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Last Modified: 8/15/2019 Location: FL, PR, USVI Business: Part A

Adjust or resubmit claim rejects FAQ

Q: How do I know when to adjust or resubmit a claim that has been rejected?
A: Occasionally, claim rejects will post to the beneficiary’s records on the Common Working File (CWF). The most common effected rejection reason code range is 34XXX (Medicare secondary payer). If a claim reject has posted to the CWF, a new claim submission is subject to duplicate editing. Claim rejects that have posted to the CWF may be adjusted, as long as they are submitted within the appropriate timeframe.
The following information is exclusively available for direct data entry (DDE) users:
The tape-to-tape (TPE-TO-TPE) flag indicators in DDE will advise whether a claim has posted to the CWF or not. Refer to the TPE-TO-TPE field on claim page 2 or the MAP171D screen from the claim inquiry screen.
The claim reject did not post to the CWF if the flag indicator is ‘X’.
The claim reject posted to the CWF if the flag indicator is ‘ ‘ (blank).
DDE screen - example
Source: Centers for Medicare & Medicaid Services (CMS) internet-only manual (IOM), publication 100-04,
Chapter 1, section 120
external pdf file; Medicare Part A Direct Data Entry (DDE) Training Manual
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