MassHealth has identified the following list of common file submission errors and resolutions. These errors 
have appeared in both test and production submissions. Please ensure that your future file submissions do not 
include any of these errors. This will enable MassHealth to expeditiously process your file submissions.

#
Loop ID
5010 File Submission Error
How to Resolve/Avoid the Error

1.	
ISA
Claims were not acknowledged by MassHealth. 
Trading partner did not receive a 999.
Ensure claims sent to the production system have a 
value of “P.” 
Only claims sent to our test system should have the 
value of “T.”

2.	
ISA
The trading partner did not include the 
MassHealth ID in ISA06.
Example: 
The trading partner included the NPI, legacy ID, 
or other ID in ISA06.
ISA06 must contain only the 10-character 
MassHealth provider/submitter ID.  

3.	
ISA
Claims were not acknowledged by MassHealth. 
Trading partner did not receive a 999.

Change the ISA11 value to the appropriate 5010 
value. 
The file's ISA11 repetition separator of “U” is invalid 
for 5010. This was accepted only in the 4010 
format.

4.	
ISA
Invalid values were submitted in ISA06 (sender 
ID) and ISA08 (receiver ID).
Ensure appropriate values are entered – ISA06 
(MassHealth submitter or trading partner ID) – 
ISA08 (version/release/industry identifier code)

5.	
ISA 
GS
File submission was sent in the 4010 format.
Ensure all appropriate values are updated to reflect 
a 5010 file submission, including updating the value 
in ISA12 and GS08. 
For further details, refer to the HIPAA 
implementation and companion guides.

6.	
PRV
The trading partner submitted an incorrect 
HIPAA qualifier in loop 2000A.
Example:
PRV01 was coded "PT" instead of "BI."
PRV02 was coded "XX" instead of "PXC."
If including taxonomy, PRV01 must equal BI and 
PRV02 must equal PXC.

7.	
REF
The trading partner included REF*1D in loop 
2010AA.
Do not include REF*1D, because it does not exist in 
5010.

8.	
REF
The trading partner submitted an MMIS ID 
instead of the provider’s tax ID number in 
loop 2010AA REF02.
Send only a federal tax ID or social security number. 
The entry must be nine digits with no hyphens.

9.	
NM
The trading partner included location 
information that was the same as the billing 
provider’s. 
Do not include location information if it is the same 
as the billing provider’s. 

10.	
CAS
The trading partner submitted a COB test file 
with one or more CAS segments in loop 2320, 
when the COB information is already included in 
the service lines.
If there are CAS segments in the claims detail line, 
do not include the CAS segment in loop 2320.

11.	
CAS
The trading partner submitted a COB adjustment 
that is out of balance.
Example: 
The SV102 element does not equal the sum of 
2430 CAS amounts + 2430SVD/02 element.
For instructions on COB balancing, please refer to 
the MassHealth companion guides.

12.	
NM106
The trading partner submitted a five-digit zip 
code in loop 2010AA but did not submit a  
four-digit suffix.

Make sure to use a zip+4 code (must be nine digits 
with no hyphens).
Please Note: You may enter a zip+4 code with zeros 
if the four-digit suffix is unknown.

13.	
CLM
When a trading partner is testing for 5010, a test 
file may not necessarily be declared as “passed” 
if the test file submission does not include an 
appropriate number of claims that represent all 
aspects of potential claim submissions from the 
provider.
Test submissions must include all claim types that a 
provider would currently bill for in the test file. For 
example:
*	COB claims;
*	replace type claims; and
*	void claims.
Test files must include a minimum of 10 and a 
maximum of 50 test claims. However, if you cannot 
meet these requirements, contact MassHealth 
Customer Service at 1-800-841-2900 and select 
options 1, 8, and 3.

14.	
DTP
The trading partner submitted a file that is 
missing either the admit date/time or the admit 
diagnosis (or should not have had either).
Example:
When DTP01 equals 435 or HI01 equals BJ, then 
both must be present. The trading partner may 
have forgotten to add HI01=BJ.
If the admit diagnosis is submitted on the file, the 
admit date must also be submitted.
If you submit the admit date, then you must submit 
the admit diagnosis too.
This is required on inpatient claims. If it is not 
required (as with outpatient claims), do not send.

15.	
CLM
The trading partner submitted an incorrect or 
missing code in CLM05-2.
Be sure to include the appropriate value (A or B) in 
CLM05-2.

16.	
NM
The trading partner included a rendering 
provider who has the same NPI as the billing 
provider.
Do not include a rendering provider if it is the same 
as the billing provider. Only providers who are 
defined as group practices by MassHealth should 
submit rendering provider information.

17.	
SBR
Loop 2320 SBR01 – Payer responsibility 
sequence number code 
Error message: 
Within a given claim, the various values for the 
payer responsibility sequence number code 
(other than value “U”) may occur no more than 
once.
When there are two or more payers on a claim, 
verify that there is no more than one instance of P, 
S, T, and A-H for 2320:SBR01 on any one claim, 
where P=Primary, S=Secondary, T=Tertiary, A-H = 
Payer Responsibility. 
The value “U” for Unknown can occur multiple 
times on the claim.

18.	
SBR
SBR09 is missing.
Be sure to include the correct claim filing indicator 
code in SBR09.

19.	
REF
The trading partner submitted an NPI and 
MassHealth ID in loop 2010AA. 
If you bill with your NPI, you must not include the 
REF*G2 segment.
If you do not bill with your NPI, you must bill with 
REF*G2 and your MassHealth ID.

20.	
N/A
The trading partner submitted a 5010 test file to 
the 5010 production system.
Please be sure to send 5010 test files to the test 
site only, as MassHealth will not review or validate 
the test file submission in the MassHealth system 
production environment and will not generate a 
999 acknowledgement.
You must resubmit those claims to the MassHealth 
system test site. 
https://mmis-portal-
tptest.ehs.state.ma.us/EHSProviderPortal/appmanager/
provider/desktop

21.	
N/A
The trading partner submitted a 5010 
production file to the 5010 test system.
Please be sure to send 5010 production files to the 
production site only, as MassHealth will not process 
the claims and will not generate a 999 
acknowledgement.
You must resubmit those claims to the MassHealth 
system production site.
https://gateway.hhs.state.ma.us/authn/login.do  

Most Common 5010 Trading Partner File Submission Errors
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