFFECTIVE DATE Y Required when ACTION is ED. TERMINATION DATE Y Required when ACTION is TD or CT. ACCRETION DATE N N/A
ECRS Web User Guide Appendix A: CWF Assistance Request Required Data Reference A-2 Table A-3: CWF Assistance Request Required Data: Informant Information Field Required? Notes FIRST NAME Y Required for all ACTIONs when Source is CHEK, LTTR, or PHON. Required for all SOURCEs when Action is AI. MIDDLE INITITAL N N/A LAST NAME Y Required for all ACTIONs when SOURCE is CHEK, LTTR, or PHON. Required for all SOURCEs when ACTION is AI. ADDRESS Y Required for all ACTIONs when the Source is CHEK, LTTR, or PHON. Required for all SOURCEs when the ACTION is AI. CITY Y Required for all ACTIONs when the SOURCE is CHEK, LTTR, or PHON Required for all SOURCEs when the ACTION is AI. STATE Y Required for all ACTIONs when the SOURCE is CHEK, LTTR, or PHON Required for all SOURCEs when the ACTION is AI. ZIP Y Required for all ACTIONs when SOURCE is CHEK, LTTR, or PHON Required for all SOURCEs when the ACTION is AI. PHONE N N/A RELATIONSHIP Y Required for all ACTIONs when the SOURCE is CHEK, LTTR, or PHON Must be A when ACTION is AI. Table A-4: CWF Assistance Request Required Data: Insurance Information Field Required? Notes INSURANCE COMPANY NAME Y Required for all SOURCEs when ACTION is II. Note: ECRS Web deletes all information entered in subsequent fields if this field is left blank and the ACTION is II. ADDRESS N N/A CITY N N/A STATE N N/A ZIP N N/A PHONE N N/A INSURANCE TYPE Y Required for all SOURCEs when ACTION is AI or IT. NEW INSURANCE TYPE Y Required when the ACTION is IT. POLICY NUMBER Y Required when the ACTION is AP and the MSP TYPE is not D, E, L, or W. Note: If the POLICY NUMBER is entered, the GROUP NUMBER is not required.
ECRS Web User Guide Appendix A: CWF Assistance Request Required Data Reference A-3 Field Required? Notes GROUP NUMBER Y Required when the ACTION is CD and the MSP TYPE is D, E, L, or W. Required when the ACTION is AP and the MSP TYPE is not D, E, L, or W. Note: If the GROUP NUMBER is entered, the POLICY NUMBER is not required. SUBSCRIBER FIRST NAME N N/A SUBSCRIBER MIDDLE INITIAL N N/A SUBSCRIBER LAST NAME N N/A Table A-5: CWF Assistance Request Required Data: Employment Information Field Required? Notes EMPLOYER NAME Y Required when the ACTION is EA or EI. ADDRESS Y Required when the ACTION is EI. ADDRESS 2 N N/A CITY Y Required when the ACTION is EI. STATE Y Required when the ACTION is EI. ZIP Y Required when the ACTION is EI. PHONE N N/A EIN N N/A EMPLOYEE # N N/A Table A-6: CWF Assistance Request Required Data: Additional Information Field Required? Notes CHECK NUMBER Y Required when the SOURCE is CHEK. CHECK DATE Y Required when the SOURCE is CHEK. CHECK AMOUNT Y Required when the SOURCE is CHEK. PRE-PAID HEALTH PLAN DATE Y Required when the ACTION is PH. SOCIAL SECURITY NUMBER Y Required when the ACTION is MX. DIAGNOISIS CODES Y • Required when the ACTION is DX. • Required when MSP TYPE is D, E, or L.
ECRS Web User Guide Appendix A: CWF Assistance Request Required Data Reference A-4 Table A-7: CWF Assistance Request Required Data: Comments/Remarks Field Required? Notes COMMENTS N N/A REMARKS Y Required when the ACTION is AR.
ECRS Web User Guide Appendix B: MSP Inquiry Required Data Reference B-1 Appendix B: MSP Inquiry Required Data Reference Table B-1: MSP Inquiry Required Data: Action Requested Field Required? DCN Y MEDICARE ID Y ACTIVITY CODE Y ACTION N SOURCE Y Table B-2: MSP Inquiry Required Data: MSP Information Field Required? Notes MSP TYPE Y • Required when the SOURCE is PHON. • Required when the ACTION is CA or CL. (MSP TYPE must be D, E, or L when the ACTION is CL.) PATIENT RELATIONSHIP Y • Required when the ACTION is blank and MSP TYPE is F. • Required when the ACTION is CA and MSP TYPE is L. • Required when the ACTION is CL and MSP TYPE is D, E, or L. EFFECTIVE DATE Y • Required when the ACTION is CA and MSP TYPE is L • Required when the ACTION is CL and MSP TYPE is D, E, or L TERMINATION DATE Y Required when the ACTION is CL and MSP TYPE is D, E, or L. CMS GROUPING CODE Y Required when the ACTION is CA and MSP TYPE is L. DIALYSIS TRAIN DATE N N/A BLACK LUNG BENEFITS N N/A BLACK LUNG EFFECTIVE DATE N N/A SEND TO CWF N N/A
ECRS Web User Guide Appendix B: MSP Inquiry Required Data Reference B-2 Table B-3: MSP Inquiry Required Data: Informant Information Field Required? Notes FIRST NAME Y • Required when the ACTION is CA or CL, unless Insurance Company information will be entered. • Required when the SOURCE is CHEK, LTTR, or PHON. MIDDLE INITITAL N N/A LAST NAME Y • Required when the ACTION is CA or CL, unless Insurance Company information will be entered. • Required when SOURCE is CHEK, LTTR, or PHON. ADDRESS Y • Required when the ACTION is CA or CL, unless Insurance Company information will be entered. • Required when the SOURCE is CHEK, LTTR, or PHON. CITY Y • Required when the ACTION is CA or CL, unless Insurance Company information will be entered. • Required when SOURCE is CHEK, LTTR, or PHON. STATE Y • Required when the ACTION is CA or CL, unless Insurance Company information will be entered. • Required when the SOURCE Coe is CHEK, LTTR, or PHON. ZIP Y • Required when the ACTION is CA or CL, unless Insurance Company information will be entered. • Required when the SOURCE is CHEK, LTTR, or PHON. PHONE N N/A RELATIONSHIP Y • Required when the SOURCE is CHEK, LTTR, or PHON. • Must be A if the ACTION is CA or CL and informant information is entered.
ECRS Web User Guide Appendix B: MSP Inquiry Required Data Reference B-3 Table B-4: MSP Inquiry Required Data: Insurance Information Field Required? Notes INSURANCE COMPANY NAME Y Required unless the ACTION is blank. ADDRESS LINE 1 Y • Required when an Insurance Company Name is entered. • Required when the ACTION Is CA or CL, unless Informant information was entered. ADDRESS LINE 2 N N/A CITY Y • Required when an Insurance Company Name is entered. • Required when the ACTION is CA or CL, unless Informant information was entered. STATE Y • Required when an Insurance Company Name is entered. • Required when the ACTION is CA or CL, unless Informant information was entered. ZIP Y • Required when an Insurance Company Name is entered. • Required when the ACTION is CA or CL, unless Informant information was entered. PHONE N N/A INSURANCE TYPE Y N/A POLICY NUMBER N N/A GROUP NUMBER N N/A SUBSCRIBER FIRST NAME N N/A SUBSCRIBER MIDDLE INITIAL N N/A SUBSCRIBER LAST NAME N N/A SUBSCRIBER SSN N N/A
ECRS Web User Guide Appendix B: MSP Inquiry Required Data Reference B-4 Table B-5: MSP Inquiry Required Data: Employment Information Field Required? Notes EMPLOYER NAME Y • Required when MSP TYPE is F and SEND TO CWF is Yes ADDRESS Y • Required when MSP TYPE is F and SEND TO CWF is Yes ADDRESS 2 N N/A CITY Y • Required when MSP TYPE is F and SEND TO CWF is Yes STATE Y • Required when MSP TYPE is F and SEND TO CWF is Yes ZIP Y • Required when MSP TYPE is F and SEND TO CWF is Yes PHONE N N/A EIN N N/A EMPLOYEE # N N/A Table B-6: MSP Inquiry Required Data: Additional Information Field Required? Notes CHECK NUMBER Y Required when the SOURCE is CHEK. CHECK AMOUNT Y Required when the SOURCE is CHEK. CHECK DATE Y Required when the SOURCE is CHEK. DIAGNOISIS CODES Y Required when the ACTION is CA or CL. ILLNESS/INJURY DATE N N/A BENEFICIARY REPRESENTATIVE TYPE N N/A BENEFICIARY REPRESENTATIVE NAME N N/A BENEFICIARY REPRESENTATIVE ADDRESS N N/A BENEFICIARY REPRESENTATIVE CITY N N/A BENEFICIARY REPRESENTATIVE STATE N N/A BENEFICIARY REPRESENTATIVE ZIP N N/A
ECRS Web User Guide Appendix B: MSP Inquiry Required Data Reference B-5 Table B-7: MSP Inquiry Required Data: Prescription Coverage Field Required? Notes INSURANCE COMPANY NAME N N/A ADDRESS LINE 1 N N/A ADDRESS LINE 2 N N/A CITY N N/A STATE N N/A ZIP N N/A PHONE N N/A POLICY NUMBER N N/A EFFECTIVE DATE N N/A TERMINATION DATE N N/A RECORD TYPE N N/A COVERAGE TYPE Y N/A BIN Y Required when COVERAGE TYPE is U. PCN Y Required when COVERAGE TYPE is U. GROUP Y Required when COVERAGE TYPE is U. ID Y Required when COVERAGE TYPE is U. SUPPLEMENTAL TYPE Y Must be L when RECORD TYPE is Supplemental PERSON CODE Y • Required when RECORD TYPE is Supplemental. • Required when SUPPLEMENTAL TYPE is L.
ECRS Web User Guide Appendix C: Prescription Drug Assistance Request Required Data Reference C-1 Appendix C: Prescription Drug Assistance Request Required Data Reference Table C-1: Prescription Drug Assistance Request Required Data: Action Requested Field Required? Notes DCN Y N/A MEDICARE ID Y N/A ACTIVITY CODE Y N/A ACTION Y N/A SOURCE Y N/A MSP TYPE Y Required when ACTION is MT NEW MSP TYPE Y Required when ACTION is MT. RECORD TYPE Y Always required when Record Type is Primary. PATIENT RELATIONSHIP Y N/A NEW PATIENT RELATIONSHIP Y Required when ACTION is PR. PERSON CODE Y Required when RECORD TYPE is Supplemental ORIGINATING CONTRACTOR Y N/A COB EFFECTIVE DATE Y N/A NEW COB EFFECTIVE DATE Y Required when ACTION is ED. TERMINATION DATE Conditional • Required when ACTION is CT • Required when ACTION is TD SUBMITTER TYPE N N/A REMOVE EXISTING TERMINATION DATE N N/A
ECRS Web User Guide Appendix C: Prescription Drug Assistance Request Required Data Reference C-2 Table C-2: Prescription Drug Assistance Request Required Data: Informant Information Field Required? Notes FIRST NAME Y Required for all ACTIONS when SOURCE is CHEK, LTTR, or PHON. MIDDLE INITITAL N N/A LAST NAME Y Required for all ACTIONS when SOURCE is CHEK, LTTR, or PHON. ADDRESS Y Required for all ACTIONS when SOURCE is CHEK, LTTR, or PHON. CITY Y Required for all ACTIONS when SOURCE is CHEK, LTTR, or PHON. STATE Y Required for all ACTIONS when SOURCE is CHEK, LTTR, or PHON. ZIP Y Required for all ACTIONS when SOURCE is CHEK, LTTR, or PHON. PHONE N N/A RELATIONSHIP Y Required for all ACTIONS when SOURCE is CHEK, LTTR, or PHON. Table C-3: Prescription Drug Assistance Request Required Data: Insurance Information Field Required? Notes INSURANCE COMPANY NAME Y Name of insurance carrier. Required for all SOURCEs when ACTION is II. Note: Action code II cannot be used with action code DO. ADDRESS N N/A ADDRESS 2 N N/A CITY N N/A STATE N N/A ZIP N N/A PHONE N N/A INSURANCE TYPE Y Required when ACTION is IT. NEW INSURANCE TYPE Y Required when ACTION is IT. COVERAGE TYPE N N/A POLICY NUMBER Y Required when the ACTION is AP. Note: If the POLICY NUMBER is entered, the GROUP NUMBER is not required. GROUP NUMBER N Group, BIN, or PCN is required with Action Code CX.
ECRS Web User Guide Appendix C: Prescription Drug Assistance Request Required Data Reference C-3 Field Required? Notes BIN Y Required when COVERAGE TYPE is U. Must be six digits and cannot be all the same number if COVERAGE TYPE is U. BIN will not be edited for formats when the ACTION CODE is BN. Group, BIN, or PCN is required with Action Code CX. PCN Y Populate with spaces if not available. Cannot have special characters, except for a non-leading dash, and no leading space. Group, BIN, or PCN is required with Action Code CX. ID Y Required when COVERAGE TYPE is U. Cannot be blank or all zeros if COVERAGE TYPE is U. SUPPLEMENTAL TYPE N N/A Table C-4: Prescription Drug Assistance Request Required Data: Employment Information Field Required? Notes EMPLOYER NAME Y Required when the ACTION is EA or EI. ADDRESS Y Required when the ACTION is EI. ADDRESS 2 N N/A CITY Y Required when the ACTION is EI. STATE Y Required when the ACTION is EI. ZIP Y Required when the ACTION is EI. PHONE N N/A EIN N N/A EMPLOYEE # N N/A Table C-5: Prescription Drug Assistance Request Required Data: Additional Information Field Required? Notes CHECK NUMBER Y Required when the Source is CHEK. CHECK DATE Y Required when the Source is CHEK. CHECK AMOUNT Y Required when the Source is CHEK. Table C-6: Prescription Drug Assistance Request Required Data: Comments/Remarks Field Required? COMMENTS N REMARKS N
ECRS Web User Guide Appendix D: Prescription Drug Inquiry Required Data Reference D-1 Appendix D: Prescription Drug Inquiry Required Data Reference Table D-1: Prescription Drug Inquiry Required Data: Initial Information Field Required? DCN Y MEDICARE ID Y ACTIVITY CODE Y SOURCE Y MSP TYPE Y PATIENT RELATIONSHIP Y SEND TO MBD Y Table D-2: Prescription Drug Inquiry Required Data: Additional Information Field Required? Notes CHECK NUMBER Y Required when the SOURCE is CHEK. CHECK DATE Y Required when the SOURCE is CHEK. CHECK AMOUNT Y Required when the SOURCE is CHEK. INFORMANT FIRST NAME Y Required when the SOURCE is CHEK, LTTR, or PHON. INFORMANT MIDDLE INITITAL N N/A INFORMANT LAST NAME Y Required when the SOURCE is CHEK, LTTR, or PHON. INFORMANT ADDRESS Y Required when the SOURCE is CHEK, LTTR, or PHON. INFORMANT CITY Y Required when the SOURCE is CHEK, LTTR, or PHON. INFORMANT STATE Y Required when the SOURCE is CHEK, LTTR, or PHON. INFORMANT ZIP Y Required when the SOURCE is CHEK, LTTR, or PHON. INFORMANT PHONE N N/A INFORMANT RELATIONSHIP Y Required when the SOURCE is CHEK, LTTR, or PHON. EMPLOYER NAME N N/A EMPLOYER ADDRESS N N/A EMPLOYER ADDRESS 2 N N/A EMPLOYER CITY N N/A EMPLOYER STATE N N/A EMPLOYER ZIP N N/A EMPLOYER PHONE N N/A EMPLOYER EIN N N/A
ECRS Web User Guide Appendix D: Prescription Drug Inquiry Required Data Reference D-2 Field Required? Notes EMPLOYER EMPLOYEE # N N/A Table D-3: Prescription Drug Inquiry Required Data: Prescription Coverage Field Required? Notes INSURANCE COMPANY NAME Y N/A ADDRESS LINE 1 N N/A ADDRESS LINE 2 N N/A CITY N N/A STATE N N/A ZIP N N/A PHONE N N/A EFFECTIVE DATE Y N/A TERMINATION DATE Y N/A RECORD TYPE N N/A COVERAGE TYPE Y N/A BIN Y Required when COVERAGE TYPE is U. PCN Y Required when COVERAGE TYPE is U. POLICY NUMBER N N/A GROUP Y Required when COVERAGE TYPE is U. ID Y Required when COVERAGE TYPE is U. SUPPLEMENTAL TYPE N N/A PERSON CODE Y • Required when RECORD TYPE is Supplemental • Required when RECORD TYPE is blank and SUPPLEMENTAL TYPE is L.
ECRS Web User Guide Appendix E: Reason and Action Codes E-1 Appendix E: Reason and Action Codes Table E-1: Reason Codes Reason Code Definition 01 Not yet read by BCRC, used with NW status 02 Being processed by BCRC, used with IP status 03 Under development by BCRC, used with IP status 04 Update sent to CWF, used with IP status 05 Error received from CWF, being resolved by BCRC, used with IP status 06 Sent to the Enrollment Data Base (EDB) for beneficiary info. Used with IP status 07 Auditor follow-up development in progress, used with IP status 10 Not processing 11 Not yet eligible for Medicare, used with HD status 12 Needs diagnosis, used with HD status (for WC set-aside trust cases only) 13 Future-dated workers’ compensation case, used with HD status (for WC set-aside trust cases only) 14 Duplicate request, development already in process, used with HD status 15 Requested Prescription Drug action(s) accepted - Posted to MBD 30 No action taken per SEE approval - Medicare primary 31 Action code and comments conflict 32 Record terminated/deleted due to OBRA 93 33 WCSA record – request must go to regional office 34 Record is “N” validity – we do not develop for “N” records 36 Policyholder Retired (G record) 37 Beneficiary verified existing record, no update needed 38 Outreach development already in process 45 Insufficient information to process, used with HD status (RAC only) 46 RAC did not update hold records, used with DE status (RAC only) 50 Requested action(s) accepted - Posted to CWF Note: When Action ‘ID’ is submitted on a CWF Assistance Request and the BCRC determines that a duplicate record exists, the MSP record will be deleted from CWF and the CWF Assistance Request will be returned with a Status/Reason CM50. 51 No changes (additions, modifications, or deletions) made to CWF, used with CM status 52 Returned–rejected by CWF; conflicting information, used with CM status 53 Returned–duplicate ECRS request, used with CM status 54 100 or more threshold met, Disability
ECRS Web User Guide Appendix E: Reason and Action Codes E-2 Reason Code Definition 55 20 or more threshold met, Working Aged 56 OBRA does not apply, no update 57 No action taken; Record already updated 58 Non-compliant GHP 59 Employer verified existing record, no update 60 Invalid MEDICARE ID 61 No Part A entitlement 62 Development letter sent; closed, no response to development 63 Development complete, no MSP 64 Development letter sent 65 Deceased, used with CM status 66 ESRD/DIB conflict 67 No response from CWF 68 Closed for Self-Report (More current information was received by the BCRC in the form of a self-report.) 69 Developed to GHP, no response 70 Developed to non-EGHP, no response 71 Developed to beneficiary; closed, no response received 72 Developed to informant, no response 73 Medicare beneficiary retired 74 Spouse retired 75 GHP lifetime of yearly benefits past maximum amount 76 No coverage with insurance company 77 Medicare Supplemental Plan 78 Employer has less than 20 employees (No MSP) 79 Per employer, Medicare beneficiary is not covered under spouse’s GHP 80 Employer has less than 100 employees (No MSP) 81 Medicare is primary due to ESRD coordination period being met 82 Per insurance, seasonal employee and not eligible for the month 83 Incoming request conflicts with information on file Note: When Action ‘ID’ is submitted on a CWF Assistance Request and the BCRC determines that no duplicate record exists, the CWF Assistance Request will be returned with a Status/Reason CM83. Comments will be provided on the response. 84 Missing information; unable to update CWF 85 Venue changed 86 Unable to verify address, used with CM status (for CWF assistance requests only) 87 MSP record exists, used with CM status (check HIMR or resubmit as assistance request)
ECRS Web User Guide Appendix E: Reason and Action Codes E-3 Reason Code Definition 88 No update, not lead contractor 91 Duplicate investigation in process 92 Change of Venue not allowed after 90 days 93 No Part D Enrollment found 94 Closed, no response/no update 96 Per Hierarchy guidelines, request cannot be honored. Note: Applies to MSP and drug coverage records (drug coverage effective April 2023). 97 Existing record is invalid and has been deleted. New record created to include changes requested. 98 Overlapping Rx Coverage Table E-2: Action Codes (All Transaction Types) Action Code Description AI Change Attorney Information AP Add Policy and/or Group Number AR Add CWF Remark Codes BN Develop for Prescription BIN CA CMS Grouping Code (Class Action Case) CD Change Date of Injury/Date of Loss CL Closed or Settled Case CP Investigate ESRD Coordination Period CT Change Termination Date CX Change Prescription Values (BIN, Group, PCN) DA Develop for Attorney Information DD Develop for the Diagnosis Code DE Develop for Employer Information (To the beneficiary only) DI Develop for Insurer Information (To the beneficiary only) DO Mark Occurrence for Deletion DR Investigate Closed or Deleted Record DT Develop For Termination Date (see Note end of table) DX Change Diagnosis Code EA Change Employer Address ED Change Effective Date EF Develop for Effective Date EI Change Employer Information ES Employer Size Below Minimum GR Develop for Group Number
ECRS Web User Guide Appendix E: Reason and Action Codes E-4 Action Code Description ID Investigate/Possible Duplicate for Deletion II Change Insurer Information IT Change Insurance Type LR Create Duplicate Liability Record MT Change MSP Type MX SSN/Medicare ID Mismatch NR Create Duplicate No-Fault Record OH Change Effective Date of Other Drug Coverage PC Update Prescription Person Code PH Add Pre-Paid Health Plan (PHP) Date PN Develop for/add PCN PR Change Patient Relationship TD Add Termination Date (see Note end of table) VP Update A Record For A Vow Of Poverty WN Notify BCRC Of Updates To WCMSA Cases Note: DT and TD are distinct codes and cannot be used interchangeably. Table E-3: Automated Action Codes Action Code Description AP Add Policy and/or Group Number AR Add CWF Remark Codes CT Change Termination Date CX Change Prescription Values (BIN, Group, PCN) DO Mark occurrence for deletion II Change insurer information Note: Partially automated for BCRC and CRC recovery users only. PH Add Pre-Paid Health Plan (PHP) date (Note: Applies to CWF requests only) PR Change Patient Relationship TD Add Termination Date
ECRS Web User Guide Appendix F: CWF Remark Codes F-1 Appendix F: CWF Remark Codes Table F-1: Remark Codes Remark Code Definition 01 Beneficiary retired as of termination date. 02 Beneficiary's employer has less than 20 employees. 03 Beneficiary's employer has less than 100 employees. 04 Beneficiary is dually entitled to Medicare, based on ESRD and Age or ESRD and disability. 05 Beneficiary is not married. 06 The Beneficiary is covered under the group health plan of a family member whose employer has less than 100 employees. 07 Beneficiary's employer has less than 20 employees and is in a multiple or multi-employer plan that has elected the working aged exception. 08 Beneficiary's employer has less than 20 employees and is in a multiple or multi-employer plan that has not elected the working aged exception. 09 Beneficiary is self-employed. 10 A family member of the beneficiary is self-employed. 20 Spouse retired as of termination date. 21 Spouse's employer has less than 20 employees. 22 Spouse's employer has less than 100 employees. 23 Spouse's employer has less than 100 employees but is in a qualifying multiple or multi-employer plan. 24 Spouse's employer has less than 20 employees and is multiple or multi-employer plan that has elected the working aged exception. 25 Spouse's employer has less than 20 employees and is multiple or multi-employer plan that has not elected the working aged exception. 26 Beneficiary's spouse is self-employed. 30 Exhausted benefits under the plan. 31 Preexisting condition exclusions exist. 32 Conditional payment criteria met. 33 Multiple primary payers, Medicare is tertiary payer. 34 Information has been collected indicating that there is not a parallel plan that covers medical services. 35 Information has been collected indicating that there is not a parallel plan that covers hospital services. 36 Denial sent by EGHP, claims paid meeting conditional payment criteria.
ECRS Web User Guide Appendix F: CWF Remark Codes F-2 Remark Code Definition 37 Beneficiary deceased. 38 Employer certification on file. 39 Health plan is in bankruptcy or insolvency proceedings. 40 The termination date is the beneficiary's retirement date. 41 The termination date is the spouse's retirement date. 42 Potential non-compliance case, beneficiary enrolled is supplemental plan. 43 GHP coverage is a legitimate supplemental plan. 44 Termination date equals transplant date. 50 Employment related accident. 51 Claim denied by workers’ comp. 52 Contested denial. 53 Workers’ compensation settlement funds exhausted. 54 Auto accident - no coverage. 55 Not payable by black lung. 56 Other accident - no liability. 57 Slipped and fell at home. 58 Lawsuit filed - decision pending. 59 Lawsuit filed - settlement received. 60 Medical malpractice lawsuit filed. 61 Product liability lawsuit filed. 62 Request for waiver filed. 70 Data match correction sheet sent. 71 Data match record updated. 72 Vow of Poverty correction.
ECRS Web User Guide Appendix G: CWF Assistance Request Header Record G-1 Appendix G: File Layouts G.1 CWF Assistance Request File Layouts CWF Assistance Request Header Record Table G-1: CWF Assistance Request Header Record Layout Data Field Length Type Displacement Edits Header Indicator 2 Alpha- Numeric 1-2 Should be: ‘H0’. If not, drop file with error code HE01. Required PDP ID 4 Numeric 3-6 ID number assigned by the BCRC. Populate with spaces. Contractor Number 5 Alpha- Numeric 7-11 Part D Plan contractor number. Required. If not valid contractor number, drop file with error code HE03. File Type 3 Alpha 12-14 Valid values: ‘CWF’ – CWF Assistance Request file If not, drop file with error code HE04. File Date 8 Date 15-22 CCYYMMDD If not valid date, drop file with error code HE05. Submitter Type 1 Alpha- Numeric 23 Part C/D Submitter Indicator Valid Values ‘C’ = Part C contractor ‘D’ = Part D contractor If not valid value, drop file with error code HE06. Filler 1244 Filler 24-1267 Unused field – fill with spaces
ECRS Web User Guide Appendix G: CWF Assistance Request Trailer Record G-2 CWF Assistance Request Trailer Record Table G-2: CWF Assistance Request Trailer Record Layout Data Field Length Type Displacement Edits Trailer Indicator 2 Alpha- Numeric 1-2 Should be: ‘T0’. If not, drop file with error code TE01. Required. PDP ID 4 Numeric 3-6 ID number assigned by the BCRC. Populate with spaces. Contractor Number 5 Alpha- Numeric 7-11 If not valid contractor number, drop file with error code TE03. File Type 3 Alpha- Numeric 12-14 Valid values: ‘CWF’ – CWF Assistance Request File If not, drop file with error code TE04. File Date 8 Date 15-22 CCYYMMDD If not valid date, drop file with error code TE05. Record Count 9 Numeric 23-31 Number of records on file. Must contain 9 digits. If invalid number or number does not match number of records in file, drop file with error code TE06. Filler 1236 Filler 32-1267 Unused Field – fill with spaces
ECRS Web User Guide Appendix G: CWF Assistance Request Detail Record G-3 CWF Assistance Request Detail Record This record layout must be used for all CWF Assistance Request file submissions. Table G-3: CWF Assistance Request Detail Record Layout Data Field Length Type Displacement Description Transaction type 4 Alpha 1-4 Set to ‘ECRS’ Required Contractor Number 5 Alpha- Numeric 5-9 Medicare contractor (MACs, MA/PD plans) number. Required DCN 15 Text 10-24 DCN; assigned by the Medicare contractor. Required. Each record shall have a unique DCN. Tran Type Code 1 Alpha 25 Transaction Type Indicator Set to ‘R’ for CWF Assistance Requests Required Trans Seq No 3 Numeric 26-28 Sequence Number assigned by COB. Internal use only. Populate with spaces. Update Operator ID 8 Alpha- Numeric 29-36 ID of user making update. Not required Contractor Name 25 Text 37-61 Contractor name Not required Contractor Phone 10 Numeric 62-71 Contractor phone number Not required Tran Stat Cd 2 Alpha 72-73 Status code Set to ‘NW’ for New Tran Reason Cd 2 Numeric 74-75 Reason Set to ‘01’ for New Trans Action Code 1 2 Alpha 76-77 Action code. Valid values are: AI = Change Attorney Information AP = Add Policy and/or Group Number AR = Add CWF Remark Codes CA = CMS Grouping Code (Class Action Case) CD = Change Date of Injury/Date of Loss CL = Closed or Settled Case CP = Investigate ESRD Coordination Period CT = Change Termination Date CX = Change Prescription Values (BIN, Group, PCN)
ECRS Web User Guide Appendix G: CWF Assistance Request Detail Record G-4 Data Field Length Type Displacement Description Trans Action Code 1 (Cont.) 2 Alpha 76-77 DA = Develop for attorney information DD = Develop for the diagnosis code DE = Develop for employer information DI = Develop for insurer information DO = Mark occurrence for deletion DR = Investigate closed or deleted record DT = Develop for termination date DX = Change diagnosis code EA = Change employer address ED = Change effective date EF = Develop for the effective date EI = Change employer information ES = Employer size below minimum (20 for working aged, 100 for disability) ID = Investigate/possible duplicate for deletion II = Change insurer information IT = Change insurer type LR = Create duplicate liability record MT = Change MSP type MX = SSN/MEDICARE ID mismatch NR = Create duplicate no-fault record OH = Change Effective Date of Other Drug Coverage PH = Add Pre-Paid Health Plan (PHP) date PR = Change patient relationship TD = Add Termination Date VP = Update a record for a vow of poverty WN = Notify BCRC of updates to WCMSA cases Required. Enter up to four Actions unless the CWF assistance request is DE, DI, DO, DR, ID, or VP. You cannot combine these six Actions with any other action codes. Note: DE and DI Actions are developed to the beneficiary only. Trans Action Code 2 2 Alpha- Numeric 78-79 Action code 2 Valid values same as Trans Action Code 1. Not required. Populate with spaces if not available. Trans Action Code 3 2 Alpha- Numeric 80-81 Action code 3 Valid values same as Trans Action Code 1. Not required. Populate with spaces if not available. Trans Action Code 4 2 Alpha- Numeric 82-83 Action code 4 Valid values same as Trans Action Code 1. Not required. Populate with spaces if not available.
ECRS Web User Guide Appendix G: CWF Assistance Request Detail Record G-5 Data Field Length Type Displacement Description Activity Code 1 Alpha 84 Activity of contractor. Valid values are: C = Claims (Prepayment) – 22001 N = Liability, No-Fault, WC, and FTCA - 42002 G = Group Health Plan – 42003 I = General Inquiry – 42004 D = Debt Collection – 42021 Required Develop to 1 Alpha 85 Development source code indicating where development letter was sent. Not required. Populate with spaces if not available. RSP 1 Alpha 86 Development response indicator. Not required. Populate with spaces if not available. Trans Source Cd 4 Alpha 87-90 Four-character code identifying source of CWF assistance request information. Valid values are: CHEK = Unsolicited check LTTR = Letter PHON= Phone call SCLM = Claim submitted to Medicare contractor for secondary payment SRVY = Survey CLAM = Claim Required Medicare ID 12 Alpha- Numeric 91-102 Health Insurance Claim Number (HICN) or Medicare Beneficiary Identifier (MBI) of beneficiary. Enter without dashes, spaces, or other special characters. Required if SSN is not entered. Beneficiary’s Social Security Number 9 Numeric 103-111 Beneficiary’s Social Security Number Required if Medicare ID not entered. Beneficiary’s Date of Birth 8 Date 112-119 Beneficiary’s Date of Birth in CCYYMMDD format Not required. Populate with zeros if not available. Beneficiary’s Sex Code 1 Numeric 120 Sex of beneficiary Valid values are: U = Unknown M = Male F = Female Not required. Populate with spaces if not available. Beneficiary’s First Name 15 Text 121-135 First name of beneficiary. Required
ECRS Web User Guide Appendix G: CWF Assistance Request Detail Record G-6 Data Field Length Type Displacement Description Beneficiary’s Initial 1 Alpha 136 Middle initial of beneficiary Beneficiary’s Last Name 24 Text 137-160 Last name of beneficiary. Required Patient Relationship 2 Numeric 161-162 Patient relationship between the policyholder and the beneficiary (required field). Description of code appears next to value. Valid values are: 01 Self; Patient is policyholder 02 Spouse 03 Child 04 Other 20 Domestic partner Notes: All patient relationship values accepted for MSP Types B and G. MSP Type A will accept 01 and 02. MSP Types D, E, L, H, W, S, and T will only accept 01. MSP Type 1 Alpha 163 One-character code identifying type of MSP coverage Valid values are: A = Working Aged B = ESRD C = Conditional Payment D = Automobile Insurance E = Workers’ Compensation F = Federal (Public) G = Disabled H = Black Lung L = Liability W =Workers’ Compensation Set-Aside Required
ECRS Web User Guide Appendix G: CWF Assistance Request Detail Record G-7 Data Field Length Type Displacement Description MSP Effective Date 8 Date 164-171 Effective date of MSP coverage in CCYYMMDD format. Notes: This field accepts dates up to three months from the current date, as follows: For GHP records (MSP Types A, B, and G): The MSP Effective Date can be in the future for currently entitled beneficiaries (i.e., enrolled in Medicare), or for beneficiaries who will be entitled starting up to three months in the future. For NGHP records (MSP Types D, E, L, H, and W): The MSP Effective Date can be in the future for beneficiaries as long as their entitlement start date is in the future. The future MSP Effective Date must be equal to the entitlement start date. (NGHP MSP occurrences for beneficiaries who are currently entitled cannot have future MSP Effective Dates.) Required MSP Term Date 8 Date 172-179 Termination date of MSP coverage in CCYYMMDD format. Type one or more zeroes in this field to remove an existing termination date. Type 9 eight times in this field if you have conflicting dates for the termination date. Not required. Populate with zeros if not available. AUX Row Number 3 Numeric 180-182 AUX record number of MSP record at CWF. Required. Populate with zeros if not available. MSP Accretion Date 8 Date 183-190 Accretion date of MSP coverage in CCYYMMDD format. Not required. Populate with zeros if not available. Originating Contractor 5 Alpha- Numeric 191-195 Contractor number of contractor that created original MSP occurrence at CWF Required Filler 6 Alpha 196-201 Populate with spaces. Beneficiary’s Address 1 32 Text 202-233 First line of beneficiary’s street address. Not required. Populate with spaces if not available. Beneficiary’s Address 2 32 Text 234-265 Second line of beneficiary’s street address. Not required. Populate with spaces if not available. Beneficiary’s City 15 Text 266-280 Beneficiary’s city Not required. Populate with spaces if not available. Beneficiary’s State 2 Alpha 281-282 Beneficiary’s state Not required. Populate with spaces if not available. Beneficiary’s ZIP Code 9 Numeric 283-291 Beneficiary’s ZIP code Not required. Populate with spaces if not available. Beneficiary’s Phone 10 Numeric 292-301 Beneficiary’s telephone number Not required. Populate with zeros if not available.
ECRS Web User Guide Appendix G: CWF Assistance Request Detail Record G-8 Data Field Length Type Displacement Description Check Date 8 Numeric 302-309 Date of check received in CCYYMMDD format. Required if value in SOURCE field = CHEK. You cannot future-date this field. Populate with zeros if SOURCE field not equal to CHEK. Check Amount 15 Alpha 310-324 Amount of check received in $999,999,999.99 format. Required if value in SOURCE field = CHEK. Populate with zeros if SOURCE field not equal to CHEK. Check Number 15 Alpha 325-339 Number of check received. Required if value in SOURCE field = CHEK. Populate with zeros if SOURCE field not equal to CHEK. Informant’s First Name 15 Text 340-354 Name of person informing contractor of change in MSP coverage. Required when SOURCE is CHEK, LTTR or PHON. Populate with spaces if Source field not equal to CHEK, LTTR or PHON. Informant’s Middle Initial 1 Alpha 355 Informants middle initial. Not required. Populate with spaces if not available. Informant’s Last Name 24 Text 356-379 Last name of person informing contractor of change in MSP coverage. Required when SOURCE is CHEK, LTTR or PHON. Populate with spaces if Source field not equal to CHEK, LTTR or PHON. Informant’s Phone 10 Numeric 380-389 Informant’s telephone number Not required. Populate with zeros if not available. Informant’s Address 1 32 Text 390-421 Informant’s street address 1 Required when SOURCE is CHEK, LTTR or PHON. Populate with spaces if Source field not equal to CHEK, LTTR or PHON. Informant’s Address 2 32 Text 422-453 Name of person informing contractor of change in MSP coverage. Not required Informant’s City 15 Text 454-468 Informant’s city. Required when SOURCE is CHEK, LTTR or PHON. Populate with spaces if Source field not equal to CHEK, LTTR or PHON. Informant’s State 2 Alpha 469-470 Informant’s state Required when SOURCE is CHEK, LTTR or PHON. Populate with spaces if Source field not equal to CHEK, LTTR or PHON. Informant’s ZIP Code 9 Numeric 471-479 Informant’s ZIP code Required when SOURCE is CHEK, LTTR or PHON. Populate with spaces if Source field not equal to CHEK, LTTR or PHON.
ECRS Web User Guide Appendix G: CWF Assistance Request Detail Record G-9 Data Field Length Type Displacement Description Informant’s Relationship Code 1 Alpha 480 Relationship of informant to beneficiary. Valid values are: A = Attorney representing beneficiary B = Beneficiary C = Child D = Defendant’s attorney E = Employer F = Father I = Insurer M = Mother N = Non-relative O = Other relative P = Provider R = Beneficiary representative other than attorney S = Spouse U = Unknown Required when SOURCE is CHEK, LTTR or PHON. Populate with spaces if Source field not equal to CHEK, LTTR or PHON. Employer’s Name 32 Text 481-512 Name of employer providing group health insurance under which beneficiary is covered Not required. Populate with spaces if not available. Employer EIN 18 Text 513-530 Employer’s Identification Number Not required. Populate with spaces if not available. Employer’s Address 1 32 Text 531-562 Employer’s Street Address 1 Not required. Populate with spaces if not available. Employer’s Address 2 32 Text 563-594 Employer’s Street Address 2 Not required. Populate with spaces if not available. Employer’s Phone 10 Numeric 595-604 Employer’s Telephone Number Not required. Populate with spaces if not available. Employer’s City 15 Text 605-619 Employer’s City Not required. Populate with spaces if not available. Employer’s State 2 Alpha 620-621 Employer’s state Not required. Populate with spaces if not available. Employer’s ZIP Code 9 Numeric 622-630 Employer’s ZIP code Not required. Populate with spaces if not available. Employee No 12 Text 631-642 Employee number of policyholder Not required. Populate with spaces if not available.
ECRS Web User Guide Appendix G: CWF Assistance Request Detail Record G-10 Data Field Length Type Displacement Description Insurer’s Name 32 Text 643-674 Name of insurance carrier for MSP coverage Required for II ACTION. Populate with spaces if ACTION not equal to II. Note: The record will be rejected and return error code PE42 on the response file if: • The action code is II; and • The Insurer’s Name field (643-674) is blank, less than two characters, or contains one of the following invalid names: Attorney, BC, BCBS, BCBX,BCRC, Benefits Coordination & Recovery, Benefits Coordination & Recovery Center, Benefits Coordination and Recove, Benefits Coordination and Recovery Center, Blue Cross, Blue Shield, BS, BX, CMS, COB, COBC, Coordination of Benefits Contrac, Coordination of Benefits Contractor, HCFA, Insurer, Medicare, Misc, Miscellaneous, N/A, NA, NO, No Fault, No-Fault, None, Supplement, Supplemental, UN, UNK, Unknown, and XX. Insurer Type 1 Alpha 675 Type of insurance A = Insurance or Indemnity (Other Types) H = Multiple Employer Health Plan with 100 or more employees. I = Multiple Employer Health Plan with 20 or more employees. J = Hospitalization only plan covering inpatient hospital K = Medical Service only plan covering non- inpatient medical M = Medicare Supplement Plan U = Unknown Not required. Populate with A if not available. Insurer’s Address 1 32 Text 676-707 Insurer’s street address 1 Not required. Populate with spaces if not available. Insurer’s Address 2 32 Text 708-739 Insurer’s street address 2 Not required. Populate with spaces if not available. Insurer’s City 15 Text 740-754 Insurer’s city Not required. Populate with spaces if not available. Insurer’s State 2 Alpha 755-756 Insurer’s state Not required. Populate with spaces if not available. Insurer’s ZIP Code 9 Numeric 757-765 Insurer’s ZIP code Not required. Populate with spaces if not available. Insurer’s Phone 10 Numeric 766-775 Insurer’s telephone number Not required. Populate with zeros if not available.
ECRS Web User Guide Appendix G: CWF Assistance Request Detail Record G-11 Data Field Length Type Displacement Description Insurer Group Number 20 Text 776-795 Group number of insurance coverage. Not required. Populate with spaces if not available. Insurer Policy Number 17 Text 796-812 Policy number of insurance coverage. Not required. Populate with spaces if not available. Subscriber First Name 15 Text 813-827 First name of individual covered by this insurance. Not required. Populate with spaces if not available. Subscriber Initial 1 Alpha 828 Middle initial of individual covered by this insurance. Not required. Populate with spaces if not available. Subscriber Last Name 24 Text 829-852 Last name of individual covered by this insurance. Not required. Populate with spaces if not available. PHP Date 8 Date 853-860 Pre-paid Health Plan date in CCYYMMDD format. Not required. Populate with zeros if not available. Remarks Code 1 2 Alpha- Numeric 861-862 Two-character CWF remark code explaining reason for transaction. See Appendix F for a list of remark codes. Not required. Populate with spaces if not available. Remarks Code 2 2 Alpha- Numeric 863-864 Two-character CWF remark code explaining reason for transaction. See Appendix F for a list of remark codes. Not required. Populate with spaces if not available. Remarks Code 3 2 Alpha- Numeric 865-866 Two-character CWF remark code explaining reason for transaction. See Appendix F for a list of remark codes. Not required. Populate with spaces if not available. Filler 25 Filler 867-891 Filler Submitter Type 1 Alpha 892 Part C/D Submitter Indicator Valid Values ‘C’ = Part C contractor ‘D’ = Part D contractor If not valid value, drop file with error code HE06. Filler 7 Filler 893-899 Filler Trans Comment 180 Text 900-1079 Comments—used by submitter Filler 8 Filler 1080-1087 Filler
ECRS Web User Guide Appendix G: CWF Assistance Request Detail Record G-12 Data Field Length Type Displacement Description New Patient Relationship 2 Numeric 1088-1089 New patient relationship between the policyholder and the beneficiary. Description of code appears next to value. Required field when ACTION is PR. Valid values are: 01 Self; Patient is policyholder 02 Spouse 03 Child 04 Other 20 Domestic partner Notes: All patient relationship values accepted for MSP Types B and G. MSP Type A will accept 01 and 02. MSP Types D, E, L, H, W, S, and T will only accept 01. New MSP Type 1 Alpha 1090 One-character code identifying type of MSP coverage. Valid values are: A = Working Aged B = ESRD C = Conditional Payment D = Automobile Insurance E = Workers’ Compensation F = Federal (Public) G = Disabled H = Black Lung L = Liability W =Workers’ Compensation Set-Aside Required when Action is MT. New MSP Effective Date 8 Date 1091-1098 Effective date of MSP coverage in CCYYMMDD format. Notes: This field accepts dates up to three months from the current date, as follows: For GHP records (MSP Types A, B, and G): The New MSP Effective Date can be in the future for currently entitled beneficiaries (i.e., enrolled in Medicare), or for beneficiaries who will be entitled starting up to three months in the future. For NGHP records (MSP Types D, E, L, H, and W): The New MSP Effective Date can be in the future for beneficiaries as long as their entitlement start date is in the future. The future New MSP Effective Date must be equal to the entitlement start date. (NGHP MSP occurrences for beneficiaries who are currently entitled cannot have future MSP Effective Dates.) Required when Action is ED.
ECRS Web User Guide Appendix G: CWF Assistance Request Detail Record G-13 Data Field Length Type Displacement Description New Insurer Type 1 Alpha 1099 New type of insurance Required when ACTION is IT Diagnosis Code 1 ICD Indicator 1 Numeric 1100 One-digit diagnosis code indicator to identify whether the submitted Diagnosis Code 1 is in ICD- 9-CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE1A and the record will be dropped. Required if Diagnosis Code 1 is submitted. Diagnosis Code 1 7 Text 1101 – 1107 ICD-9-CM Diagnosis Code or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if action code is CA or CL. Required if Diagnosis Code 1 ICD Indicator is submitted. If Diagnosis Code 1 ICD Indicator = 0, Diagnosis Code 1 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 1 ICD Indicator = 9, Diagnosis Code 1 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. * Refer to Appendix B for complete set of required fields for various source codes. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE69 and the record will be dropped. Diagnosis Code 2 ICD Indicator 1 Numeric 1108 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9- CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE1B and the record will be dropped. Required if Diagnosis Code 2 is submitted.
ECRS Web User Guide Appendix G: CWF Assistance Request Detail Record G-14 Data Field Length Type Displacement Description Diagnosis Code 2 7 Text 1109-1115 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 2 ICD Indicator is submitted. If Diagnosis Code 2 ICD Indicator = 0, Diagnosis Code 2 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 2 ICD Indicator = 9, Diagnosis Code 2 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE70 and the record will be dropped. Diagnosis Code 3 ICD Indicator 1 Numeric 1116 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9- CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE1C and the record will be dropped. Required if Diagnosis Code 3 is submitted. Diagnosis Code 3 7 Text 1117 – 1123 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 3 ICD Indicator is submitted. If Diagnosis Code 3 ICD Indicator = 0, Diagnosis Code 3 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 3 ICD Indicator = 9, Diagnosis Code 3 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE71 and the record will be dropped. Not required. Diagnosis Code 4 ICD Indicator 1 Numeric 1124 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9- CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE1D and the record will be dropped. Required if Diagnosis Code 4 is submitted.
ECRS Web User Guide Appendix G: CWF Assistance Request Detail Record G-15 Data Field Length Type Displacement Description Diagnosis Code 4 7 Text 1125 - 1131 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 4 ICD Indicator is submitted. If Diagnosis Code 4 ICD Indicator = 0, Diagnosis Code 4 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 4 ICD Indicator = 9, Diagnosis Code 4 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE72 and the record will be dropped. Diagnosis Code 5 ICD Indicator 1 Numeric 1132 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9- CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE1E and the record will be dropped. Required if Diagnosis Code 5 is submitted. Diagnosis Code 5 7 Text 1133 - 1139 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 5 ICD Indicator is submitted. If Diagnosis Code 5 ICD Indicator = 0, Diagnosis Code 5 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 5 ICD Indicator = 9, Diagnosis Code 5 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE73 and the record will be dropped. Diagnosis Code 6 ICD Indicator 1 Numeric 1140 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9- CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE1F and the record will be dropped. Required if Diagnosis Code 6 is submitted.
ECRS Web User Guide Appendix G: CWF Assistance Request Detail Record G-16 Data Field Length Type Displacement Description Diagnosis Code 6 7 Text 1141 – 1147 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 6 ICD Indicator is submitted. If Diagnosis Code 6 ICD Indicator = 0, Diagnosis Code 6 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 6 ICD Indicator = 9, Diagnosis Code 6 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE1G and the record will be dropped. Diagnosis Code 7 ICD Indicator 1 Numeric 1148 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9- CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE1H and the record will be dropped. Required if Diagnosis Code 7 is submitted. Diagnosis Code 7 7 Text 1149 – 1155 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 7 ICD Indicator is submitted. If Diagnosis Code 7 ICD Indicator = 0, Diagnosis Code 7 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 7 ICD Indicator = 9, Diagnosis Code 7 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE1I and the record will be dropped. Diagnosis Code 8 ICD Indicator 1 Numeric 1156 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9- CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM If an invalid code is entered, the user will see error code PE1J and the record will be dropped. Required if Diagnosis Code 8 is submitted.
ECRS Web User Guide Appendix G: CWF Assistance Request Detail Record G-17 Data Field Length Type Displacement Description Diagnosis Code 8 7 Text 1157 – 1163 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 8 ICD Indicator is submitted. If Diagnosis Code 8 ICD Indicator = 0, Diagnosis Code 8 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 8 ICD Indicator = 9, Diagnosis Code 8 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE1K and the record will be dropped. Diagnosis Code 9 ICD Indicator 1 Numeric 1164 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9- CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE1L and the record will be dropped. Required if Diagnosis Code 9 is submitted. Diagnosis Code 9 7 Text 1165 – 1171 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 9 ICD Indicator is submitted. If Diagnosis Code 9 ICD Indicator = 0, Diagnosis Code 9 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 9 ICD Indicator = 9, Diagnosis Code 9 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE1M and the record will be dropped. Diagnosis Code 10 ICD Indicator 1 Numeric 1172 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9- CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE1N and the record will be dropped. Required if Diagnosis Code 10 is submitted.
ECRS Web User Guide Appendix G: CWF Assistance Request Detail Record G-18 Data Field Length Type Displacement Description Diagnosis Code 10 7 Text 1173 – 1179 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 10 ICD Indicator is submitted. If Diagnosis Code 10 ICD Indicator = 0, Diagnosis Code 10 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 10 ICD Indicator = 9, Diagnosis Code 10 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE1O and the record will be dropped. Diagnosis Code 11 ICD Indicator 1 Numeric 1180 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9- CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE1P and the record will be dropped. Required if Diagnosis Code 11 is submitted. Diagnosis Code11 7 Text 1181 – 1187 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 11 ICD Indicator is submitted. If Diagnosis Code 11 ICD Indicator = 0, Diagnosis Code 11 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 11 ICD Indicator = 9, Diagnosis Code 11 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE1Q and the record will be dropped. Diagnosis Code 12 ICD Indicator 1 Numeric 1188 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9- CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE1R and the record will be dropped. Required if Diagnosis Code 12 is submitted.
ECRS Web User Guide Appendix G: CWF Assistance Request Detail Record G-19 Data Field Length Type Displacement Description Diagnosis Code 12 7 Text 1189 – 1195 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 12 ICD Indicator is submitted. If Diagnosis Code 12 ICD Indicator = 0, Diagnosis Code 12 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 12 ICD Indicator = 9, Diagnosis Code 12 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE1S and the record will be dropped. Diagnosis Code 13 ICD Indicator 1 Numeric 1196 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9- CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE1T and the record will be dropped. Required if Diagnosis Code 13 is submitted. Diagnosis Code 13 7 Text 1197 – 1203 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 13 ICD Indicator is submitted. If Diagnosis Code 13 ICD Indicator = 0, Diagnosis Code 13 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 13 ICD Indicator = 9, Diagnosis Code 13 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE1U and the record will be dropped. Diagnosis Code 14 ICD Indicator 1 Numeric 1204 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9- CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE1V and the record will be dropped. Required if Diagnosis Code 14 is submitted.
ECRS Web User Guide Appendix G: CWF Assistance Request Detail Record G-20 Data Field Length Type Displacement Description Diagnosis Code 14 7 Text 1205 – 1211 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 14 ICD Indicator is submitted. If Diagnosis Code 14 ICD Indicator = 0, Diagnosis Code 14 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 14 ICD Indicator = 9, Diagnosis Code 14 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE1W and the record will be dropped. Diagnosis Code 15 ICD Indicator 1 Numeric 1212 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9- CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE1X and the record will be dropped. Required if Diagnosis Code 15 is submitted. Diagnosis Code 15 7 Text 1213 – 1219 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 15 ICD Indicator is submitted. If Diagnosis Code 15 ICD Indicator = 0, Diagnosis Code 15 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 15 ICD Indicator = 9, Diagnosis Code 15 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE1Y and the record will be dropped. Diagnosis Code 16 ICD Indicator 1 Numeric 1220 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9- CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE1Z and the record will be dropped. Required if Diagnosis Code 16 is submitted.
ECRS Web User Guide Appendix G: CWF Assistance Request Detail Record G-21 Data Field Length Type Displacement Description Diagnosis Code 16 7 Text 1221 – 1227 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 16 ICD Indicator is submitted. If Diagnosis Code 16 ICD Indicator = 0, Diagnosis Code 16 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 16 ICD Indicator = 9, Diagnosis Code 16 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE2A and the record will be dropped. Diagnosis Code 17 ICD Indicator 1 Numeric 1228 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9- CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE2B and the record will be dropped. Required if Diagnosis Code 17 is submitted. Diagnosis Code 17 7 Text 1229 – 1235 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 17 ICD Indicator is submitted. If Diagnosis Code 17 ICD Indicator = 0, Diagnosis Code 17 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 17 ICD Indicator = 9, Diagnosis Code 17 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE2C and the record will be dropped. Diagnosis Code 18 ICD Indicator 1 Numeric 1236 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9- CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE2D and the record will be dropped. Required if Diagnosis Code 18 is submitted.
ECRS Web User Guide Appendix G: CWF Assistance Request Detail Record G-22 Data Field Length Type Displacement Description Diagnosis Code 18 7 Text 1237 – 1243 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 18 ICD Indicator is submitted. If Diagnosis Code 18 ICD Indicator = 0, Diagnosis Code 18 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 18 ICD Indicator = 9, Diagnosis Code 18 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE2E and the record will be dropped. Diagnosis Code 19 ICD Indicator 1 Numeric 1244 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9- CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE2F and the record will be dropped. Required if Diagnosis Code 19 is submitted. Diagnosis Code 19 7 Text 1245 – 1251 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 19 ICD Indicator is submitted. If Diagnosis Code 19 ICD Indicator = 0, Diagnosis Code 19 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 19 ICD Indicator = 9, Diagnosis Code 19 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE2G and the record will be dropped. Diagnosis Code 20 ICD Indicator 1 Numeric 1252 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9- CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE2H and the record will be dropped. Required if Diagnosis Code 20 is submitted.
ECRS Web User Guide Appendix G: CWF Assistance Request Detail Record G-23 Data Field Length Type Displacement Description Diagnosis Code 20 7 Text 1253 – 1259 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 20 ICD Indicator is submitted. If Diagnosis Code 20 ICD Indicator = 0, Diagnosis Code 20 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 20 ICD Indicator = 9, Diagnosis Code 20 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE2I and the record will be dropped. Filler 8 Filler 1260 – 1267 Filler
ECRS Web User Guide Appendix G: CWF Assistance Request Response Header Record G-24 CWF Assistance Request Response Header Record Table G-4: CWF Assistance Request Response Header Record Layout Data Field Length Type Displacement Error Code if Invalid Data Header Indicator 2 Alpha-Numeric 1-2 HE01 PDP ID 4 Numeric 3-6 HE02 Contractor Number 5 Alpha-Numeric 7-11 HE03 File Type 3 Alpha 12-14 HE04 File Date 8 Date 15-22 HE05 Filler 1245 Filler 23-1267 Unused Field – fill with spaces Error Code 1 4 Alpha-Numeric 1268-1271 Error code describing reason why file was rejected. Error Code 2 4 Alpha-Numeric 1272-1275 Error code describing reason why file was rejected. Error Code 3 4 Alpha-Numeric 1276-1279 Error code describing reason why file was rejected. Error Code 4 4 Alpha-Numeric 1280-1283 Error code describing reason why file was rejected.
ECRS Web User Guide Appendix G: CWF Assistance Request Response Detail Record G-25 CWF Assistance Request Response Detail Record This record layout must be returned for all CWF Assistance Request file transmissions. Table G-5: CWF Assistance Request Response Detail Record Layout Data Field Length Type Displacement Error Code if Invalid Data Transaction type 4 Alpha 1-4 PE00 Contractor Number 5 Alpha- Numeric 5-9 PE01 DCN 15 Text 10-24 PE02 Tran Type Code 1 Alpha 25 PE03 Trans Seq No 3 Numeric 26-28 PE04 Update Operator ID 8 Alpha- Numeric 29-36 PE06 Contractor Name 25 Text 37-61 PE07 Contractor Phone 10 Numeric 62-71 PE08 Tran Stat Cd 2 Alpha 72-73 Status code returned from ECRS Tran Reason Cd 2 Numeric 74-75 Reason code returned from ECRS Trans Action Code 1 2 Alpha 76-77 PE92 Trans Action Code 2 2 Alpha- Numeric 78-79 PE93 Trans Action Code 3 2 Alpha- Numeric 80-81 PE94 Trans Action Code 4 2 Alpha- Numeric 82-83 PE95 Activity Code 1 Alpha 84 PE61 Develop to 1 Alpha 85 PE0C RSP 1 Alpha 86 PE66 Trans Source Cd 4 Alpha 87-90 PE05 Medicare ID 12 Alpha- Numeric 91-102 PE09, PE2O Beneficiary’s Social Security Number 9 Numeric 103-111 PE10 Beneficiary’s Date of Birth 8 Date 112-119 PE11 Beneficiary’s Sex Code 1 Numeric 120 None Beneficiary’s First Name 15 Text 121-135 PE12 Beneficiary’s Initial 1 Alpha 136 PE13
ECRS Web User Guide Appendix G: CWF Assistance Request Response Detail Record G-26 Data Field Length Type Displacement Error Code if Invalid Data Beneficiary’s Last Name 24 Text 137-160 PE14 Patient Relationship 2 Numeric 161-162 PE0J MSP Type 1 Alpha 163 PE39 MSP Effective Date 8 Date 164-171 PE67 MSP Term Date 8 Date 172-179 PE68 MSP Aux Number 3 Numeric 180-182 PE87 MSP Accretion Date 8 Date 183-190 PE88 Originating Contractor 5 Alpha- Numeric 191-195 PE96 Change Lead To 5 Alpha- Numeric 196-200 PE0D Send Venue Letter 1 Alpha 201 None Beneficiary’s Address 1 32 Text 202-233 PE15 Beneficiary’s Address 2 32 Text 234-265 PE16 Beneficiary’s City 15 Text 266-280 PE17 Beneficiary’s State 2 Alpha 281-282 PE18 Beneficiary’s ZIP Code 9 Numeric 283-291 PE19 Beneficiary’s Phone 10 Numeric 292-301 PE20 Check Date 8 Numeric 302-309 PE98 Check Amount 15 Alpha 310-324 PE99 Check Number 15 Alpha 325-339 PE0A Informant’s First Name 15 Text 340-354 PE21 Informant’s Middle Initial 1 Alpha 355 PE22 Informant’s Last Name 24 Text 356-379 PE23 Informant’s Phone 10 Numeric 380-389 PE29 Informant’s Address 1 32 Text 390-421 PE24 Informant’s Address 2 32 Text 422-453 PE25 Informant’s City 15 Text 454-468 PE26 Informant’s State 2 Alpha 469-470 PE27 Informant’s ZIP Code 9 Numeric 471-479 PE28 Informant’s Relationship Code 1 Alpha 480 None Employer’s Name 32 Text 481-512 PE30
ECRS Web User Guide Appendix G: CWF Assistance Request Response Detail Record G-27 Data Field Length Type Displacement Error Code if Invalid Data Employer EIN 18 Text 513-530 PE37 Employer’s Address 1 32 Text 531-562 PE31 Employer’s Address 2 32 Text 563-594 PE32 Employer’s Phone 10 Numeric 595-604 PE36 Employer’s City 15 Text 605-619 PE33 Employer’s State 2 Alpha 620-621 PE34 Employer’s ZIP Code 9 Numeric 622-630 PE35 Employee No 12 Text 631-642 PE38 Insurer’s Name 32 Text 643-674 PE42 Insurer Type 1 Alpha 675 None Insurer’s Address 1 32 Text 676-707 PE43 Insurer’s Address 2 32 Text 708-739 PE44 Insurer’s City 15 Text 740-754 PE45 Insurer’s State 2 Alpha 755-756 PE46 Insurer’s ZIP Code 9 Numeric 757-765 PE47 Insurer’s Phone 10 Numeric 766-775 None (field not in use) Insurer Group Number 20 Text 776-795 PE62 Insurer Policy Number 17 Text 796-812 PE63 Subscriber First Name 15 Text 813-827 PE58 Subscriber Initial 1 Alpha 828 PE59 Subscriber Last Name 24 Text 829-852 PE60 PHP Date 8 Date 853-860 PE97 Remarks Code 1 2 Alpha- Numeric 861-862 PE89 Remarks Code 2 2 Alpha- Numeric 863-864 PE90 Remarks Code 3 2 Alpha- Numeric 865-866 PE91 Filler 25 Filler 867-891 None Submitter Type 1 Alpha 892 Severe Error will be created and entire file will be dropped. HE06 error will be returned on Header record of response file. Filler 7 Filler 893-899 Filler New Patient Relationship 2 Numeric 900-901 PE0O New MSP Type 1 Alpha 902 PE0N
ECRS Web User Guide Appendix G: CWF Assistance Request Response Detail Record G-28 Data Field Length Type Displacement Error Code if Invalid Data New MSP Effective Date 8 Date 903-910 PE0L New Insurer Type 1 Alpha 911 PE0M Diagnosis Code 1 ICD Indicator 1 Text 912 PE1A Diagnosis Code 1 7 Text 913-919 PE69 Diagnosis Code 2 ICD Indicator 1 Text 920 PE1B Diagnosis Code 2 7 Text 921-927 PE70 Diagnosis Code 3 ICD Indicator 1 Text 928 PE1C Diagnosis Code 3 7 Text 929-935 PE71 Diagnosis Code 4 ICD Indicator 1 Text 936 PE1D Diagnosis Code 4 7 Text 937-943 PE72 Diagnosis Code 5 ICD Indicator 1 Text 944 PE1E Diagnosis Code 5 7 Text 945-951 PE73 Diagnosis Code 6 ICD Indicator 1 Text 952 PE1F Diagnosis Code 6 7 Text 953-959 PE1G Diagnosis Code 7 ICD Indicator 1 Text 960 PE1H Diagnosis Code 7 7 Text 961-967 PE1I Diagnosis Code 8 ICD Indicator 1 Text 968 PE1J Diagnosis Code 8 7 Text 969-975 PE1K Diagnosis Code 9 ICD Indicator 1 Text 976 PE1L Diagnosis Code 9 7 Text 977-983 PE1M Diagnosis Code 10 ICD Indicator 1 Text 984 PE1N Diagnosis Code 10 7 Text 985-991 PE1O Diagnosis Code 11 ICD Indicator 1 Text 992 PE1P Diagnosis Code11 7 Text 993-999 PE1Q Diagnosis Code 12 ICD Indicator 1 Text 1000 PE1R Diagnosis Code 12 7 Text 1001-1007 PE1S Diagnosis Code 13 ICD Indicator 1 Text 1008 PE1T
ECRS Web User Guide Appendix G: CWF Assistance Request Response Detail Record G-29 Data Field Length Type Displacement Error Code if Invalid Data Diagnosis Code 13 7 Text 1009-1015 PE1U Diagnosis Code 14 ICD Indicator 1 Text 1016 PE1V Diagnosis Code 14 7 Text 1017-1023 PE1W Diagnosis Code 15 ICD Indicator 1 Text 1024 PE1X Diagnosis Code 15 7 Text 1025-1031 PE1Y Diagnosis Code 16 ICD Indicator 1 Text 1032 PE1Z Diagnosis Code 16 7 Text 1033-1039 PE2A Diagnosis Code 17 ICD Indicator 1 Text 1040 PE2B Diagnosis Code 17 7 Text 1041-1047 PE2C Diagnosis Code 18 ICD Indicator 1 Text 1048 PE2D Diagnosis Code 18 7 Text 1049-1055 PE2E Diagnosis Code 19 ICD Indicator 1 Text 1056 PE2F Diagnosis Code 19 7 Text 1057-1063 PE2G Diagnosis Code 20 ICD Indicator 1 Text 1064 PE2H Diagnosis Code 20 7 Text 1065-1071 PE2I Filler 8 Filler 1072-1079 None COB Comment ID 8 Alpha- Numeric 1080-1087 PE57 COB Comment 180 Text 1088-1267 PE56 Error Code 1 4 Alpha- Numeric 1268-1271 Error code describing reason why file was rejected. Error Code 2 4 Alpha- Numeric 1272-1275 Error code describing reason why file was rejected. Error Code 3 4 Alpha- Numeric 1276-1279 Error code describing reason why file was rejected. Error Code 4 4 Alpha- Numeric 1280-1283 Error code describing reason why file was rejected.
ECRS Web User Guide Appendix G: Prescription Drug Assistance Request Header Record G-30 G.2 Prescription Drug Assistance Request File Layouts Prescription Drug Assistance Request Header Record Table G-6: Prescription Drug Assistance Request Header Record Layout Data Field Length Type Displacement Edits Header Indicator 2 Alpha- Numeric 1-2 Should be: ‘H0’. If not, drop file with error code HE01 PDP ID 4 Numeric 3-6 ‘0001’, ‘0002’, etc. ID number assigned by the BCRC. If not valid plan, drop file with error code HE02 Contractor Number 5 Alpha- Numeric 7-11 If not valid contractor number, drop file with error code HE03. File Type 3 Alpha 12-14 Valid values: ‘PDR’ – RX Drug Assistance Request file If not, drop file with error code HE04. File Date 8 Date 15-22 CCYYMMDD If not valid date, drop file with error code HE05. Submitter Type 1 Alpha- Numeric 23 Part C/D Submitter Indicator Valid Values ‘C’ = Part C contractor ‘D’ = Part D contractor If not valid value, drop file with error code HE06. Filler 1244 Filler 24-1267 Unused Field – fill with spaces
ECRS Web User Guide Appendix G: Prescription Drug Assistance Request Trailer Record G-31 Prescription Drug Assistance Request Trailer Record Table G-7: Prescription Drug Assistance Request Trailer Record Layout Data Field Length Type Displacement Edits Trailer Indicator 2 Alpha- Numeric 1-2 Should be: ‘T0’. If not, drop file with error code TE01. PDP ID 4 Numeric 3-6 ‘0001’, ‘0002’, etc. ID number assigned by the BCRC. If not valid plan, drop file with error code TE02. Contractor Number 5 Alpha- Numeric 7-11 If not valid contractor number, drop file with error code TE03. File Type 3 Alpha- Numeric 12-14 Valid value: PDR’ – RX Drug Assistance Request File If not valid value, drop file with error code TE04. File Date 8 Date 15-22 CCYYMMDD If not valid date, drop file with error code TE05. Record Count 9 Numeric 23-31 Number of records on file. Must contain 9 digits. If invalid number or number does not match number of records in file, drop file with error code TE06. Filler 1236 Filler 32-1267 Unused Field – fill with spaces.
ECRS Web User Guide Appendix G: Prescription Drug Assistance Request Detail Record G-32 Prescription Drug Assistance Request Detail Record Table G-8: Prescription Drug Assistance Request Detail Record Layout Data Field Length Type Displacement Description Transaction type 4 Alpha 1-4 Set to ‘ECRS’ Contractor Number 5 Alpha- Numeric 5-9 Part C/D Plan contractor number Required DCN 15 Alpha- Numeric 10-24 DCN: assigned by the Part C/D plan. Required. Each record shall have a unique DCN. Trans Type Code 1 Alpha 25 Transaction Type Indicator Set to ‘D’ for Prescription Drug Assistance Requests Required Trans Seq. No 3 Numeric 26-28 Sequence Number assigned by the COB. Internal use only. Populate with spaces. Update Operator ID 8 Alpha- Numeric 29-36 ID of user making update. Not required Contractor Name 25 Alpha- Numeric 37-61 Contractor name Not required Contractor Phone 10 Numeric 62-71 Contractor phone number Not required Trans Status Code 2 Alpha 72-73 Transaction status code: Set to ‘NW’ for New Trans Reason Code 2 Numeric 74-75 Transaction reason code: Set to ‘01’ for New Action Code 1 2 Alpha 76-77 Two-character code defining action to take on Prescription Drug record (required field). Valid values are: II Change Insurer Information DR Investigate Closed or Deleted Record Notes: Action code II cannot be used with Action code DO. Action code DR cannot be used with any other action codes. Action Code 2 2 Alpha 78-79 Transaction action code 2: Valid values same as Trans Action Code 1. Not required. Populate with spaces if not available. Action Code 3 2 Alpha 80-81 Transaction action code 3: Valid values same as Trans Action Code 1. Not required. Populate with spaces if not available. Action Code 4 2 Alpha 82-83 Transaction action code 4: Valid values same as Trans Action Code 1. Not required. Populate with spaces if not available.
ECRS Web User Guide Appendix G: Prescription Drug Assistance Request Detail Record G-33 Data Field Length Type Displacement Description Activity Code 1 Alpha 84 Activity of contractor: Valid values are: Required Trans Source Code 4 Alpha 85-88 Four-character code identifying source of RX DRUG assistance request information Valid values are: Required Medicare ID 12 Alpha- Numeric 89-100 Health Insurance Claim Number (HICN) or Medicare Beneficiary Identifier (MBI) of beneficiary. Enter without dashes, spaces, or other special characters. Beneficiary Date of Birth 8 Date 101-108 Beneficiary’s Date of Birth in CCYYMMDD format Not Required. Populate with zeros if not available. Beneficiary Sex Code 1 Alpha 109 Sex of Beneficiary: Valid values are: U = Unknown M = Male F = Female Not required. Populate with spaces if not available. Beneficiary First Name 15 Text 110-124 First Name of beneficiary Required Beneficiary Middle Initial 1 Text 125 Middle Initial of beneficiary Beneficiary Last Name 24 Text 126-149 Last Name of beneficiary Required Beneficiary Address Line 1 32 Text 150-181 First line of beneficiary’s street address Beneficiary Address Line 2 32 Text 182-213 Second line of beneficiary’s street address Beneficiary City 15 Text 214-228 Beneficiary’s city Beneficiary State 2 Alpha 229-230 Beneficiary’s state Beneficiary ZIP code 9 Numeric 231-239 Beneficiary’s ZIP code Beneficiary Phone 10 Numeric 240-249 Beneficiary’s telephone number
ECRS Web User Guide Appendix G: Prescription Drug Assistance Request Detail Record G-34 Data Field Length Type Displacement Description Patient Relationship 2 Numeric 250-251 Patient relationship between the policyholder and the beneficiary (required field). Description of code appears next to value. Valid values are: 01 Self; Patient is policyholder 02 Spouse 03 Child 04 Other 20 Domestic partner Notes: All patient relationship values accepted for MSP Types B and G. MSP Type A will accept 01 and 02. New Patient Relationship 2 Numeric 252-253 New patient relationship between policyholder and beneficiary. Description of code appears next to value. Required when ACTION is PR. 01 Self; Patient is policyholder 02 Spouse 03 Child 04 Other 20 Domestic partner Notes: All patient relationship values accepted for MSP Types B and G. MSP Type A will accept 01 and 02. Person Code 3 Numeric 254-256 Plan-specific Person Code. Values are: 001 Self 002 Spouse 003 Other Required when: RECORD TYPE is Supplemental MSP Type 1 Alpha 257 One-character code identifying type of MSP coverage. Valid values are: A = Working Aged B = ESRD C = Conditional Payment F = Federal (Public) G = Disabled Required when Action is MT. New MSP Type 1 Alpha 258 One-character code identifying new type of MSP coverage. Required when Action is MT.
ECRS Web User Guide Appendix G: Prescription Drug Assistance Request Detail Record G-35 Data Field Length Type Displacement Description Record Type 3 Alpha- Numeric 259-261 Drug Record Type: PRI Primary SUP Supplemental Required Drug Coverage Effective Date 8 Date 262-269 COB effective date of drug coverage in CCYYMMDD format. Notes: This field accepts dates up to three months from the current date, as follows: For GHP records (MSP Types A, B, and G): The Drug Coverage Effective Date can be in the future for beneficiaries who are currently enrolled in Part D, or for beneficiaries who will be enrolled starting up to three months in the future. New Drug Coverage Effective Date 8 Date 270-277 New COB effective date of drug coverage in CCYYMMDD format. Notes: This field accepts dates up to three months from the current date, as follows: For GHP records (MSP Types A, B, and G): The New Drug Coverage Effective Date can be in the future for beneficiaries who are currently enrolled in Part D, or for beneficiaries who will be enrolled starting up to three months in the future. Term Date 8 Date 278-285 MSP termination date of Drug coverage in CCYYMMDD format. Originating Contractor 5 Alpha- Numeric 286-290 Contractor number of contractor that created original Drug occurrence. Informant First Name 15 Text 291-305 Name of person informing contractor of change in Drug coverage. Required when SOURCE is CHEK or LTTR. Populate with spaces if Source field not equal to CHEK or LTTR. Informant Middle Initial 1 Text 306 Informants middle initial. Informant Last Name 24 Text 307-330 Last name of person informing contractor of change in Drug coverage. Required when SOURCE is CHEK or LTTR. Populate with spaces if Source field not equal to CHEK or LTTR. Informant Address 32 Text 331-362 Informant’s street address Required when SOURCE is CHEK or LTTR. Populate with spaces if Source field not equal to CHEK or LTTR. Informant City 15 Text 363-377 Informant's city Required when SOURCE is CHEK or LTTR. Populate with spaces if SOURCE field not equal to CHEK or LTTR.
ECRS Web User Guide Appendix G: Prescription Drug Assistance Request Detail Record G-36 Data Field Length Type Displacement Description Informant State 2 Text 378-379 Informant's state Required when SOURCE is CHEK or LTTR. Populate with spaces if SOURCE field not equal to CHEK or LTTR. Informant ZIP code 9 Numeric 380-388 Informant's ZIP code Required when SOURCE is CHEK or LTTR. Populate with spaces if SOURCE field not equal to CHEK or LTTR. Informant Phone 10 Numeric 389-398 Informant's telephone number Not Required. Populate with spaces if not available. Informant's Relationship Code 1 Alpha 399 Relationship of informant to beneficiary. Valid values are: Required when SOURCE is CHEK or LTTR. Populate with spaces if SOURCE field not equal to CHEK or LTTR. Employers Name 32 Text 400-431 Name of employer providing group health insurance under which beneficiary is covered Not required. Populate with spaces if not available. Employers Address 1 32 Text 432-463 Employer’s street address 1 Not required. Populate with spaces if not available. Employers Address 2 32 Text 464-495 Employer’s street address 2 Not required. Populate with spaces if not available. Employers City 15 Text 496-510 Employer’s city Not required. Populate with spaces if not available. Employers State 2 Alpha 511-512 Employer’s state Not required. Populate with spaces if not available. Employers ZIP code 9 Numeric 513-521 Employer’s ZIP code Not required. Populate with spaces if not available. Employers Phone 10 Numeric 522-531 Employer's phone number Not required. Populate with spaces if not available. Employers EIN 18 Text 532-549 Employer’s identification number Not required. Populate with spaces if not available. Employee Number 12 Text 550-561 Employee number of policyholder Not required. Populate with spaces if not available.
ECRS Web User Guide Appendix G: Prescription Drug Assistance Request Detail Record G-37 Data Field Length Type Displacement Description Supplemental Type 1 Alpha- Numeric 562 Prescription drug policy type. Valid values are: L Supplemental N Non-qualified State Program P PAP R Charity T Federal Government Programs 1 Medicaid 2 Tricare 3 Major Medical RX Drug Coverage Type 1 Alpha- Numeric 563 Prescription drug coverage type Valid Values are: U Drug Network V Drug Non-network Z Health account (such as a flexible spending account provided by other party to pay prescription drug costs or premiums) Required Insurance Company Name 32 Text 564-595 Name of insurer providing supplemental prescription drug insurance under which beneficiary is covered. Action code II cannot be used with action code DO. Note: The record will be rejected and return error code PE42 on the response file if: • The action code is II; and • The Insurer’s Name field (564-595) is blank, less than two characters, or contains one of the following invalid names: ADAP, Assistance Program, Attorney, BC, BCBS, BCBX, BCRC, Beneficiary’s name (Effective July 2026), Benefits Coordination & Recovery, Benefits Coordination & Recovery Center, Benefits Coordination and Recove, Benefits Coordination and Recovery Center, Blue Cross, Blue Shield, BS, BX, CMS, COB, COBC, Coordination of Benefits Contrac, Coordination of Benefits Contractor, HCFA, Insurer, Medicaid, Medicare, Misc, Miscellaneous, N/A, NA, NO, No Fault, No-Fault, None, PAP, QSP, Qualified State Program, SPAP, Supplement, Supplemental, TRICARE, UN, UNK, Unknown, (Effective July 2026) US DEPT OF VETERANS AFFAIRS, VA, VA BENEFITS, VA COVERAGE, VETERANS ADMINISTRATION, VETERANS AFFAIRS, and XX. Insurance Company Address 1 32 Text 596-627 Address 1 of insurer providing supplemental prescription drug insurance under which beneficiary is covered.
ECRS Web User Guide Appendix G: Prescription Drug Assistance Request Detail Record G-38 Data Field Length Type Displacement Description Insurance Company Address 2 32 Text 628-659 Address 2 of insurer providing supplemental prescription drug insurance under which beneficiary is covered. Insurance Company City 15 Text 660-674 City of insurer providing supplemental prescription drug insurance under which beneficiary is covered. Insurance Company State 2 Alpha 675-676 State of insurer providing supplemental prescription drug insurance under which beneficiary is covered. Insurance Company ZIP code 9 Numeric 677-685 ZIP code of insurer providing supplemental prescription drug insurance under which beneficiary is covered. Insurer Type 1 Alpha 686 Type of insurance A Insurance or Indemnity (Other Types) B Group Health Organization (GHO) C Preferred Provider Organization D TPA/ASO E Stop Loss TPA F Self-insured/Self-Administered (Self- Insured) G Collectively-bargained Health and Welfare Fund H Multiple Employer Health Plan with 100 or more employees. I Multiple Employer Health Plan with 20 or more employees. J Hospitalization only plan covering inpatient hospital K Medical Service only plan covering non- inpatient medical M Medicare Supplement Plan U Unknown Required when ACTION is IT New Insurer Type 1 Alpha 687 New type of insurance Required when ACTION is IT Policy Number 17 Text 688-704 Prescription drug policy number RX BIN 6 Text 705-710 Prescription Drug BIN Number Required if TYPE = U. Must be six digits and cannot be all the same number if COVERAGE TYPE is U. BIN will not be edited for formats when the ACTION CODE is BN. Group, BIN, or PCN is required with Action Code CX. Not required with Action Codes BN, GR, or PN (Effective July 2026).
ECRS Web User Guide Appendix G: Prescription Drug Assistance Request Detail Record G-39 Data Field Length Type Displacement Description RX PCN 10 Text 711-720 Prescription Drug PCN Number Populate with spaces if not available. Cannot have special characters, except for a non- leading dash, and no leading space. Group, BIN, or PCN is required with Action Code CX. Not required with Action Codes BN, GR, or PN (Effective July 2026). RX Group 15 Text 721-735 Prescription Drug Group Number Populate with spaces if not available. Group, BIN, or PCN is required with Action Code CX. Not required with Action Codes BN, GR, or PN (Effective July 2026). RX ID 20 Text 736-755 Prescription Drug ID Number Required if TYPE = U. Populate with spaces if not available. Cannot be blank or all zeros if COVERAGE TYPE is U. Not required with Action Codes BN, GR, or PN (Effective July 2026). RX Phone 10 Numeric 756-765 Prescription Drug Phone Number Not required. Populate with spaces if not available. Check Amount 15 Alpha- Numeric 766-780 Amount of check received in $999,999,999.99 format. Required if value in SOURCE field = CHEK Populate with zeros if Source field not equal to CHEK. Check Date 8 Date 781-788 Date of check received in CCYYMMDD format Required if value in SOURCE field = CHEK Populate with zeros if Source field not equal to CHEK. Check Number 15 Alpha- Numeric 789-803 Number of check received. Required if value in SOURCE field = CHEK Populate with zeros if Source field not equal to CHEK. Remark Code 1 2 Alpha- Numeric 804-805 Two-character PDR remark code explaining reason for transaction. Not required Remark Code 2 2 Alpha- Numeric 806-807 Two-character PDR remark code explaining reason for transaction. Not required Remark Code 3 2 Alpha- Numeric 808-809 Two-character PDR remark code explaining reason for transaction. Not required
ECRS Web User Guide Appendix G: Prescription Drug Assistance Request Detail Record G-40 Data Field Length Type Displacement Description Comment ID 8 Alpha- Numeric 810-817 ID of operator entering trans comments—used by submitter Trans Comment 180 Text 818-997 Comments—used by submitter Filler 188 Filler 998-1185 Unused field – fill with spaces Effective Date of Other Drug Coverage 8 Date 1186-1193 Effective date of other drug insurance coverage provided by the other insurance (Other Health Information) in CCYYMMDD format. New Effective Date of Other Drug Coverage 8 Date 1194-1201 New effective date of other drug insurance coverage provided by the other insurance in CCYYMMDD format. Filler 66 Filler 1202-1267 Unused field – fill with spaces
ECRS Web User Guide Appendix G: Prescription Drug Assistance Request Header Record G-41 Prescription Drug Assistance Request Response Header Record Table G-9: Prescription Drug Assistance Request Response Header Record Layout Data Field Length Type Displacement Error Code if Invalid Data Header Indicator 2 Alpha-Numeric 1-2 HE01 PDP ID 4 Numeric 3-6 HE02 Contractor Number 5 Alpha-Numeric 7-11 HE03 File Type 3 Alpha 12-14 HE04 File Date 8 Date 15-22 HE05 Submitter Type 1 Alpha-Numeric 23 HE06 Filler 1244 Filler 24-1267 Unused Field – fill with spaces Error Code 1 4 Alpha 1268-1271 Error code describing reason why file was rejected Error Code 2 4 Alpha 1272-1275 Error code describing reason why file was rejected Error Code 3 4 Alpha 1276-1279 Error code describing reason why file was rejected Error Code 4 4 Alpha 1280-1283 Error code describing reason why file was rejected
ECRS Web User Guide Appendix G: Prescription Drug Assistance Request Response Detail Record G-42 Prescription Drug Assistance Request Response Detail Record Table G-10: Prescription Drug Assistance Request Response Detail Record Layout Data Field Length Type Displacement Error Code if Invalid Data Transaction type 4 Alpha 1-4 PE00 Contractor Number 5 Alpha-Numeric 5-9 PE01 DCN 15 Alpha-Numeric 10-24 PE02 Trans Type Code 1 Alpha 25 PE03 Trans Seq. No 3 Numeric 26-28 PE04 Update Operator ID 8 Alpha-Numeric 29-36 PE06 Contractor Name 25 Alpha-Numeric 37-61 PE07 Contractor Phone 10 Numeric 62-71 PE08 Trans Status Code 2 Alpha 72-73 Status code returned from ECRS Trans Reason Code 2 Numeric 74-75 Reason code returned from ECRS Action Code 1 2 Alpha 76-77 PE92 Action Code 2 2 Alpha 78-79 PE93 Action Code 3 2 Alpha 80-81 PE94 Action Code 4 2 Alpha 82-83 PE95 Activity Code 1 Alpha 84 PE61 Trans Source Code 4 Alpha 85-88 PE05 Medicare ID 12 Alpha-Numeric 89-100 PE09 Beneficiary Date of Birth 8 Date 101-108 PE11 Beneficiary Sex CD 1 Alpha 109 None Beneficiary First Name 15 Text 110-124 PE12 Beneficiary Middle Initial 1 Text 125 PE13 Beneficiary Last Name 24 Text 126-149 PE14 Beneficiary Address Line 1 32 Text 150-181 PE15
ECRS Web User Guide Appendix G: Prescription Drug Assistance Request Response Detail Record G-43 Data Field Length Type Displacement Error Code if Invalid Data Beneficiary Address Line 2 32 Text 182-213 PE16 Beneficiary City 15 Text 214-228 PE17 Beneficiary State 2 Alpha 229-230 PE18 Beneficiary ZIP code 9 Numeric 231-239 PE19 Beneficiary Phone 10 Numeric 240-249 PE20 Patient Relationship 2 Numeric 250-251 PE0J New Patient Relationship 2 Numeric 252-253 PE0O Person Code 3 Numeric 254-256 PE0K MSP Type 1 Alpha 257 PE39 New MSP Type 1 Alpha 258 PE0N Record Type 3 Alpha-Numeric 259-261 PE41 COB Effective Date 8 Date 262-269 PE48 New COB Effective Date 8 Date 270-277 PE0L Term Date 8 Date 278-285 PE0G Originating Contractor 5 Alpha-Numeric 286-290 NONE Informant First Name 15 Text 291-305 PE21 Informant Middle Initial 1 Text 306 PE22 Informant Last Name 24 Text 307-330 PE23 Informant Address 32 Text 331-362 PE24 Informant City 15 Text 363-377 PE25 Informant State 2 Text 378-379 PE26 Informant ZIP code 9 Numeric 380-388 PE27 Informant Phone 10 Numeric 389-398 PE28 Informant's Relationship Code 1 Alpha 399 None Employers Name 32 Text 400-431 PE30
ECRS Web User Guide Appendix G: Prescription Drug Assistance Request Response Detail Record G-44 Data Field Length Type Displacement Error Code if Invalid Data Employers Address 1 32 Text 432-463 PE31 Employers Address 2 32 Text 464-495 PE32 Employers City 15 Text 496-510 PE33 Employers State 2 Alpha 511-512 PE34 Employers ZIP code 9 Numeric 513-521 PE35 Employers Phone 10 Numeric 522-531 PE36 Employers EIN 18 Text 532-549 PE37 Employee Number 12 Text 550-561 PE38 Supplemental Type 1 Alpha-Numeric 562 None RX Drug Coverage Type 1 Alpha-Numeric 563 None Insurance Company Name 32 Text 564-595 PE42 Insurance Company Address 1 32 Text 596-627 PE43 Insurance Company Address 2 32 Text 628-659 PE44 Insurance Company City 15 Text 660-674 PE45 Insurance Company State 2 Alpha 675-676 PE46 Insurance Company ZIP code 9 Numeric 677-685 PE47 Insurer Type 1 Alpha 686 None New Insurer Type 1 Alpha 687 PE0M Policy Number 17 Text 688-704 PE49 RX BIN 6 Text 705-710 PE50 RX PCN 10 Text 711-720 PE51 RX Group 15 Text 721-735 PE52 RX ID 20 Text 736-755 PE53 RX Phone 10 Numeric 756-765 PE54 Check Amount 15 Alpha-Numeric 766-780 PE99
ECRS Web User Guide Appendix G: Prescription Drug Assistance Request Response Detail Record G-45 Data Field Length Type Displacement Error Code if Invalid Data Check Date 8 Date 781-788 PE98 Check Number 15 Alpha-Numeric 789-803 PE0A Remark Code 1 2 Alpha-Numeric 804-805 PE89 Remark Code 2 2 Alpha-Numeric 806-807 PE90 Remark Code 3 2 Alpha-Numeric 808-809 PE91 Comment ID 8 Alpha-Numeric 810-817 None Trans Comment 180 Text 818-997 None COB Comment ID 8 Alpha-Numeric 998-1005 PE57 COB Comment 180 Text 1006-1185 PE56 Effective Date of Other Drug Coverage 8 Date 1186-1193 PE2K New Effective Date of Other Drug Coverage 8 Date 1194-1201 PE2L, PE2M, or PE2N Filler 65 Filler 1202-1267 Filler Error Code 1 4 Alpha 1268-1271 Error code describing reason why file was rejected Error Code 2 4 Alpha 1272-1275 Error code describing reason why file was rejected Error Code 3 4 Alpha 1276-1279 Error code describing reason why file was rejected Error Code 4 4 Alpha 1280-1283 Error code describing reason why file was rejected
ECRS Web User Guide Appendix G: MSP Inquiry Header Record G-46 G.3 MSP Inquiry File Layouts MSP Inquiry Header Record Table G-11: MSP Inquiry Header Record Layout Data Field Length Type Displacement Edits Header Indicator 2 Alpha- Numeric 1-2 Header Record Type Indicator (Indicates a Header record) Set to ‘H0’. Required PDP ID 4 Numeric 3-6 ID number assigned by the BCRC. Populate with Spaces Contractor Number 5 Alpha- Numeric 7-11 Part D Plan contractor number Required File Type 3 Alpha 12-14 Type of File Set to ‘MSP’ – MSP Inquiry File Required File Date 8 Date 15-22 Date File Created in CCYYMMDD format Required Submitter Type 1 Alpha- Numeric 23 Part C/D contractor indicator Valid values ‘C’ = Part C contractor ‘D’ = Part D contractor If not valid value, drop file with error code HE06. Filler 1244 Filler 24-1267 Unused field – populate with spaces
ECRS Web User Guide Appendix G: MSP Inquiry Trailer Record G-47 MSP Inquiry Trailer Record Table G-12: MSP Inquiry Trailer Record Layout Data Field Length Type Displacement Edits Trailer Indicator 2 Alpha- Numeric 1-2 Trailer Record Type Indicator Set to ‘T0’. Required PDP ID 4 Numeric 3-6 ID number assigned by the BCRC. Populate with Spaces Contractor Number 5 Alpha- Numeric 7-11 Part D Plan contractor number Required File Type 3 Alpha- Numeric 12-14 Type of File Set to ‘MSP’ – MSP Inquiry File Required File Date 8 Date 15-22 Date File Created in CCYYMMDD format Required Record Count 9 Numeric 23-31 Number of Prescription Drug Inquiry Records in file. Must contain 9 digits. Required Filler 1236 Filler 32-1267 Unused Field – Populate with spaces
ECRS Web User Guide Appendix G: MSP Inquiry Detail Record G-48 MSP Inquiry Detail Record This record layout must be used for all MSP Inquiry file submissions. Note: If the beneficiary is deceased, and there is no representative payee on file, then the inquiry will be closed with Reason Code 65: Deceased, used with CM status. Table G-13: MSP Inquiry Detail Record Layout Data Field Length Type Displacement Description Transaction type 4 Alpha 1 – 4 Type of record Set to ‘ECRS’ Required Contractor Number 5 Alpha- Numeric 5-9 Medicare contractor (MACs, MA/PD plans) number. Required DCN 15 Text 10-24 DCN; assigned by the Medicare contractor. Required. Each record shall have a unique DCN. Tran Type Code 1 Alpha 25 Transaction type indicator Set to ‘I’ for MSP Inquiry Required Trans Seq No 3 Numeric 26-28 Sequence number assigned by the COB. Internal use only. Populate with spaces. Update Operator ID 8 Alpha- Numeric 29-36 ID of user making update. Not required Contractor Name 25 Text 37-61 Contractor name Not required Contractor Phone 10 Numeric 62-71 Contractor phone number Not required Tran Stat Cd 2 Alpha 72-73 Status code Set to ‘NW’ for New Tran Reason Cd 2 Numeric 74-75 Reason Set to ‘01’ for New Trans Action Code 1 2 Alpha 76-77 Action code 1 Valid values are: CA Class Action Suit (CMS Grouping Code) CL Closed or Settled Case Not required. Populate with spaces if not available.
ECRS Web User Guide Appendix G: MSP Inquiry Detail Record G-49 Data Field Length Type Displacement Description Trans Action Code 2 2 Alpha- Numeric 78-79 Action code 2 Valid values same as Trans Action Code 1. Not required. Populate with spaces if not available. Trans Action Code 3 2 Alpha- Numeric 80-81 Action code 3 Valid values same as Trans Action Code 1. Not required. Populate with spaces if not available. Trans Action Code 4 2 Alpha- Numeric 82-83 Action code 4 Valid values same as Trans Action Code 1. Not required. Populate with spaces if not available. Activity Code 1 Alpha 84 Activity of contractor. Valid values are: Required First Development 1 Alpha 85 Development source code indicating where initial development letter was sent. Valid values are: Not required. Populate with spaces if not available. Second Development 1 Alpha 86 Development source code indicating where subsequent development letter was sent. Valid values are: A Attorney B Beneficiary E Employer I Insurer P Provider R Beneficiary Representative (other than attorney) Not required. Populate with spaces if not available. RSP 1 Alpha 87 Development response indicator. Valid values are: A Attorney B Beneficiary E Employer I Insurer P Provider R Beneficiary Representative Not required. Populate with spaces if not available.
ECRS Web User Guide Appendix G: MSP Inquiry Detail Record G-50 Data Field Length Type Displacement Description Trans Source Cd 4 Alpha 88-91 Four-character code identifying source of MSP inquiry information. Valid values are: CHEK = Unsolicited check LTTR = Letter PHON = Phone call SCLM = Claim submitted to Medicare contractor for secondary payment SRVY = Survey CLAM = Claim Required Medicare ID 12 Alpha- Numeric 92-103 Health Insurance Claim Number of beneficiary (HICN) or Medicare Beneficiary Identifier (MBI). Enter without dashes, spaces, or other special characters. Required if SSN is not entered. Beneficiary’s Social Security Number 9 Numeric 104-112 Beneficiary’s Social Security Number Required if Medicare ID not entered. Beneficiary’s Date of Birth 8 Date 113-120 Beneficiary’s Date of Birth in CCYYMMDD format Required Beneficiary’s Sex Code 1 Alpha 121 Sex of beneficiary Valid values are: U = Unknown M = Male F = Female Required. Default to U if unavailable. Beneficiary’s First Name 15 Text 122-136 Beneficiary’s First Name Required Beneficiary’s Initial 1 Alpha 137 Beneficiary’s Middle Initial Not required Beneficiary’s Last Name 24 Text 138-161 Beneficiary’s Last Name Required
ECRS Web User Guide Appendix G: MSP Inquiry Detail Record G-51 Data Field Length Type Displacement Description Patient Relationship 2 Numeric 162-163 Patient Relationship between policyholder and patient. Required field when: ACTION is Blank and MSP TYPE is F ACTION is CA and MSP TYPE is L ACTION is CL and MSP TYPE is D, E, or L Valid values are: 01 Self; Patient is policyholder 02 Spouse 03 Child 04 Other 20 Domestic partner Populate with zeros if not available. Notes: All patient relationship values accepted for MSP Types B and G. MSP Type A will accept 01 and 02. MSP Types D, E, L, H, W, S, and T will only accept 01. MSP Type 1 Alpha 164 One-character code identifying type of MSP coverage. Valid values are: A Working Aged B ESRD C Conditional Payment D Automobile Insurance E Workers’ Compensation F Federal (Public) G Disabled H Black Lung L Liability W Workers’ Compensation Set- Aside Required
ECRS Web User Guide Appendix G: MSP Inquiry Detail Record G-52 Data Field Length Type Displacement Description MSP Effective Date 8 Date 165-172 Effective date of MSP coverage in CCYYMMDD format, cannot equal termination date. Not required. Populate with zeros if not available. Notes: This field accepts dates up to three months from the current date, as follows: For GHP records (MSP Types A, B, and G): The MSP Effective Date can be in the future for currently entitled beneficiaries (i.e., enrolled in Medicare), or for beneficiaries who will be entitled starting up to three months in the future. For NGHP records (MSP Types D, E, L, H, and W): The MSP Effective Date can be in the future for beneficiaries as long as their entitlement start date is in the future. The future MSP Effective Date must be equal to the entitlement start date. (NGHP MSP occurrences for beneficiaries who are currently entitled cannot have future MSP Effective Dates.) MSP Term Date 8 Date 173-180 Termination date of MSP coverage in CCYYMMDD format, cannot equal Effective Date. Not required. Populate with zeros if not available. Send CWF 1 Alpha 181 Indicates whether to send MSP inquiry to CWF. Valid values are: Y Send to CWF (default unless INFMT REL field = D, in which case default is N and this is a protected field) N Do not send to CWF For EGHP MSP Types: In addition to the minimum HUSP fields, the EMPLR NAME, STREET, CITY, ST, and ZIP fields are required or the system will set this switch to N and develop the record. CMS Grouping Code 2 Alpha 182-183 CMS Grouping Code Not required. Populate with spaces if not available. Beneficiary’s Address 1 32 Text 184-215 Beneficiary’s Address 1 Not required. Populate with spaces if not available. Beneficiary’s Address 2 32 Text 216-247 Beneficiary’s Address 2 Not required. Populate with spaces if not available
ECRS Web User Guide Appendix G: MSP Inquiry Detail Record G-53 Data Field Length Type Displacement Description Beneficiary’s City 15 Text 248-262 Beneficiary’s City Not required. Populate with spaces if not available. Beneficiary’s State 2 Alpha 263-264 Beneficiary’s State Not required. Populate with spaces if not available. Beneficiary’s ZIP Code 9 Numeric 265-273 Beneficiary’s ZIP code Not required. Populate with spaces if not available Beneficiary’s Phone 10 Numeric 274-283 No edits other than data type edits. If not valid, drop the record with edit code ‘PE20’. Check Date 8 Numeric 284-291 Date of check in CCYYMMDD format. Required if Source is CHEK Check Amount 15 Alpha 292-306 Amount of check in $999,999,999.99 format. Required if Source is CHEK Check Number 15 Alpha 307-321 Check Number Required if Source is CHEK Informant’s First Name 15 Text 322-336 Informant’s First Name Required if Source is CHEK, LTTR, or PHON. Not required if SOURCE is SCLM. Populate with spaces if not available. * Refer to Appendix B for complete set of required fields for various source codes. Informant’s Middle Initial 1 Alpha 337 Informant’s Middle Initial Not required. Populate with spaces if not available. Informant’s Last Name 24 Text 338-361 Informant’s Last Name Required if Source is CHEK, LTTR, or PHON. Not required if SOURCE is SCLM. Populate with spaces if not available. * Refer to Appendix B for complete set of required fields for various source codes. Informant’s Phone 10 Numeric 362-371 Informant’s Phone Number Not required. Populate with zeros if not available.
ECRS Web User Guide Appendix G: MSP Inquiry Detail Record G-54 Data Field Length Type Displacement Description Informant’s Address 1 32 Text 372-403 Informant’s Address 1 Required if Source is CHEK, LTTR, or PHON. Not required if SOURCE is SCLM. Populate with spaces if not available. * Refer to Appendix B for complete set of required fields for various source codes. Informant’s Address 2 32 Text 404-435 Informant’s Address 2 Not required. Populate with spaces if not available. Informant’s City 15 Text 436-450 Informant’s City Required if Source is CHEK, LTTR, or PHON. Not required if SOURCE is SCLM. Populate with spaces if not available. * Refer to Appendix B for complete set of required fields for various source codes. Informant’s State 2 Alpha 451-452 Informant’s State Required if Source is CHEK, LTTR, or PHON. Not required if SOURCE is SCLM. Populate with spaces if not available. * Refer to Appendix B for complete set of required fields for various source codes. Informant’s ZIP Code 9 Numeric 453-461 Informant’s ZIP Required if Source is CHEK, LTTR, or PHON. Not required if SOURCE is SCLM. Populate with spaces if not available. * Refer to Appendix B for complete set of required fields for various source codes.
ECRS Web User Guide Appendix G: MSP Inquiry Detail Record G-55 Data Field Length Type Displacement Description Informant’s Relationship Code 1 Alpha 462 Relationship of informant to beneficiary. Valid values are: A Attorney representing beneficiary B Beneficiary C Child D Defendant’s attorney E Employer F Father I Insurer M Mother N Non-relative O Other relative P Provider R Beneficiary representative other than attorney S Spouse U Unknown Required if Source is CHEK, LTTR, or PHON. Not required if SOURCE is SCLM. Populate with spaces if not available. * Refer to Appendix B for complete set of required fields for various source codes. Employer’s Name 32 Text 463-494 Name of employer providing group health insurance under which beneficiary is covered. Not required. Populate with spaces if not available. Employer EIN 18 Text 495-512 Employer’s EIN providing group health insurance under which beneficiary is covered. Not required. Populate with spaces if not available. Employer’s Address 1 32 Text 513-544 Employer’s Address 1 providing group health insurance under which beneficiary is covered. Not required. Populate with spaces if not available. Employer’s Address 2 32 Text 545-576 Employer’s Address 2 providing group health insurance under which beneficiary is covered. Not required. Populate with spaces if not available.
ECRS Web User Guide Appendix G: MSP Inquiry Detail Record G-56 Data Field Length Type Displacement Description Employer’s Phone 10 Numeric 577-586 Employer’s phone number providing group health insurance under which beneficiary is covered. Not required. Populate with spaces if not available. Employer’s City 15 Text 587-601 Employer’s city providing group health insurance under which beneficiary is covered. Not required. Populate with spaces if not available. Employer’s State 2 Alpha 602-603 Employer’s state providing group health insurance under which beneficiary is covered. Not required. Populate with spaces if not available. Employer’s ZIP Code 9 Numeric 604-612 Employer’s ZIP code providing group health insurance under which beneficiary is covered. Not required. Populate with spaces if not available. Employee No 12 Text 613-624 Policyholder’s employee number Not required. Populate with spaces if not available. Insurer’s name 32 Text 625-656 Name of insurance carrier for MSP coverage. Populate with spaces if not available. * Refer to Appendix B for complete set of required fields for various source codes. Note: The record will be rejected and return error code PE42 on the response file if the insurer’s name is blank, less than two characters, or contains one of the following invalid names: Attorney, BC, BCBS, BCBX,BCRC, Benefits Coordination & Recovery, Benefits Coordination & Recovery Center, Benefits Coordination and Recove, Benefits Coordination and Recovery Center, Blue Cross, Blue Shield, BS, BX, CMS, COB, COBC, Coordination of Benefits Contrac, Coordination of Benefits Contractor, HCFA, Insurer, Medicare, Misc, Miscellaneous, N/A, NA, NO, No Fault, No-Fault, None, Supplement, Supplemental, UN, UNK, Unknown, and XX.
ECRS Web User Guide Appendix G: MSP Inquiry Detail Record G-57 Data Field Length Type Displacement Description Insurer Type 1 Alpha 657 Type of Insurance Valid values are: Populate with spaces if not available. * Refer to Appendix B for complete set of required fields for various source codes. Insurer’s Address 1 32 Text 658-689 Address 1 of insurance carrier for MSP coverage. Populate with spaces if not available. * Refer to Appendix B for complete set of required fields for various source codes. Insurer’s Address 2 32 Text 690-721 Address 2 of insurance carrier for MSP coverage. Not required. Insurer’s City 15 Text 722-736 City insurance carrier for MSP coverage. Populate with spaces if not available. * Refer to Appendix B for complete set of required fields for various source codes. Insurer’s State 2 Alpha 737-738 State of insurance carrier for MSP coverage. Populate with spaces if not available. * Refer to Appendix B for complete set of required fields for various source codes. Insurer’s ZIP Code 9 Numeric 739-747 ZIP Code of insurance carrier for MSP coverage. Populate with spaces if not available. * Refer to Appendix B for complete set of required fields for various source codes. Insurer’s Phone 10 Numeric 748-757 Insurer’s Phone Number Not required. Populate with zeros if not available. Insurer Group Number 20 Text 758-777 Group number of insurance coverage. Not required. Populate with spaces if not available. Insurer Policy Number 17 Text 778-794 Policy number of insurance coverage. Not required. Populate with spaces if not available.
ECRS Web User Guide Appendix G: MSP Inquiry Detail Record G-58 Data Field Length Type Displacement Description Subscriber First Name 15 Text 795-809 First Name of individual covered by this insurance. Not required. Populate with spaces if not available. Subscriber Initial 1 Alpha 810 Middle initial of individual covered by this insurance. Not required. Populate with spaces if not available. Subscriber Last Name 24 Text 811-834 Last Name of individual covered by this insurance. Not required. Populate with spaces if not available. Subscriber Social Security Number 9 Numeric 835-843 Social Security Number of the policyholder/subscriber Required Filler 25 Filler 844-868 Filler Illness/Injury Date 8 Date 869-876 Date illness or injury occurred for workers’ compensation, automobile, or liability coverage (in CCYYMMDD format). Not required. Populate with zeros if not available. Illness/Injury Description 64 Text 877-940 Description of illness or injury for workers’ compensation, automobile, or liability coverage. Not required. Populate with zeros if not available. Representative Name 32 Text 941-972 Name of individual representing a beneficiary’s medical affairs or estate. Representation may be applicable in a workers’ compensation, automobile, or liability insurance case. Type name in first name/middle initial/last name format. Not required. Populate with spaces when not available. Representative Address 1 32 Text 973-1004 Representative’s Street address 1. Not required. Populate with spaces when not available. Representative Address 2 32 Text 1005-1036 Representative’s Street address 2. Not required. Populate with spaces when not available. Representative City 15 Text 1037-1051 Representative’s City Not required. Populate with spaces when not available.
ECRS Web User Guide Appendix G: MSP Inquiry Detail Record G-59 Data Field Length Type Displacement Description Representative State 2 Alpha 1052-1053 Representative’s Street address 2. Not required. Populate with spaces when not available. Representative ZIP 9 Numeric 1054-1062 Representative’s ZIP code. Not required. Populate with spaces when not available. Representative Type 1 Alpha 1063 Type of relationship between beneficiary and his or her representative. Valid values are: Not required. Populate with spaces if not available. Dialysis Train Date 8 Date 1064-1071 Date beneficiary received self-dialysis training (in CCYYMMDD format). Not required. Populate with zeros if not available. Black Lung Indicator 1 Alpha 1072 One-character code indicating whether beneficiary receives benefits under the Black Lung Program. Valid values are: Y = Yes N = No Not required. Populate with spaces if not available. Black Lung Effective Date 8 Date 1073-1080 Date beneficiary began receiving benefits under the Black Lung Program in CCYYMMDD format. Not required. Populate with zeros if not available. Diagnosis Code 1 ICD Indicator 1 Numeric 1081 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9-CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE1A and the record will be dropped. Required if Diagnosis Code 1 is submitted.
ECRS Web User Guide Appendix G: MSP Inquiry Detail Record G-60 Data Field Length Type Displacement Description Diagnosis Code 1 7 Text 1082-1088 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if action code is CA or CL. Required if Diagnosis Code 1 ICD Indicator is submitted. If Diagnosis Code 1 ICD Indicator = 0, Diagnosis Code 1 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 1 ICD Indicator = 9, Diagnosis Code 1 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. * Refer to Appendix B for complete set of required fields for various source codes. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE69 and the record will be dropped. Diagnosis Code 2 ICD Indicator 1 Numeric 1089 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9-CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE1B and the record will be dropped. Required if Diagnosis Code 2 is submitted. Diagnosis Code 2 7 Text 1090-1096 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 2 ICD Indicator is submitted. If Diagnosis Code 2 ICD Indicator = 0, Diagnosis Code 2 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 2 ICD Indicator = 9, Diagnosis Code 2 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE70 and the record will be dropped.
ECRS Web User Guide Appendix G: MSP Inquiry Detail Record G-61 Data Field Length Type Displacement Description Diagnosis Code 3 ICD Indicator 1 Numeric 1097 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9-CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE1C and the record will be dropped. Required if Diagnosis Code 3 is submitted. Diagnosis Code 3 7 Text 1098-1104 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 3 ICD Indicator is submitted. If Diagnosis Code 3 ICD Indicator = 0, Diagnosis Code 3 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 3 ICD Indicator = 9, Diagnosis Code 3 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE71 and the record will be dropped. Diagnosis Code 4 ICD Indicator 1 Numeric 1105 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9-CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE1D and the record will be dropped. Required if Diagnosis Code 4 is submitted.
ECRS Web User Guide Appendix G: MSP Inquiry Detail Record G-62 Data Field Length Type Displacement Description Diagnosis Code 4 7 Text 1106-1112 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 4 ICD Indicator is submitted. If Diagnosis Code 4 ICD Indicator = 0, Diagnosis Code 4 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 4 ICD Indicator = 9, Diagnosis Code 4 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE72 and the record will be dropped. Diagnosis Code 5 ICD Indicator 1 Numeric 1113 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9-CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE1E and the record will be dropped. Required if Diagnosis Code 5 is submitted. Diagnosis Code 5 7 Text 1114-1120 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 5 ICD Indicator is submitted. If Diagnosis Code 5 ICD Indicator = 0, Diagnosis Code 5 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 5 ICD Indicator = 9, Diagnosis Code 5 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE73 and the record will be dropped.
ECRS Web User Guide Appendix G: MSP Inquiry Detail Record G-63 Data Field Length Type Displacement Description Diagnosis Code 6 ICD Indicator 1 Numeric 1121 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9-CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE1F and the record will be dropped. Required if Diagnosis Code 6 is submitted. Diagnosis Code 6 7 Text 1122-1128 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 6 ICD Indicator is submitted. If Diagnosis Code 6 ICD Indicator = 0, Diagnosis Code 6 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 6 ICD Indicator = 9, Diagnosis Code 6 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE1G and the record will be dropped. Diagnosis Code 7 ICD Indicator 1 Numeric 1129 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9-CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE1H and the record will be dropped. Required if Diagnosis Code 7 is submitted.
ECRS Web User Guide Appendix G: MSP Inquiry Detail Record G-64 Data Field Length Type Displacement Description Diagnosis Code 7 7 Text 1130-1136 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 7 ICD Indicator is submitted. If Diagnosis Code 7 ICD Indicator = 0, Diagnosis Code 7 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 7 ICD Indicator = 9, Diagnosis Code 7 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE1I and the record will be dropped. Diagnosis Code 8 ICD Indicator 1 Numeric 1137 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9-CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE1J and the record will be dropped. Required if Diagnosis Code 8 is submitted. Diagnosis Code 8 7 Text 1138-1144 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 8 ICD Indicator is submitted. If Diagnosis Code 8 ICD Indicator = 0, Diagnosis Code 8 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 8 ICD Indicator = 9, Diagnosis Code 8 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE1K and the record will be dropped.
ECRS Web User Guide Appendix G: MSP Inquiry Detail Record G-65 Data Field Length Type Displacement Description Diagnosis Code 9 ICD Indicator 1 Numeric 1145 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9-CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE1L and the record will be dropped. Required if Diagnosis Code 9 is submitted. Diagnosis Code 9 7 Text 1146-1152 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 9 ICD Indicator is submitted. If Diagnosis Code 9 ICD Indicator = 0, Diagnosis Code 9 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 9 ICD Indicator = 9, Diagnosis Code 9 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE1M and the record will be dropped. Diagnosis Code 10 ICD Indicator 1 Numeric 1153 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9-CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE1N and the record will be dropped. Required if Diagnosis Code 10 is submitted.
ECRS Web User Guide Appendix G: MSP Inquiry Detail Record G-66 Data Field Length Type Displacement Description Diagnosis Code 10 7 Text 1154-1160 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 10 ICD Indicator is submitted. If Diagnosis Code 10 ICD Indicator = 0, Diagnosis Code 10 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 10 ICD Indicator = 9, Diagnosis Code 10 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE1O and the record will be dropped. Diagnosis Code 11 ICD Indicator 1 Numeric 1161 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9-CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE1P and the record will be dropped. Required if Diagnosis Code 11 is submitted. Diagnosis Code11 7 Text 1162-1168 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 11 ICD Indicator is submitted. If Diagnosis Code 11 ICD Indicator = 0, Diagnosis Code 11 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 11 ICD Indicator = 9, Diagnosis Code 11 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE1Q and the record will be dropped.
ECRS Web User Guide Appendix G: MSP Inquiry Detail Record G-67 Data Field Length Type Displacement Description Diagnosis Code 12 ICD Indicator 1 Numeric 1169 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9-CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE1R and the record will be dropped. Required if Diagnosis Code 12 is submitted. Diagnosis Code 12 7 Text 1170-1176 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 12 ICD Indicator is submitted. If Diagnosis Code 12 ICD Indicator = 0, Diagnosis Code 12 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 12 ICD Indicator = 9, Diagnosis Code 12 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE1S and the record will be dropped. Diagnosis Code 13 ICD Indicator 1 Numeric 1177 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9-CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE1T and the record will be dropped. Required if Diagnosis Code 13 is submitted.
ECRS Web User Guide Appendix G: MSP Inquiry Detail Record G-68 Data Field Length Type Displacement Description Diagnosis Code 13 7 Text 1178-1184 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 13 ICD Indicator is submitted. If Diagnosis Code 13 ICD Indicator = 0, Diagnosis Code 13 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 13 ICD Indicator = 9, Diagnosis Code 13 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE1U and the record will be dropped. Diagnosis Code 14 ICD Indicator 1 Numeric 1185 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9-CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE1V and the record will be dropped. Required if Diagnosis Code 14 is submitted. Diagnosis Code 14 7 Text 1186-1192 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 14 ICD Indicator is submitted. If Diagnosis Code 14 ICD Indicator = 0, Diagnosis Code 14 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 14 ICD Indicator = 9, Diagnosis Code 14 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE1W and the record will be dropped.
ECRS Web User Guide Appendix G: MSP Inquiry Detail Record G-69 Data Field Length Type Displacement Description Diagnosis Code 15 ICD Indicator 1 Numeric 1193 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9-CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE1X and the record will be dropped. Required if Diagnosis Code 15 is submitted. Diagnosis Code 15 7 Text 1194-1200 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 15 ICD Indicator is submitted. If Diagnosis Code 15 ICD Indicator = 0, Diagnosis Code 15 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 15 ICD Indicator = 9, Diagnosis Code 15 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE1Y and the record will be dropped. Diagnosis Code 16 ICD Indicator 1 Numeric 1201 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9-CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE1Z and the record will be dropped. Required if Diagnosis Code 16 is submitted.
ECRS Web User Guide Appendix G: MSP Inquiry Detail Record G-70 Data Field Length Type Displacement Description Diagnosis Code 16 7 Text 1202-1208 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 16 ICD Indicator is submitted. If Diagnosis Code 16 ICD Indicator = 0, Diagnosis Code 16 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 16 ICD Indicator = 9, Diagnosis Code 16 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE2A and the record will be dropped. Diagnosis Code 17 ICD Indicator 1 Numeric 1209 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9-CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE2B and the record will be dropped. Required if Diagnosis Code 17 is submitted. Diagnosis Code 17 7 Text 1210-1216 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 17 ICD Indicator is submitted. If Diagnosis Code 17 ICD Indicator = 0, Diagnosis Code 17 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 17 ICD Indicator = 9, Diagnosis Code 17 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE2C and the record will be dropped.
ECRS Web User Guide Appendix G: MSP Inquiry Detail Record G-71 Data Field Length Type Displacement Description Diagnosis Code 18 ICD Indicator 1 Numeric 1217 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9-CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE2D and the record will be dropped. Required if Diagnosis Code 18 is submitted. Diagnosis Code 18 7 Text 1218-1224 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 18 ICD Indicator is submitted. If Diagnosis Code 18 ICD Indicator = 0, Diagnosis Code 18 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 18 ICD Indicator = 9, Diagnosis Code 18 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE2E and the record will be dropped. Diagnosis Code 19 ICD Indicator 1 Numeric 1225 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9-CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE2F and the record will be dropped. Required if Diagnosis Code 19 is submitted.
ECRS Web User Guide Appendix G: MSP Inquiry Detail Record G-72 Data Field Length Type Displacement Description Diagnosis Code 19 7 Text 1226-1232 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 19 ICD Indicator is submitted. If Diagnosis Code 19 ICD Indicator = 0, Diagnosis Code 19 must contain a valid ICD-10-CM diagnosis code. If Diagnosis Code 19 ICD Indicator = 9, Diagnosis Code 19 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE2G and the record will be dropped. Diagnosis Code 20 ICD Indicator 1 Numeric 1233 One-digit diagnosis code indicator to identify whether the diagnosis code received is in ICD-9-CM or ICD-10-CM format. 0 = ICD-10-CM format 9 = ICD-9-CM format If an invalid code is entered, the user will see error code PE2H and the record will be dropped. Required if Diagnosis Code 20 is submitted. Diagnosis Code 20 7 Text 1234-1240 ICD-9-CM or ICD-10-CM diagnosis code that applies to this MSP occurrence. Required if Diagnosis Code 20 ICD Indicator is submitted. If Diagnosis Code 20 ICD Indicator = 0, Diagnosis Code 20 must contain a valid ICD-20-CM diagnosis code. If Diagnosis Code 20 ICD Indicator = 9, Diagnosis Code 20 must contain a valid ICD-9-CM diagnosis code. Populate with spaces if not applicable. NGHP MSP types will require a valid diagnosis code to be entered. If an invalid code is entered, the user will see error code PE2I and the record will be dropped. Filler 17 Filler 1241-1267 Unused Field – fill with spaces
ECRS Web User Guide Appendix G: MSP Inquiry Response Header Record G-73 Table G-14: MSP Inquiry Response Header Record Layout Data Field Length Type Displacement Edits Header Indicator 2 Alpha- Numeric 1-2 HE01 PDP ID 4 Numeric 3-6 HE02 Contractor Number 5 Alpha- Numeric 7-11 If not valid contractor number, drop file with error code HE03. File Type 3 Alpha 12-14 HE04 File Date 8 Date 15-22 HE05 Filler 1245 Filler 23-1267 Unused Field – fill with spaces Error Code 1 4 Alpha 1268-1271 Error code describing reason why file was rejected Error Code 2 4 Alpha 1272-1275 Error code describing reason why file was rejected Error Code 3 4 Alpha 1276-1279 Error code describing reason why file was rejected Error Code 4 4 Alpha 1280-1283 Error code describing reason why file was rejected
ECRS Web User Guide Appendix G: MSP Inquiry Response Detail Record G-74 MSP Inquiry Response Detail Record This record layout must be returned for all MSP Inquiry file submissions. Table G-15: MSP Inquiry Response Detail Record Layout Data Field Length Type Displacement Edit Transaction type 4 Alpha 1-4 PE00 Contractor Number 5 Alpha- Numeric 5-9 PE01 DCN 15 Text 10-24 PE02 Tran Type Code 1 Alpha 25 PE03 Trans Seq No 3 Numeric 26-28 PE04 Update Operator ID 8 Alpha- Numeric 29-36 PE06 Contractor Name 25 Text 37-61 PE07 Contractor Phone 10 Numeric 62-71 PE08 Tran Stat Cd 2 Alpha 72-73 None. Will contain the Status returned from ECRS. Tran Reason Cd 2 Numeric 74-75 None. Will contain the Reason returned from ECRS. Trans Action Code 1 2 Alpha 76-77 PE92 Trans Action Code 2 2 Alpha- Numeric 78-79 PE93 Trans Action Code 3 2 Alpha- Numeric 80-81 PE94 Trans Action Code 4 2 Alpha- Numeric 82-83 PE95 Activity Code 1 Alpha 84 PE61 First Development 1 Alpha 85 PE64 Second Development 1 Alpha 86 PE65 RSP 1 Alpha 87 PE66 Trans Source Cd 4 Alpha 88-91 PE05 Medicare ID 12 Alpha- Numeric 92-103 PE09 Beneficiary’s Social Security Number 9 Numeric 104-112 PE10 Beneficiary’s Date of Birth 8 Date 113-120 PE11 Beneficiary’s Sex Code 1 Alpha 121 None
ECRS Web User Guide Appendix G: MSP Inquiry Response Detail Record G-75 Data Field Length Type Displacement Edit Beneficiary’s First Name 15 Text 122-136 PE12 Beneficiary’s Initial 1 Alpha 137 PE13 Beneficiary’s Last Name 24 Text 138-161 PE14 Patient Relationship 2 Numeric 162-163 PE0J MSP Type 1 Alpha 164 PE39 MSP Effective Date 8 Date 165-172 PE67 MSP Term Date 8 Date 173-180 PE68 Send CWF 1 Alpha 181 None CMS Grouping Code 2 Alpha 182-183 PE0E Beneficiary’s Address 1 32 Text 184-215 PE15 Beneficiary’s Address 2 32 Text 216-247 PE16 Beneficiary’s City 15 Text 248-262 PE17 Beneficiary’s State 2 Alpha 263-264 PE18 Beneficiary’s ZIP Code 9 Numeric 265-273 PE19 Beneficiary’s Phone 10 Numeric 274-283 PE20 Check Date 8 Numeric 284-291 PE98 Check Amount 15 Alpha 292-306 PE99 Check Number 15 Alpha 307-321 PE0A Informant’s First Name 15 Text 322-336 PE21 Informant’s Middle Initial 1 Alpha 337 PE22 Informant’s Last Name 24 Text 338-361 PE23 Informant’s Phone 10 Numeric 362-371 PE29 Informant’s Address 1 32 Text 372-403 PE24 Informant’s Address 2 32 Text 404-435 PE25 Informant’s City 15 Text 436-450 PE26 Informant’s State 2 Alpha 451-452 PE27 Informant’s ZIP Code 9 Numeric 453-461 PE28 Informant’s Relationship Code 1 Alpha 462 None Employer’s Name 32 Text 463-494 PE30 Employer EIN 18 Text 495-512 PE37
ECRS Web User Guide Appendix G: MSP Inquiry Response Detail Record G-76 Data Field Length Type Displacement Edit Employer’s Address 1 32 Text 513-544 PE31 Employer’s Address 2 32 Text 545-576 PE32 Employer’s Phone 10 Numeric 577-586 PE36 Employer’s City 15 Text 587-601 PE33 Employer’s State 2 Alpha 602-603 PE34 Employer’s ZIP Code 9 Numeric 604-612 PE35 Employee No 12 Text 613-624 PE38 Insurer’s Name 32 Text 625-656 PE42 Insurer Type 1 Alpha 657 PE0Q Insurer’s Address 1 32 Text 658-689 PE43 Insurer’s Address 2 32 Text 690-721 PE44 Insurer’s City 15 Text 722-736 PE45 Insurer’s State 2 Alpha 737-738 PE46 Insurer’s ZIP Code 9 Numeric 739-747 PE47 Insurer’s Phone 10 Numeric 748-757 None (field not in use) Insurer Group Number 20 Text 758-777 PE62 Insurer Policy Number 17 Text 778-794 PE63 Subscriber First Name 15 Text 795-809 PE58 Subscriber Initial 1 Alpha 810 PE59 Subscriber Last Name 24 Text 811-834 PE60 Subscriber Social Security Number 9 Numeric 835-843 PE0F Filler 25 Filler 844-868 None Illness/Injury Date 8 Date 869-876 PE75 Illness/Injury Description 64 Text 877-940 PE76 Representative Name 32 Text 941-972 PE77 Representative Address 1 32 Text 973-1004 PE78 Representative Address 2 32 Text 1005-1036 PE79 Representative City 15 Text 1037-1051 PE80 Representative State 2 Alpha 1052-1053 PE81 Representative ZIP 9 Numeric 1054-1062 PE82 Representative Type 1 Alpha 1063 PE83 Dialysis Train Date 8 Date 1064-1071 PE84
ECRS Web User Guide Appendix G: MSP Inquiry Response Detail Record G-77 Data Field Length Type Displacement Edit Black Lung Indicator 1 Alpha 1072 PE85 Black Lung Effective Date 8 Date 1073-1080 PE86 Submitter Type 1 Alpha- Numeric 1081 If not valid value, drop file with error code HE06. Diagnosis Code 1 Indicator 1 Text 1082 PE1A Diagnosis Code 1 7 Text 1083-1089 PE69 Diagnosis Code 2 Indicator 1 Text 1090 PE1B Diagnosis Code 2 7 Text 1091-1097 PE70 Diagnosis Code 3 Indicator 1 Text 1098 PE1C Diagnosis Code 3 7 Text 1099-1105 PE71 Diagnosis Code 4 Indicator 1 Text 1106 PE1D Diagnosis Code 4 7 Text 1107 - 1113 PE72 Diagnosis Code 5 Indicator 1 Text 1114 PE1E Diagnosis Code 5 7 Text 1115 - 1121 PE73 Diagnosis Code 6 Indicator 1 Text 1122 PE1F Diagnosis Code 6 7 Text 1123 – 1129 PE1G Diagnosis Code 7 Indicator 1 Text 1130 PE1H Diagnosis Code 7 7 Text 1131 – 1137 PE1I Diagnosis Code 8 Indicator 1 Text 1138 PE1J Diagnosis Code 8 7 Text 1139 – 1145 PE1K Diagnosis Code 9 Indicator 1 Text 1146 PE1L Diagnosis Code 9 7 Text 1147 – 1153 PE1M Diagnosis Code 10 Indicator 1 Text 1154 PE1N Diagnosis Code 10 7 Text 1155-1161 PE1O Diagnosis Code 11 Indicator 1 Text 1162 PE1P Diagnosis Code 11 7 Text 1163-1169 PE1Q Diagnosis Code 12 Indicator 1 Text 1170 PE1R
ECRS Web User Guide Appendix G: MSP Inquiry Response Detail Record G-78 Data Field Length Type Displacement Edit Diagnosis Code 12 7 Text 1171-1177 PE1S Diagnosis Code 13 Indicator 1 Text 1178 PE1T Diagnosis Code 13 7 Text 1179-1185 PE1U Diagnosis Code 14 Indicator 1 Text 1186 PE1V Diagnosis Code 14 7 Text 1187-1193 PE1W Diagnosis Code 15 Indicator 1 Text 1194 PE1X Diagnosis Code 15 7 Text 1195-1201 PE1Y Diagnosis Code 16 Indicator 1 Text 1202 PE1Z Diagnosis Code 16 7 Text 1203-1209 PE2A Diagnosis Code 17 Indicator 1 Text 1210 PE2B Diagnosis Code 17 7 Text 1211-1217 PE2C Diagnosis Code 18 Indicator 1 Text 1218 PE2D Diagnosis Code 18 7 Text 1219-1225 PE2E Diagnosis Code 19 Indicator 1 Text 1226 PE2F Diagnosis Code 19 7 Text 1227-1233 PE2G Diagnosis Code 20 Indicator 1 Text 1234 PE2H Diagnosis Code 20 7 Text 1235-1241 PE2I Filler 17 Filler 1242-1267 None Error Code 1 4 Alpha- Numeric 1268-1271 Error code describing reason why file was rejected Error Code 2 4 Alpha- Numeric 1272-1275 Error code describing reason why file was rejected Error Code 3 4 Alpha- Numeric 1276-1279 Error code describing reason why file was rejected Error Code 4 4 Alpha- Numeric 1280-1283 Error code describing reason why file was rejected
ECRS Web User Guide Appendix G: Prescription Drug Inquiry Header Record G-79 G.4 Prescription Drug Inquiry File Layouts Prescription Drug Inquiry Header Record Table G-16: Prescription Drug Inquiry Header Record Layout Data Field Length Type Displacement Description Header Indicator 2 Alpha- Numeric 1-2 Header Record Type Indicator (Indicates a Header record) Set to ‘H0’. Required PDP ID 4 Numeric 3-6 ID number assigned by the BCRC. Populate with Spaces Contractor Number 5 Alpha- Numeric 7-11 Part D Plan contractor number Required File Type 3 Alpha 12-14 Type of File Set to ‘PDI’ – Prescription Drug Inquiry File Required File Date 8 Date 15-22 Date File Created in CCYYMMDD format Required Filler 1245 Filler 23-1267 Unused Field – Populate with spaces
ECRS Web User Guide Appendix G: Prescription Drug Inquiry Trailer Record G-80 Prescription Drug Inquiry Trailer Record Table G-17: Prescription Drug Inquiry Trailer Record Layout Data Field Length Type Displacement Description Trailer Indicator 2 Alpha- Numeric 1-2 Trailer Record Type Indicator Set to ‘T0’. Required PDP ID 4 Numeric 3-6 ID number assigned by the BCRC. Populate with Spaces Contractor Number 5 Alpha- Numeric 7-11 Part D Plan contractor number Required File Type 3 Alpha- Numeric 12-14 Type of File Set to ‘PDI’ – Prescription Drug Inquiry File Required File Date 8 Date 15-22 Date File Created in CCYYMMDD format Required Record Count 9 Numeric 23-31 Number of Prescription Drug Inquiry Records in file. Must contain 9 digits. Required Filler 1236 Filler 32-1267 Unused Field – Populate with spaces
ECRS Web User Guide Appendix G: Prescription Drug Inquiry Detail Record G-81 Prescription Drug Inquiry Detail Record Table G-18: Prescription Drug Inquiry Detail Record Layout Data Field Length Type Displacement Description Transaction Type 4 Alpha 1-4 Type of Record Set to ‘ECRS’ Required Contractor Number 5 Alpha- Numeric 5-9 Part D Plan contractor number Required DCN 15 Text 10-24 DCN; assigned by the Part D Plan. Required. Each record shall have a unique DCN. Tran Type Code 1 Alpha 25 Transaction Type Indicator Set to ‘P’ for Prescription Drug Inquiry Required Trans Seq No 3 Numeric 26-28 Sequence Number assigned by the COB. Internal use only. Populate with spaces. Tran Stat Cd 2 Alpha 29-30 Status Code Set to ‘NW’ for New Tran Reason Cd 2 Numeric 31-32 Reason Set to ‘01’ for New Trans Source Cd 4 Alpha 33-36 Source of Record Valid Values are: CHEK – Check LTTR – Letter PHON – Phone SCLM – Secondary Claim CLAM – Claim SRVY – Survey Required Update Operator ID 8 Alpha- Numeric 37-44 ID of user making update. Not required Contractor Name 25 Text 45-69 Contractor name Not required Contractor Phone 10 Numeric 70-79 Contractor phone number Not required Medicare ID 12 Alpha- Numeric 80-91 Beneficiary Health Insurance Claim Number (HICN) or Medicare Beneficiary Identifier (MBI) Required if SSN is not entered. Beneficiary’s Social Security Number 9 Numeric 92-100 Beneficiary’s Social Security Number Required if Medicare ID not entered.
ECRS Web User Guide Appendix G: Prescription Drug Inquiry Detail Record G-82 Data Field Length Type Displacement Description Beneficiary’s Date of Birth 8 Date 101-108 Beneficiary’s Date of Birth in CCYYMMDD format Required Beneficiary’s Sex Code 1 Alpha 109 Sex of beneficiary Valid values are: U – Unknown M – Male F – Female Default to ‘U’ if not available Required Beneficiary’s First Name 15 Text 110-124 Beneficiary’s First Name Required Beneficiary’s Initial 1 Alpha 125 Beneficiary’s Middle Initial Not required Beneficiary’s Last Name 24 Text 126-149 Beneficiary’s Last Name Required Patient Relationship 2 Character 150-151 Patient Relationship between policyholder and patient. Valid values are: 01 Self; Patient is policyholder 02 Spouse 03 Child 04 Other 20 Domestic partner Required Notes: All patient relationship values accepted for MSP Types B and G. MSP Type A will accept 01 and 02. Check Date 8 Numeric 152-159 Date of check in CCYYMMDD format. Required if Source is CHEK Check Amount 15 Alpha 160-174 Amount of check in $999,999,999.99 format. Required if Source is CHEK Check Number 15 Alpha 175-189 Check Number Required if Source is CHEK Beneficiary’s Address 1 32 Text 190-221 Beneficiary’s Address 1 Not required. Populate with spaces if not available. Beneficiary’s Address 2 32 Text 222-253 Beneficiary’s Address 2 Not required. Populate with spaces if not available
ECRS Web User Guide Appendix G: Prescription Drug Inquiry Detail Record G-83 Data Field Length Type Displacement Description Beneficiary’s City 15 Text 254-268 Beneficiary’s City Not required. Populate with spaces if not available. Beneficiary’s State 2 Alpha 269-270 Beneficiary’s State Not required. Populate with spaces if not available. Beneficiary’s ZIP Code 9 Numeric 271-279 Beneficiary’s ZIP code Not required. Populate with spaces if not available Beneficiary’s Phone 10 Numeric 280-289 Beneficiary’s Phone Not required. Populate with zeros if not available Informant’s First Name 15 Text 290-304 Informant’s First Name Required Informant’s Middle Initial 1 Alpha 305 Informant’s Middle Initial Not required. Populate with spaces if not available. Informant’s Last Name 24 Text 306-329 Informant’s Last Name Required Informant’s Relationship Code 1 Alpha 330 Relationship of informant to beneficiary. Valid values are: A = Attorney representing beneficiary B = Beneficiary C = Child D = Defendant’s attorney E = Employer F = Father I = Insurer M = Mother N = Non-relative O = Other relative P = Provider R = Beneficiary representative other than attorney S = Spouse U = Unknown Required Informant’s Address 1 32 Text 331-362 Informant’s Address 1 Required Informant’s Address 2 32 Text 363-394 Informant’s Address 2 Not required. Populate with spaces if not available.
ECRS Web User Guide Appendix G: Prescription Drug Inquiry Detail Record G-84 Data Field Length Type Displacement Description Informant’s City 15 Text 395-409 Informant’s City Required Informant’s State 2 Alpha 410-411 Informant’s State Required Informant’s ZIP Code 9 Numeric 412-420 Informant’s ZIP Required Informant’s Phone 10 Numeric 421-430 Informant’s Phone Number Not required. Populate with zeros if not available. Employer’s Name 32 Text 431-462 Name of employer providing group health insurance under which beneficiary is covered. Not required. Populate with spaces if not available. Employer’s Address 1 32 Text 463-494 Employer’s Address 1 providing group health insurance under which beneficiary is covered. Not required. Populate with spaces if not available. Employer’s Address 2 32 Text 495-526 Employer’s Address 2 providing group health insurance under which beneficiary is covered. Not required. Populate with spaces if not available. Employer’s City 15 Text 527-541 Employer’s City providing group health insurance under which beneficiary is covered. Not required. Populate with spaces if not available. Employer’s State 2 Alpha 542-543 Employer’s State providing group health insurance under which beneficiary is covered. Not required. Populate with spaces if not available. Employer’s ZIP Code 9 Numeric 544-552 Employer’s ZIP code providing group health insurance under which beneficiary is covered. Not required. Populate with spaces if not available. Employer’s Phone 10 Numeric 553-562 Employer’s Phone Number providing group health insurance under which beneficiary is covered. Not required. Populate with spaces if not available.
ECRS Web User Guide Appendix G: Prescription Drug Inquiry Detail Record G-85 Data Field Length Type Displacement Description Employer EIN 18 Text 563-580 Employer’s Identification Number (EIN) providing group health insurance under which the beneficiary is covered. Not required. Populate with spaces if not available. Employee No 12 Text 581-592 Policyholder’s Employee Number Not required. Populate with spaces if not available. Person Code 3 Numeric 593-595 Person Code. Plan specific (Relationship assigned plan administrator at the plan level) Valid values are: 001 = Self 002 = Spouse 003 = Other Required only for Supplemental Drug Coverage records. If not Supplemental Drug Coverage record, populate with spaces. Sup Type 1 Alpha- Numeric 596 Supplemental Drug Coverage Type Valid values are: L = Supplemental N = Non-qualified SPAP R = Charity T = Federal Government Programs 3 = Major Medical Required if Record Type = ‘SUP’. Otherwise not required, populate with spaces. MSP Type 1 Alpha- Numeric 597 Medicare Secondary Payer Type Valid values are: A Working Aged B ESRD C Conditional payment F Federal (public) G Disabled Required if Record Type of Primary ‘PRI’ is selected. Populate with spaces if not available.
ECRS Web User Guide Appendix G: Prescription Drug Inquiry Detail Record G-86 Data Field Length Type Displacement Description Type 1 Alpha- Numeric 598 Prescription Drug Coverage Type Valid values are: U = Drug network V = Drug non-network Z = Health account (such as a flexible spending account provided by other party to pay prescription drug costs or premiums) Required (Effective July 2026). Rec Type 3 Alpha- Numeric 599-601 Prescription Drug Coverage Type of Insurance Valid values are: PRI = Primary SUP = Supplemental Required (Effective July 2026). If Sup Type is populated and this field is blank, SUP will be assumed. Insurer’s name 32 Text 602-633 Name of insurer providing Supplemental Prescription Drug Insurance under which beneficiary is covered. Note: The record will be rejected and return error code PE42 on the response file if the insurer’s name is blank, less than two characters, or contains one of the following invalid names: ADAP, Assistance Program, Attorney, BC, BCBS, BCBX,BCRC, Beneficiary’s name (Effective July 2026), Benefits Coordination & Recovery, Benefits Coordination & Recovery Center, Benefits Coordination and Recove, Benefits Coordination and Recovery Center, Blue Cross, Blue Shield, BS, BX, CMS, COB, COBC, Coordination of Benefits Contrac, Coordination of Benefits Contractor, HCFA, Insurer, Medicaid, Medicare, Misc, Miscellaneous, N/A, NA, NO, No Fault, No-Fault, None, PAP, QSP, Qualified State Program, SPAP, Supplement, Supplemental, TRICARE, UN, UNK, Unknown, (Effective July 2026) US DEPT OF VETERANS AFFAIRS, VA, VA BENEFITS, VA COVERAGE, VETERANS ADMINISTRATION, VETERANS AFFAIRS, and XX. Required
ECRS Web User Guide Appendix G: Prescription Drug Inquiry Detail Record G-87 Data Field Length Type Displacement Description Insurer’s Address 1 32 Text 634-665 Address 1 of insurer providing Supplemental Prescription Drug Insurance under which beneficiary is covered. Not required. Populate with spaces if not available. Insurer’s Address 2 32 Text 666-697 Address 2 of insurer providing Supplemental Prescription Drug Insurance under which beneficiary is covered. Not required. Populate with spaces if not available. Insurer’s City 15 Text 698-712 City of insurer providing Supplemental Prescription Drug Insurance under which beneficiary is covered. Not required. Populate with spaces if not available. Insurer’s State 2 Alpha 713-714 State of insurer providing Supplemental Prescription Drug Insurance under which beneficiary is covered. Not required. Populate with spaces if not available. Insurer’s ZIP Code 9 Numeric 715-723 ZIP code of insurer providing Supplemental Prescription Drug Insurance under which beneficiary is covered. Not required. Populate with spaces if not available.
ECRS Web User Guide Appendix G: Prescription Drug Inquiry Detail Record G-88 Data Field Length Type Displacement Description Drug Coverage Effective Date 8 Date 724-731 Effective Date of Supplemental Prescription Drug Coverage. Required Notes: This field accepts dates up to three months from the current date for primary coverage, as follows: For GHP records (MSP Types A, B, and G): The Drug Coverage Effective Date can be in the future for beneficiaries who are currently enrolled in Part D, or for beneficiaries who will be enrolled starting up to three months in the future. The record will be rejected with status code “CM – Complete” and reason code “98 – Overlapping Rx Coverage” on the response file if the effective date or termination date for an incoming primary or supplemental drug record falls within or overlaps an existing record’s effective date or termination date, and the submitter of the new record matches the submitter of the existing record. If the submitter of the new record does not match the submitter of the existing record, the new record will be accepted. Term Date 8 Date 732-739 Termination Date of Supplemental Prescription Drug Coverage. Not Required. Populate with zeros if not available. The record will be rejected with status code “CM – Complete” and reason code “98 – Overlapping Rx Coverage” on the response file if the effective date or termination date for an incoming primary or supplemental drug record falls within or overlaps an existing record’s effective date or termination date, and the submitter of the new record matches the submitter of the existing record. If the submitter of the new record does not match the submitter of the existing record, the new record will be accepted. Policy Number 17 Text 740-756 Prescription Drug Policy Number Not required. Populate with spaces if not available.
ECRS Web User Guide Appendix G: Prescription Drug Inquiry Detail Record G-89 Data Field Length Type Displacement Description RX BIN 6 Text 757-762 Prescription Drug BIN Number Required if TYPE = U. Must be six numeric digits and cannot be all the same number if COVERAGE TYPE is U. BIN will not be edited for formats when the ACTION CODE is BN. RX PCN 10 Text 763-772 Prescription Drug PCN Number Populate with spaces if not available. Cannot have special characters, except for a non-leading dash, and no leading space. RX Group 15 Text 773-787 Prescription Drug Group Number Populate with spaces if not available. RX ID 20 Text 788-807 Prescription Drug ID Number Required if TYPE = U. Cannot be blank or all zeros if COVERAGE TYPE is U. RX Phone 18 Text plus ‘(‘ and ‘)’ 808-825 Prescription Drug Phone Number Not required. Populate with spaces if not available. Filler 442 Filler 826-1267 Unused Field – fill with spaces
ECRS Web User Guide Appendix G: Prescription Drug Inquiry Response Header Record G-90 Prescription Drug Inquiry Response Header Record Table G-19: Prescription Drug Inquiry Response Header Record Layout Data Field Length Type Displacement Error Code if Invalid Data Header Indicator 2 Alpha-Numeric 1-2 HE01 PDP ID 4 Numeric 3-6 HE02 Contractor Number 5 Alpha-Numeric 7-11 HE03 File Type 3 Alpha 12-14 HE04 File Date 8 Date 15-22 HE05 Submitter Type 1 Alpha-Numeric 23 HE06 Filler 1244 Filler 24-1267 Unused field – fill with spaces Error Code 1 4 Alpha 1268-1271 Error code describing reason why file was rejected Error Code 2 4 Alpha 1272-1275 Error code describing reason why file was rejected Error Code 3 4 Alpha 1276-1279 Error code describing reason why file was rejected Error Code 4 4 Alpha 1280-1283 Error code describing reason why file was rejected
ECRS Web User Guide Appendix G: Prescription Drug Inquiry Response Detail Record G-91 Prescription Drug Inquiry Response Detail Record Table G-20: Prescription Drug Inquiry Response Detail Record Layout Data Field Length Type Displacement Error Code if Invalid Data Transaction type 4 Alpha 1-4 PE00 Contractor Number 5 Alpha- Numeric 5-9 PE01 DCN 15 Text 10-24 PE02 Tran Type Code 1 Alpha 25 PE03 Trans Seq No 3 Numeric 26-28 PE04 Tran Stat Cd 2 Alpha 29-30 None. Will contain status code returned from ECRS. Tran Reason Cd 2 Numeric 31-32 None. Will contain reason code returned from ECRS. Trans Source Cd 4 Alpha 33-36 PE05 Update Operator ID 8 Alpha- Numeric 37-44 PE06 Contractor Name 25 Text 45-69 PE07 Contractor Phone 10 Numeric 70-79 PE08 Medicare ID 12 Alpha- Numeric 80-91 PE09 Beneficiary’s Social Security Number 9 Numeric 92-100 PE10 Beneficiary’s Date of Birth 8 Date 101-108 PE11 Beneficiary’s Sex Code 1 Alpha 109 None Beneficiary’s First Name 15 Text 110-124 PE12 Beneficiary’s Initial 1 Alpha 125 PE13 Beneficiary’s Last Name 24 Text 126-149 PE14 Patient Relationship 2 Character 150-151 PE0J Check Date 8 Numeric 152-159 PE98 Check Amount 15 Alpha 160-174 PE99 Check Number 15 Alpha 175-189 PE0A Beneficiary’s Address 1 32 Text 190-221 PE15 Beneficiary’s Address 2 32 Text 222-253 PE16 Beneficiary’s City 15 Text 254-268 PE17
ECRS Web User Guide Appendix G: Prescription Drug Inquiry Response Detail Record G-92 Data Field Length Type Displacement Error Code if Invalid Data Beneficiary’s State 2 Alpha 269-270 PE18 Beneficiary’s ZIP Code 9 Numeric 271-279 PE19 Beneficiary’s Phone 10 Numeric 280-289 PE20 Informant’s First Name 15 Text 290-304 PE21 Informant’s Middle Initial 1 Alpha 305 PE22 Informant’s Last Name 24 Text 306-329 PE23 Informant’s Relationship Code 1 Alpha 330 None Informant’s Address 1 32 Text 331-362 PE24 Informant’s Address 2 32 Text 363-394 PE25 Informant’s City 15 Text 395-409 PE26 Informant’s State 2 Alpha 410-411 PE27 Informant’s ZIP Code 9 Numeric 412-420 PE28 Informant’s Phone 10 Numeric 421-430 PE29 Employer’s Name 32 Text 431-462 PE30 Employer’s Address 1 32 Text 463-494 PE31 Employer’s Address 2 32 Text 495-526 PE32 Employer’s City 15 Text 527-541 PE33 Employer’s State 2 Alpha 542-543 PE34 Employer’s ZIP Code 9 Numeric 544-552 PE35 Employer’s Phone 10 Numeric 553-562 PE36 Employer EIN 18 Text 563-580 PE37 Employee No 12 Text 581-592 PE38 Person Code 3 Numeric 593-595 PE0K Sup Type 1 Alpha- Numeric 596 PE0P MSP Type 1 Alpha- Numeric 597 PE39 Type 1 Alpha- Numeric 598 PE40 Rec Type 3 Alpha- Numeric 599-601 PE41 Insurer’s name 32 Text 602-633 PE42 Insurer’s Address 1 32 Text 634-665 PE43 Insurer’s Address 2 32 Text 666-697 PE44 Insurer’s City 15 Text 698-712 PE45
ECRS Web User Guide Appendix G: Prescription Drug Inquiry Response Detail Record G-93 Data Field Length Type Displacement Error Code if Invalid Data Insurer’s State 2 Alpha 713-714 PE46 Insurer’s ZIP Code 9 Numeric 715-723 PE47 COB Effective Date 8 Date 724-731 PE48 Term Date 8 Date 732-739 PE0G Policy Number 17 Text 740-756 PE49 RX BIN 6 Text 757-762 PE50 RX PCN 10 Text 763-772 PE51 RX Group 15 Text 773-787 PE52 RX ID 20 Text 788-807 PE53 RX Phone 18 Text plus ‘(‘ and ‘)’ 808-825 PE54 Filler 442 Filler 826-1267 Unused Field – fill with spaces Error Code 1 4 Alpha- Numeric 1268-1271 Error code describing reason why file was rejected. Error Code 2 4 Alpha- Numeric 1272-1275 Error code describing reason why file was rejected. Error Code 3 4 Alpha- Numeric 1276-1279 Error code describing reason why file was rejected. Error Code 4 4 Alpha- Numeric 1280-1283 Error code describing reason why file was rejected.
ECRS Web User Guide Appendix H: Error Codes H-1 Appendix H: Error Codes Table H-1: Header Record Errors Error Code Description HE01 Invalid Header Indicator (Not = ‘H0’) HE02 Invalid Plan ID HE03 Invalid Contractor Number HE04 Invalid File Type HE05 Invalid File Date HE06 Invalid Submitter Type Table H-2: Trailer Record Errors Error Code Description TE01 Invalid Trailer Indicator (Not = ‘T0’) TE02 Invalid Plan ID TE03 Contractor Number TE04 Invalid File Type TE05 Invalid File Date TE06 Invalid Record Count Table H-3: Detail Record and File Structure Errors Error Code Description DE01 Invalid Character FS01 Invalid File Structure FS02 Invalid Record Length Table H-4: Response Record Errors Error Code Description PE00 Invalid Transaction Type entered (Not = ‘ECRS’) PE01 Invalid Contractor Number entered PE02 Invalid DCN Number PE03 Invalid Transaction Type Code PE04 Invalid Transaction Sequence Number PE05 Invalid Trans Source Code PE06 Invalid Update Operator Id
ECRS Web User Guide Appendix H: Error Codes H-2 Error Code Description PE07 Invalid Contractor Name PE08 Invalid Contractor Phone Number PE09 Invalid Medicare ID PE10 Invalid Beneficiary’s Social Security Number PE11 Invalid Beneficiary’s Date of Birth PE12 Invalid Beneficiary’s First Name PE13 Invalid Beneficiary’s Middle Initial PE14 Invalid Beneficiary’s Last Name PE15 Invalid Beneficiary’s Address 1 PE16 Invalid Beneficiary’s Address 2 PE17 Invalid Beneficiary’s City PE18 Invalid Beneficiary’s State PE19 Invalid Beneficiary’s ZIP Code PE20 Invalid Beneficiary’s Phone Number PE21 Invalid Informant’s First Name PE22 Invalid Informant’s Middle Initial PE23 Invalid Informant’s Last Name PE24 Invalid Informant’s Address 1 PE25 Invalid Informant’s Address 2 PE26 Invalid Informant’s City PE27 Invalid Informant’s State PE28 Invalid Informant’s ZIP Code PE29 Invalid Informant’s Phone Number PE30 Invalid Employer’s Name PE31 Invalid Employer’s Address 1 PE32 Invalid Employer’s Address 2 PE33 Invalid Employer’s City PE34 Invalid Employer’s State PE35 Invalid Employer’s ZIP PE36 Invalid Employer’s Phone Number PE37 Invalid Employer’s EIN PE38 Invalid Employee Number PE39 Invalid MSP Type PE40 Invalid Type PE41 Invalid Record Type PE42 Invalid Insurer’s Name
ECRS Web User Guide Appendix H: Error Codes H-3 Error Code Description PE43 Invalid Insurer’s Address 1 PE44 Invalid Insurer’s Address 2 PE45 Invalid Insurer’s City PE46 Invalid Insurer’s State PE47 Invalid Insurer’s ZIP PE48 Invalid Effective Date or COB Effective Date Note: For descriptions of the acceptance criteria for the COB Effective Date (PDAR) or Effective Date (PDI) fields for GHP and NGHP records, see Appendix G. PE49 Invalid Policy Number PE50 Invalid Rx BIN PE51 Invalid Rx PCN PE52 Invalid Rx Group PE53 Invalid Rx ID PE54 Invalid Rx Phone PE56 Invalid COB Comment PE57 Invalid COB Comment ID PE58 Invalid Subscriber’s First Name PE59 Invalid Subscriber’s Middle Initial PE60 Invalid Subscriber’s Last Name PE61 Invalid Activity Code PE62 Invalid Insurer Group Number PE63 Invalid Insurer Policy Number PE64 Invalid First Development PE65 Invalid Second Development PE66 Invalid Response PE67 Invalid Effective Date or MSP Effective Date Note: For descriptions of the acceptance criteria for the Effective Date (MSP Inquiry) or MSP Effective Date (CWF AR) fields for GHP and NGHP records, see Appendix G. PE68 Invalid MSP Term Date Term Date was not provided for action TD or CT Term Date is less than Effective Date Matching record is already termed Matching record has the same Term Date as the one provided PE69 Invalid Diagnosis Code 1 PE70 Invalid Diagnosis Code 2 PE71 Invalid Diagnosis Code 3
ECRS Web User Guide Appendix H: Error Codes H-4 Error Code Description PE72 Invalid Diagnosis Code 4 PE73 Invalid Diagnosis Code 5 PE75 Invalid Illness/Injury Date PE76 Invalid Illness/Injury Description PE77 Invalid Representative Name PE78 Invalid Representative Address 1 PE79 Invalid Representative Address 2 PE80 Invalid Representative City PE81 Invalid Representative State PE82 Invalid Representative ZIP PE83 Invalid Representative Type PE84 Invalid Dialysis Train Date PE85 Invalid Black Lung Indicator PE86 Invalid Black Lung Effective Date PE87 Invalid MSP AUX Number PE88 Invalid MSP Accretion Date PE89 Invalid Remarks Code 1 PE90 Invalid Remarks Code 2 PE91 Invalid Remarks Code 3 PE92 Invalid Trans Action Code 1 PE93 Invalid Trans Action Code 2 PE94 Invalid Trans Action Code 3 PE95 Invalid Trans Action Code 4 PE96 Invalid Originating Contractor PE97 Invalid PHP Date PE98 Invalid Check Date PE99 Invalid Check Amount PE0A Invalid Check Number PE0C Invalid Develop To PE0D Invalid Change Lead To PE0E Invalid CMS Grouping Code PE0F RX BIN when PDI Coverage Type is “U.” Cannot be blank or if values are: 000000, 111111, 222222 through 999999 (see PE50).
ECRS Web User Guide Appendix H: Error Codes H-5 Error Code Description PE0G Invalid Term Date Term Date was not provided for action TD or CT Term Date is less than Effective Date Matching record is already termed Matching record has the same Term Date as the one provided PE0H Patient relationship required for coverage type of U PE0I Insurance type required for coverage type of U PE0J Invalid Patient relationship for the associated MSP Type Type A Valid Relationship Codes 01, 02 Type B Valid Relationship Codes 01, 02, 03, 04, 20 Type G Valid Relationship Codes 01, 02, 03, 04, 20 Type D, E, L, H, W, S, and T Valid Relationship Codes 01 Note: Types D, E, L, H, and W are not allowed in PDI or PDAR transactions. PE0K Invalid or Missing Person Code PE0L Invalid New Effective Date or New COB Effective Date Note: For descriptions of the acceptance criteria for the New Effective Date or New COB Effective Date fields for GHP and NGHP records, see Appendix G. PE0M Invalid New Insurer Type PE0N Invalid New MSP Type PE0O Invalid New Patient Relationship A matching record already exists with the new patient relationship PE0P Add/Update of Supplemental Type M, O, Q, and S is not allowed PE0Q Invalid Insurance Type. MSP Inquiry submitted with an Insurance Type other than “A,” “J,” “K,” “R,” “S,” or blank. PE1A Invalid Diagnosis Code 1 ICD Indicator PE69 Invalid Diagnosis Code 1 PE1B Invalid Diagnosis Code 2 ICD Indicator PE70 Invalid Diagnosis Code 2 PE1C Invalid Diagnosis Code 3 ICD Indicator PE71 Invalid Diagnosis Code 3 PE1D Invalid Diagnosis Code 4 ICD Indicator PE72 Invalid Diagnosis Code 4 PE1E Invalid Diagnosis Code 5 ICD Indicator PE73 Invalid Diagnosis Code 5 PE1F Invalid Diagnosis Code 6 ICD Indicator PE1G Invalid Diagnosis Code 6 PE1H Invalid Diagnosis Code 7 ICD Indicator PE1I Invalid Diagnosis Code 7 PE1J Invalid Diagnosis Code 8 ICD Indicator
ECRS Web User Guide Appendix H: Error Codes H-6 Error Code Description PE1K Invalid Diagnosis Code 8 PE1L Invalid Diagnosis Code 9 ICD Indicator PE1M Invalid Diagnosis Code 9 PE1N Invalid Diagnosis Code 10 ICD Indicator PE1O Invalid Diagnosis Code 10 PE1P Invalid Diagnosis Code 11 ICD Indicator PE1Q Invalid Diagnosis Code11 PE1R Invalid Diagnosis Code 12 ICD Indicator PE1S Invalid Diagnosis Code 12 PE1T Invalid Diagnosis Code 13 ICD Indicator PE1U Invalid Diagnosis Code 13 PE1V Invalid Diagnosis Code 14 ICD Indicator PE1W Invalid Diagnosis Code 14 PE1X Invalid Diagnosis Code 15 ICD Indicator PE1Y Invalid Diagnosis Code 15 PE1Z Invalid Diagnosis Code 16 ICD Indicator PE2A Invalid Diagnosis Code 16 PE2B Invalid Diagnosis Code 17 ICD Indicator PE2C Invalid Diagnosis Code 17 PE2D Invalid Diagnosis Code 18 ICD Indicator PE2E Invalid Diagnosis Code 18 PE2F Invalid Diagnosis Code 19 ICD Indicator PE2G Invalid Diagnosis Code 19 PE2H Invalid Diagnosis Code 20 ICD Indicator PE2I Invalid Diagnosis Code 20 PE2J Matching record not found for update PE2K Effective Date of Other Drug Coverage is not in MMDDCCYY format PE2L New Effective Date of Other Drug Coverage is not in MMDDCCYY format PE2M New Effective Date of Other Drug Coverage submitted is equal to the Effective Date submitted PE2N New Effective Date of Other Drug Coverage submitted is equal to the current Effective Date of Other Drug Coverage for the matching record PE2O Updates To Matching Record Are In Process, Resubmit Request
ECRS Web User Guide Appendix I: Frequently Asked Questions I-1 Appendix I: Frequently Asked Questions (FAQs) Table I-1: Am I Using the Correct Option? Main Menu Request/Inquiry Type Use this Request/Inquiry to: Create Requests or Inquiries CWF Assistance Request Add a new Assistance Request for changes to existing CWF MSP auxiliary occurrences. Create Requests or Inquiries MSP Inquiry Add a new Inquiry about a new or possible MSP situation not yet documented at CWF. Create Requests or Inquiries Prescription Drug Assistance Request Add a new Assistance Request for Part D information. Create Requests or Inquiries Prescription Drug Inquiry Add a new Inquiry about a possible Prescription Drug situation not yet documented at MBD. Search for Requests or Inquiries CWF Assistance Request • View a list of all CWF Assistance Requests submitted by the contractor • Check the progress of a CWF Assistance Request transaction • Delete CWF Assistance Requests that have not been processed by the COB. • View summary detail for a selected CWF Assistance Request transaction. Search for Requests or Inquiries MSP Inquiries • View a list of all MSP Inquiries submitted by the contractor • Check the progress of an MSP Inquiry transaction. • Delete MSP Inquiry requests that have not been processed by the COB. • View summary detail for a selected MSP Inquiry transaction. Search for Requests or Inquiries Prescription Drug Assistance Requests • View a list of all Prescription Drug Assistance Requests submitted by the contractor • Check the progress of a Prescription Drug Assistance Request transaction • Delete Prescription Drug Assistance Requests that have not been processed by the COB. • View summary detail for a selected Prescription Drug Assistance Request transaction.
ECRS Web User Guide Appendix I: Frequently Asked Questions I-2 Main Menu Request/Inquiry Type Use this Request/Inquiry to: Search for Requests or Inquiries Prescription Drug Inquiries • View a list of all Prescription Drug Inquiries submitted by the contractor. • Check the progress of a Prescription Drug Inquiry transaction. • Delete Prescription Drug Inquiry requests that have not been processed by the COB. • View summary detail for a selected Prescription Drug Inquiry transaction. Reports Contractor Workload Tracking Review your contractor site’s workload (for Medicare contractors) Reports Consolidated ECRS Workload Search Verify the receipt and status of all submitted requests (for Medicare contractors, not including ROs and COs) Reports CMS Workload Tracking Review contractor workloads (for CMS users). Reports Quality Assurance Surveillance Plan (QASP) Report Review Inquiry, and Assistance request statistics (for CMS users) Files Upload File Upload batch files for processing assistance requests and inquiries. (Requires special user authority.) Files Download Response File Download responses to previously uploaded batch files, after transactions have been processed by COB. (Requires special user authority.) I.1 General Issues What are the operating hours for the ECRS Web application? Attempts are made to have ECRS Web available at all times. However, certain portions of the application, such as HIMR, may only be available from 8 a.m. until 5 p.m. EST. In addition, system maintenance is performed on Sundays, which also may affect availability. Do all contractors see the same exact information on ECRS Web, or does it vary from state to state? ECRS Web information is restricted by contractor number and access code. Contractors can view information associated with other contractors if they have the necessary contractor number and access code, in addition to a valid Medicare ID. Can users print ECRS Web pages? Yes, some pages can be printed by clicking the Print icon on that page.
ECRS Web User Guide Appendix I: Frequently Asked Questions I-3 I.2 Inquiry and Assistance Request Issues Are completed MSP Inquiries, CWF Assistance Requests, Prescription Drug Assistance Requests, and Prescription Drug inquiries purged? No, but there are origin date parameters on the search pages that allow you to specify date ranges. The default, unless changed by the user, only shows transactions for the most recent 31 calendar days. You can search requests based on the following criteria: • Contractor Number • Medicare ID • SSN • DCN • Status • Reason • User ID • Origin Date range When searching by Medicare ID, DCN, or SSN, Origin Date range is not required, and results include all contractors, not just your own. Why can I only update or delete an Inquiry or Assistance Request while it is in NW (new) status? When an inquiry or assistance request is initially submitted, it has to wait until the batch application processes in the evening before changes or inquiries are actually processed. During the time that the transaction sits in wait, it is considered to be in NW status. It is only during this time that you can delete or update a transaction, because it has not yet been processed. Does a contractor need to send three separate Assistance Requests to delete three auxiliary records for the same beneficiary? Yes. When an assistance request is submitted with the action code of DO, the delete is automated within the system, so three separate requests must be submitted to assure all occurrences are deleted. In the event a transaction is sent via ECRS Web through both an Assistance Request and an Inquiry option, does ECRS have an edit in place that will find these duplicate records? ECRS Web does not have an edit in place to detect this potential duplicate situation. However, an MSP Inquiry will reject with a reason code 87 when a duplicate record is present on the Case Coverage Database. If a contractor has multiple contractor numbers, can they choose one to use consistently for Inquiries and Assistance Request transactions? Yes. You can use whatever contractor number is best for your work process.
ECRS Web User Guide Appendix I: Frequently Asked Questions I-4 Can contractors delete an Inquiry once it has been entered and is later found to contain an error? Medicare contractors can delete an inquiry if they discover the error on the same day and the inquiry is in NW status. If the error is discovered after the inquiry has been processed, the contractor can submit a CWF Assistance Request (for MSP Inquiries), or a Prescription Drug Assistance Request (for Prescription drug Inquiries), or notify the BCRC. What action code should contractors use when they receive information regarding a termination date for a 77777 or 11102 record that is more than six months from the date of accretion? Select CWF Assistance Request under the heading Create Requests and Inquiries, from the Main Menu. On the Action Requested page, use ACTION TD, and enter the Termination Date on the CWF Auxiliary Record Data page. Does the BCRC view the Comments fields on the Assistance Request Detail pages and the MSP Inquiry Detail page? On the Assistance Request Detail pages, the BCRC views the comments as necessary for each ECRS type. On the MSP Inquiry Detail page, the Comments field has been removed and replaced with additional Action and reason codes.
ECRS Web User Guide Appendix J: Acronyms J-1 Appendix J: Acronyms Table J-1: Acronyms Term/Acronym Definition ADAP AIDS Drug Assistance Program BCRC Benefits Coordination & Recovery Center CMS Centers for Medicare & Medicaid Services COB Coordination of Benefits CWF Common Working File DOS Date of Service DCN Document Control Number ECRS Electronic Correspondence Referral System EFT Electronic File Transfer EGHP Employer Group Health Plan EIDM CMS Enterprise Identity Management EIN Employer Identification Number GHP Group Health Plan HICN Health Insurance Claim Number HIMR Health Insurance Master Record HUSP Health Utilization Secondary Payer IAL Identity Assurance Level IDM Identity Management IVR Interactive Voice Response LOA Level of Assurance MBD Medicare Beneficiary Database MBI Medicare Beneficiary Identifier MFA Multi-Factor Authentication MSP Medicare Secondary Payer NDC National Drug Code NGHP Non-Group Health Plan PAP Patient Assistance Program PDAR Prescription Drug Assistance Request PII Personally Identifiable Information RIDP Remote Identity Proofing
ECRS Web User Guide Appendix J: Acronyms J-2 Term/Acronym Definition RO Regional Office SPAP State Pharmaceutical Assistance Program SSN Social Security Number
ECRS Web User Guide Appendix K: Previous Version Updates K-1 Appendix K: Previous Version Updates Version 7.9 Overlapping drug coverage record processing is being updated. If the effective date or termination date for an incoming primary or supplemental drug record falls within or overlaps an existing record’s effective date or termination date, and the submitter of the new record matches the submitter of the existing record, the record will be rejected. If the submitter of the new record does not match the existing record, the new record will be accepted (Sections 6.4 and Appendix G). The process for accessing ECRS Web CBTs has changed (Section 2.2). Version 7.8 The supplemental type “M-Medigap” has been removed from the list of valid values on the following pages: MSP Inquiry Prescription Drug, Prescription Drug Inquiry Prescription Drug Information, and Prescription Drug Assistance Request Insurance Information. Additionally, Prescription Drug Inquiry and Prescription Drug Assistance Request batch transactions will be rejected with error code PE0P if “M” is submitted in the supplemental type field (Sections 4.8, 5.5, and 6.4, Appendix G, and Appendix H). Version 7.7 Per CMS direction, the supplemental type “O-Other” has been removed from the list of valid values on the following pages: MSP Inquiry Prescription Drug, Prescription Drug Inquiry Prescription Drug Information, and Prescription Drug Assistance Request Insurance Information. Additionally, Prescription Drug Inquiry and Prescription Drug Assistance Request batch transactions will be rejected with error code PE0P if “O” is submitted in the supplemental type field (Sections 4.8, 5.5, and 6.4 and Appendix G).
ECRS Web User Guide Revision History K-1 Revision History Date Version Reason for Change October 7, 2024 v. 7.7 New Feature (NF) 1806: The supplemental type “O-Other” has been removed from the list of valid values on the following pages: MSP Inquiry Prescription Drug, Prescription Drug Inquiry Prescription Drug Information, and Prescription Drug Assistance Request Insurance Information. Additionally, Prescription Drug Inquiry and Prescription Drug Assistance Request batch transactions will be rejected with error code PE0P if “O” is submitted in the supplemental type field. April 7, 2025 v. 7.8 New Feature (NF) 2100: The supplemental type “M-Medigap” has been removed from the list of valid values on the following pages: MSP Inquiry Prescription Drug, Prescription Drug Inquiry Prescription Drug Information, and Prescription Drug Assistance Request Insurance Information. Additionally, Prescription Drug Inquiry and Prescription Drug Assistance Request batch transactions will be rejected with error code PE0P if “M” is submitted in the supplemental type field. January 5, 2026 v. 7.9 New Feature (NF) 2772: Overlapping drug coverage record processingis being updated. If the effective date or termination date for an incoming primary or supplemental drug record falls within or overlas an existing record’s effective date, and the submitter of the new record matches the submiter of the existing record, the new record will be accepted. NF 3136:The process for accessing ECRS Web CBTs has changed. April 13, 2026 v. 8.0 New Feature (NF) 2796: Effective July 2026: To avoid erroneous rejections, Rx codes BIN, PCN, Rx Group, and Rx ID are not required for Prescription Drug Assistance Requests when the Action is BN – Develop for Prescription BIN Number, GR – Develop for Group Number, or PN – Develop for/add PCN. NF 2797: Effective July 2026: To prevent the creation of records with invalid or missing information, Type and Record Type will be required for Prescription Drug Inquiries. NF 2631: Effective July 2026: To reduce the number of records with invalid insurer names, additional insurer names have been added to the rejection lists for Prescription Drug Assistance Requests and Prescription Drug Inquiries. NF 3008: The ECRS login page has been updated.
Continue your research in ChatGPT or Claude
Connect Omnilex to search the legal corpus from your AI assistant.