Medicare Medicaid (FAI)


This page provides valuable CMS guidance, materials and information for the successful electronic submission of Medicare-Medicaid data.

For convenient navigation, the combined content of each sub-category located on the left side of the page is provided below.

1/10/2025
2024 PDE Monthly Report Distribution Status1/10/2025Medicare Medicaid (FAI)
12/10/2024
Update to the PDE Outbound File Layout12/10/2024Medicare Medicaid (FAI)
5/10/2024
2024 PDE Monthly Report Distribution Status5/10/2024Medicare Medicaid (FAI)
11/4/2022
Encounter Data Processing System Maintenance 11/4/2022Medicare Medicaid (FAI)
10/4/2021
MMP DME Addendum to Encounter Data Submission and Processing Guide and State assigned Medicaid Companion Guides10/4/2021Companion Guides
MMP Inst Addendum to Encounter Data Submission and Processing Guide and State assigned Medicaid Companion Guides10/4/2021Companion Guides
MMP Prof Addendum to Encounter Data Submission and Processing Guide and State assigned Medicaid Companion Guides10/4/2021Companion Guides
11/15/2018
Dental Error Code Listing11/15/2018References
9/17/2018
MMP NCPDP Companion Guide9/17/2018Companion Guides
6/12/2018
Information and Guidance for Plans6/12/2018References
X12 Version 5010 Standards6/12/2018References
3/2/2018
Dental Validation Report Layout3/2/2018Report Layouts
7/24/2017
NCPDP Error Code Listing7/24/2017References
7/25/2016
MMP Webinar Training - January 22, 20157/25/2016Training
4/22/2016
MMP Dental Companion Guide Addendum4/22/2016Companion Guides
2/9/2016
MMP Edits Update Effective February 29, 2016 - Clarification2/9/2016References
5/18/2015
NCPDP Response Report Layout5/18/2015Report Layouts
10/28/2014
In what position on the NCPDP file will CMS populate the CMS assigned number for each claim?10/28/2014FAQs
Is CMS expecting the value that was provided in Field 896 in the NCPDP PAH 4.2 pharmacy encounter file to be used for credit/debit transactions after the claim has been processed?10/28/2014FAQs
Will CMS send back rejects on the NCPDP file for compounds under the DE or will we see the CD identifier starting in position 47?10/28/2014FAQs
Will more than 1 response line be sent per claim on the NCPDP file if there are both detail and compound rejects?10/28/2014FAQs
7/9/2014
Does CMS/Palmetto perform compliance validation on 837 files received from ICOs for Medicaid services?7/9/2014FAQs
If a single Medicare encounter is rejected will the HLs be renumbered to be in sequence?7/9/2014FAQs
If a single Medicare encounter is rejected will the ST/SE count be recalculated to reflect the new count for the transaction?7/9/2014FAQs
If multiple Medicare encounters for a subscriber exists and there is a encounter being rejected, would all loops/segments pertaining to the encounter be rejected and therefore deleted from the file sent to the State, starting with 2300:CLM up to the next 2300:CLM?7/9/2014FAQs
If multiple encounters for a subscriber exists and rejecting a Medicaid claim, would all loops/segments pertaining to the encounter be rejected and therefore deleted from the file being sent to the State, starting with 2300:CLM up to the next 2300:CLM?7/9/2014FAQs
If rejecting a single Medicare encounter for a single subscriber and a single billing provider, would all loops/segments pertaining to the encounter be rejected, starting with ST and up to SE?7/9/2014FAQs
If rejecting a single Medicare encounter for a single subscriber, would all loops/segments pertaining to the encounter be rejected and therefore deleted from the file sent to the State, starting with the billing provider HL and up to the next HL (next subscriber or billing provider)?7/9/2014FAQs
If rejecting a single Medicare encounter for a subscriber, would all loops/segments pertaining to the encounter be rejected and therefore deleted from the file sent to the State, starting with the subscriber HL and up to the next HL (next subscriber or billing provider)?7/9/2014FAQs
If rejecting a single encounter for a single subscriber and a single billing provider, would all loops/segments pertaining to the Medicaid encounter be rejected and therefore deleted from the file being sent to the State, starting with ST and up to SE?7/9/2014FAQs
If rejecting a single encounter for a single subscriber, would all loops/segments pertaining to the Medicaid encounter be rejected and therefore deleted from the file being sent to the State, starting with the billing provider HL and up to the next HL (next subscriber or billing provider)?7/9/2014FAQs
If rejecting a single encounter for a subscriber, would all loops/segments pertaining to the Medicaid encounter be rejected and therefore deleted from the file being sent to the State, starting with the subscriber HL and up to the next HL (next subscriber or billing provider)?7/9/2014FAQs
If rejecting at the claim level for the Medicaid file, is the compliant portion reformatted to a compliant 837 transaction?7/9/2014FAQs
If rejecting only the non-compliant portion of the Medicaid file, is the rejection at the transaction (ST – SE), or claim level?7/9/2014FAQs
If rejecting the last Medicare encounter for the subscriber, would all loops/segments pertaining to the encounter be rejected and therefore deleted from the file sent to the State, starting with 2300:CLM up to the next HL (next subscriber or billing provider)?7/9/2014FAQs
If rejecting the last encounter for the subscriber, would all loops/segments pertaining to the Medicaid encounter be rejected and therefore deleted from the file being sent to the State, starting with 2300:CLM up to the next HL (next subscriber or billing provider)?7/9/2014FAQs
In the event of a compliance failure on the Medicaid file does CMS/Palmetto reject the non-compliant portion of the file or the entire file?7/9/2014FAQs
Will the NCPDP file be part of the audit tracking?7/9/2014FAQs
4/15/2014
For transaction identification purposes, State agencies will need a complete list of Submitter-IDs as referenced in the above document for ISA06, GS02, and 1000A NM109. In order for State agencies to identify which MMP submitted which data State agencies would need to know which plan codes belong to which MMPs, hence our request for a complete list of plan codes (submitter ids) and their associated owners.4/15/2014FAQs
How long will it take from Medicare receipt of the submitted MMP encounter data to when this data is posted to State agencies?4/15/2014FAQs
How will MMPs test with Medicare and State agencies on an end-to-end integration test?4/15/2014FAQs
In those cases where no NPI is submitted for a specific encounter, will Medicare leave this alone or provide a default value?4/15/2014FAQs
What file naming conventions will be in place for data sent to the State agencies?4/15/2014FAQs
What is the naming convention that MMPs use for these Medicaid data submissions?4/15/2014FAQs
When will a test file be available to show State agencies the exact implementation of the interface between Medicare and State agencies?4/15/2014FAQs
When you say “unique plan id”, you are referring to the MMPs 5 position H contract number, correct?4/15/2014FAQs
Will ISA08 equal GS03 (80892 for Medicaid)?4/15/2014FAQs
Will MMP use Addendum to Encounter Data System Companion Guide and State Assigned Medicaid Companion Guides Version Number 2.0, dated November 15, 2013 (CSSCOperations.com) – specifically sections 4.0 and 5.0?4/15/2014FAQs
Will Medicare make any changes to the data submitted by an MMP prior to State agencies receiving it?4/15/2014FAQs
Will Medicare require State agencies to respond to Medicare with an audit file? If so, in what format. Is this still necessary or required?4/15/2014FAQs
Will Palmetto group encounters from the same MMP together?4/15/2014FAQs
Will data rejected by Medicare be omitted from the data sent to State agencies?4/15/2014FAQs
Will data sent to State agencies consist of data submitted by multiple MMPs in a single consolidated file?4/15/2014FAQs
Will data sent to State agencies, be separated by submitting plan? Either they will send a consolidated file or will send separate files per submitter. Presuming they will send a consolidate single file per day, where the data is identified at a high level loop per submitter. Please confirm if this is the case and where the iteration will be based (loop-wise).4/15/2014FAQs
Will encounters from the same billing provider be grouped together?4/15/2014FAQs
With the exception of those fields referenced in sections 4.0 and 5.0, will the MMP use the State agencies provided companion guide for all remaining data elements?4/15/2014FAQs
8/19/2013
Washington Publishing Company8/19/2013References
8/15/2013
State Data Resource Center8/15/2013References