CMS Releases Chart of Top 10 Section 111 Reporting Errors

CMS recently released a chart of the top 10 Section 111 reporting errors for January 1, 2023, through June 30, 2023. The top 10 errors are listed below.

1. Error Code CR12 – Representative Phone (Field 75) – This field is required if the injured party has a representative. This error code was returned for a total of 13,271 records.

2. Error Code SP32 – Invalid Termination Date (Field 79) – This error code is not documented in the Section 111 User Guide, but CMS has indicated that this error code is returned when the ORM Termination Date is the same as the CMS Date of Incident. This error code was returned for a total of 7,224 records.

3. Error Code CI05 – Diagnosis Code 1 (Field 18) – This error code is returned if a valid diagnosis code is not reported. This error code was returned for a total of 5,505 records.

4. Error Code CP13 – No Fault Insurance Limit (Field 61) – This error code is returned if the reported no fault insurance limit is less than $500.00. This error code was returned for a total of 5,475 records.

5. Error Code SP49 – Action Type (Field 3) – This error code is returned if a delete transaction could not be matched to a previously submitted and accepted claim report. This error code was returned for a total of 4,798 records.

6. Error Code CI03 – Alleged Cause of Injury (Field 15) – This error code is returned if an invalid diagnosis code is reported for the alleged cause of injury. This error code was returned for a total of 2,259 records.

7. Error Code TN99 – TIN/Office Code (Fields 52 and 53) – This error code is returned if no matching, valid TIN Reference File Detail Record was found for the TIN/Office Code combination submitted. This error code was returned for a total of 1,750 records.

8. Error Code CI06 – Diagnosis Code 2 (Field 19) – This error code is returned if an invalid diagnosis code is reported for the second diagnosis code. This error code was returned for a total of 1,036 records.

9. Error Code CJ07 – TPOC Threshold – This error code is returned if the ORM Indicator is “N” and the cumulative total of all submitted TPOC Amounts is $0.00. This error code was returned for a total of 724 records.

10. Error Code CI31 – ICD Indicator (Field 17) – This error code is returned for claims submitted with a CMS Date of Incident on or after October 1, 2015, that contain an ICD indicator of “9” or a space. This error code was returned for a total of 574 records.

The chart showing the top 10 reporting errors is available at https://www.cms.gov/files/document/top-10-section-111-non-group-health-plan-reporting-errors-january-1-june-30-2023.pdf. Error Codes CR12, CP13, and CI03 are “soft” errors, meaning that these errors will not cause CMS to reject the record, but the error code will appear on the response file. RREs should be certain to review any errors on the response file and correct any errors in the next claim file submission. If you have any questions regarding Section 111 reporting, please do not hesitate to contact us.