| Code | Display | Definition |
| ESMD_410 |
Cannot read file/Corrupt Files |
When Review Contractors receive packages from HIHs/Providers via esMD, they may encounter issues with opening PDF files due to corruption, either during transmission or while the HIH/Provider prepared the bundle. In such cases, the Review Contractor notifies the HIH/Provider about the corrupted file. The HIH/Provider reviews and corrects the issue by generating a valid PDF and resubmits the corrected file through esMD as a new transaction. This process ensures that the Review Contractor receives an accessible and valid file while maintaining the integrity of the esMD document exchange. |
| ESMD_411 |
Submission sent to incorrect RC |
When Review Contractors receive packages from HIHs/Providers via esMD, they may identify that the package was sent to the wrong Review Contractor. Upon detecting this error, the Review Contractor notifies the HIH, highlighting the issue. The HIH then updates the intendedRecipient information in the metadata to correctly identify the appropriate Review Contractor. After making the correction, the HIH resubmits the request through esMD, ensuring it reaches the correct Review Contractor for processing. This workflow helps maintain the accuracy and efficiency of the esMD document exchange process. |
| ESMD_412 |
Virus Found |
When Review Contractors receive packages from HIHs/Providers via esMD, the package undergoes a virus scan as part of the validation process. If a virus is detected in any file, the Review Contractor generates a 'Virus Found' error message and sends it to the HIH. Upon receiving this notification, the HIH reviews the affected file, removes the virus, or replaces the file with a clean version. After addressing the issue, the HIH resubmits the corrected package through esMD for processing. This ensures the security and integrity of the esMD document exchange system. |
| ESMD_413 |
Other |
When Review Contractors receive packages from HIHs/Providers via esMD, they may encounter issues that do not fall under predefined error categories. In such cases, the Review Contractor generates an 'Other' error message, accompanied by a detailed description explaining the specific issue (e.g., missing required metadata, unsupported file format, or incorrect data structure). The detailed description helps the HIH understand the nature of the problem. The HIH reviews this information, corrects the transaction as per the provided details, and resubmits it through esMD. This process ensures clarity in error resolution and supports seamless transaction processing. |
| ESMD_414 |
Incomplete File |
When Review Contractors receive packages from HIHs/Providers via esMD, they may identify that one or more files in the package are incomplete or missing essential data. In such cases, the Review Contractor generates an 'Incomplete File' error message, specifying the details of the incomplete or missing file(s) to help the HIH understand the issue. The HIH reviews the error message, corrects the file(s) by ensuring all required data is included, and resubmits the updated package through esMD. This process ensures the completeness and accuracy of the submitted files for successful processing. |
| ESMD_415 |
Unsolicited Response |
When Review Contractors receive packages from HIHs/Providers via esMD, they may determine that the submission is an 'Unsolicited Response', meaning the package or transaction was sent without a corresponding request or prior authorization. In such cases, the Review Contractor generates an 'Unsolicited Response' error message, notifying the HIH of the issue. The HIH reviews the error details, verifies the transaction's context, and ensures that future submissions align with valid requests or authorizations. If required, the HIH corrects the metadata and resubmits the transaction through esMD. This process ensures that only authorized and relevant submissions are processed. |
| ESMD_416 |
Documentation cannot be matched to a case/claim |
When Review Contractors receive packages from HIHs/Providers via esMD, they may identify that the submitted documentation cannot be matched to an existing case or claim due to discrepancies in identifiers, metadata, or missing information. In such cases, the Review Contractor generates a 'Documentation cannot be matched to a case/claim' error message, specifying the details of the mismatch. The HIH reviews the error, verifies and updates the relevant metadata (e.g., case ID, claim ID, or associated details), and resubmits the corrected documentation through esMD. This process ensures accurate linking of documentation to the intended case or claim for efficient processing. |
| ESMD_417 |
Duplicate |
When Review Contractors receive packages from HIHs/Providers via esMD, they may identify that a transaction is a duplicate of a previously submitted package. In such cases, the Review Contractor generates a 'Duplicate' error message, notifying the HIH of the duplicate submission and providing details about the original transaction. No further action or resubmission is required from the HIH, as the duplicate submission is flagged and handled appropriately by the Review Contractor to avoid redundant processing. This ensures the system's efficiency by preventing unnecessary transactions. |
| GEX10 |
The date(s) of service on the cover sheet (CS) received is missing or invalid |
When Review Contractors receive packages from HIHs/Providers via esMD, they may identify that the date(s) of service provided on the cover sheet (CS) is either missing or invalid (e.g., incorrect format, out-of-range dates, or conflicting with other submitted information). In such cases, the Review Contractor generates a 'The date(s) of service on the cover sheet (CS) received is missing or invalid' error message, specifying the issue with the date(s). The HIH reviews the error, updates the cover sheet with accurate and valid service date(s), and resubmits the corrected transaction through esMD. This ensures the submitted documentation aligns with the required standards for processing. |
| GEX11 |
The NPI on the CS received is missing or invalid |
When Review Contractors receive packages from HIHs/Providers via esMD, they may identify that the National Provider Identifier (NPI) on the cover sheet (CS) is either missing or invalid (e.g., incorrect format, unregistered NPI, or does not match the associated provider). In such cases, the Review Contractor generates a 'The NPI on the CS received is missing or invalid' error message, specifying the issue with the NPI. The HIH reviews the error, verifies the provider's NPI, corrects the cover sheet with the valid NPI, and resubmits the updated transaction through esMD. This ensures accurate identification of the provider and facilitates proper processing. |
| GEX12 |
The state where services were provided is missing or invalid on the CS |
When Review Contractors receive packages from HIHs/Providers via esMD, they may identify that the state where services were provided, as listed on the cover sheet (CS), is either missing or invalid (e.g., incorrect state code, unrecognized format, or conflicting with the submitted information). In such cases, the Review Contractor generates a 'The state where services were provided is missing or invalid on the CS' error message, specifying the issue. The HIH reviews the error, verifies the state information, corrects the cover sheet with the accurate state details, and resubmits the updated transaction through esMD. This ensures accurate geographic data and facilitates appropriate processing. |
| GEX13 |
The Medicare ID on the CS received is missing or invalid |
When Review Contractors receive packages from HIHs/Providers via esMD, they may identify that the Medicare ID provided on the cover sheet (CS) is either missing or invalid (e.g., incorrect format, unrecognized ID, or does not match the associated beneficiary). In such cases, the Review Contractor generates a 'The Medicare ID on the CS received is missing or invalid' error message, specifying the issue with the Medicare ID. The HIH reviews the error, verifies the beneficiary's Medicare ID, corrects the cover sheet with the accurate ID, and resubmits the updated transaction through esMD. This ensures accurate identification of the beneficiary and proper processing of the submission. |
| GEX14 |
The billed amount on the CS received is missing or invalid |
When Review Contractors receive packages from HIHs/Providers via esMD, they may identify that the billed amount provided on the cover sheet (CS) is either missing or invalid (e.g., incorrect format, unreasonable value, or conflicting with the accompanying documentation). In such cases, the Review Contractor generates a 'The billed amount on the CS received is missing or invalid' error message, specifying the issue with the billed amount. The HIH reviews the error, verifies the billed amount information, updates the cover sheet with the correct amount, and resubmits the corrected transaction through esMD. This ensures accurate financial data for proper claim processing. |
| GEX15 |
The contact phone number on the CS received is missing or invalid |
When Review Contractors receive packages from HIHs/Providers via esMD, they may identify that the contact phone number provided on the cover sheet (CS) is either missing or invalid (e.g., incorrect format, incomplete number, or unrecognized area code). In such cases, the Review Contractor generates a 'The contact phone number on the CS received is missing or invalid' error message, specifying the issue with the phone number. The HIH reviews the error, verifies the contact details, updates the cover sheet with the correct phone number, and resubmits the corrected transaction through esMD. This ensures accurate contact information for effective communication and processing. |
| GEX16 |
The beneficiary name on the cover sheet received is missing or invalid |
When Review Contractors receive packages from HIHs/Providers via esMD, they may identify that the beneficiary name provided on the cover sheet (CS) is either missing or invalid (e.g., misspelled, incomplete, or does not match the Medicare records). In such cases, the Review Contractor generates a 'The beneficiary name on the cover sheet received is missing or invalid' error message, specifying the issue with the beneficiary name. The HIH reviews the error, verifies the beneficiary's details, updates the cover sheet with the accurate name, and resubmits the corrected transaction through esMD. This ensures accurate identification of the beneficiary for proper processing and record matching. |
| GEX17 |
The claim number on the cover sheet received is missing or invalid |
When Review Contractors receive packages from HIHs/Providers via esMD, they may identify that the claim number provided on the cover sheet (CS) is either missing or invalid (e.g., incorrect format, unrecognized number, or does not match the submitted claim details). In such cases, the Review Contractor generates a 'The claim number on the cover sheet received is missing or invalid' error message, specifying the issue with the claim number. The HIH reviews the error, verifies the claim number against their records, updates the cover sheet with the correct information, and resubmits the corrected transaction through esMD. This ensures accurate linkage of the documentation to the appropriate claim for efficient processing. |
| GEX18 |
The ACN on the coversheet received is missing or invalid |
When Review Contractors receive packages from HIHs/Providers via esMD, they may identify that the claim number provided on the cover sheet (CS) is either missing or invalid (e.g., incorrect format, unrecognized number, or does not match the submitted claim details). In such cases, the Review Contractor generates a 'The claim number on the cover sheet received is missing or invalid' error message, specifying the issue with the claim number. The HIH reviews the error, verifies the claim number against their records, updates the cover sheet with the correct information, and resubmits the corrected transaction through esMD. This ensures accurate linkage of the documentation to the appropriate claim for efficient processing. |