edi testing

EDI Generation of Notice of Compensation Denial (LIBC-496)

The purpose of the LIBC-496 process is to verify if the Claim Administrator has implemented the necessary changes to their system that would trigger the generation of the Notice of Compensation Denial (LIBC-496) based on the following EDI transaction/maintenance type codes:

  • FROI 04
  • SROI 04
  • FROI 02
  • SROI 02

FROI 04

  1. The Claim Administrator must submit a FROI 04 transaction with Full Denial Reason Code (DN0198) ‘2.B.’. NCD # 1 is generated.

SROI 04

  1. The Claim Administrator must submit a FROI 00 to create a new test claim.
  2. The Claim Administrator follows up with a SROI 04 with Full Denial Reason Code (DN0198) ‘4.A.’ and Denial Reason Narrative. NCD # 5 is generated and the narrative field under # 5 is populated.

FROI 02

The Claim Administrator must submit a FROI 02 to change the claim created in Step 2 with Full Denial Reason Code (DN0198) ‘3.A.’. NCD # 3 is generated.

SROI 02

The Claim Administrator must submit a SROI 02 to change the claim created in Step 2 with Full Denial Reason Code (DN0198) ‘3.I.’. NCD # 3 is generated.

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