CMS Technical Alert Issued

On June 4, 2014, CMS issued a technical alert of the changes to the CJ07 Error Code.  This is in conjunction with the new reporting threshold for Liability Insurance (including Self-Insured) settlements, judgment awards or other payments.  Beginning on January 1, 2015, all Claim Input File Detail Records and Direct Data Entry (DDE) claim submissions will have CJ07 edits returned when they meet the following criteria that has been outlined by CMS:

  • If the most recent TPOC Date is on or between October 1, 2012 and September 30, 2014and the cumulative TPOC Amount is less than or equal to $300
  • If the most recent TPOC Date is on or after October 1, 2014 and the cumulative TPOC Amount is less than or equal to $1000

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