Hospice Billing

Common Working File System Edit F5052 and M5052

Why do claims suspend for edit F5052 and M5052?

When a NOE transaction is entered into the system it goes to the FISS for editing. If the NOE passes editing in FISS for the required fields, the transaction is then sent to the appropriate CWF host site for the beneficiary information to process through CWF editing. CWF editing could take several days depending on how many host sites the transaction has to check to find the beneficiary records. CWF checks the information entered on the NOE and verifies the beneficiary information (last name, first initial of the first name, date of birth, and HIC number match. When a beneficiary file is not located at the first CWF host site, the NOE will suspend and fire edit F5052 or M5052. This edit directs the system to check another CWF host site to locate the beneficiary file. Once the beneficiary file is located and the NOE passes all other CWF editing the NOE will process and finalize.

Do I need to take any action when a NOE suspends for edit F5052 or M5052?

While the NOE is in suspense with edit code F5052 or M5052 no provider action is necessary. Hospice providers should not attempt to correct a NOE that is in suspense and has not been RTPd for corrections. If any of the information entered on the NOE is incorrect, CWF will reject the NOE and FISS will RTP the NOE to the provider for correction.

Can I submit another NOE if I have entered incorrect beneficiary information?

If a provider discovers soon after filing the NOE, a misspelled beneficiary last name or an incorrect date of birth or incorrect HIC number, a new NOE may be submitted prior to the NOE finalizing, as long as the NOE has not suspended with edit F5052 or M5052. If any other information is incorrect, the provider cannot submit another NOE prior to the incorrect NOE finalizing.