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Claim Submissions Limited to 5,000

Ohio Department of Medicaid (ODM) is aware trading partners are submitting Electronic Data Interchange (EDI) transactions with more than 5,000 CLM segments. Submissions of over 5,000 CLM segments are causing downstream issues and affecting the delivery of corresponding 277CAs back to trading partners.

Trading partners should remember to limit their transaction size to less than 5,000 CLM segments as required by ODM Companion Guides. This best practice is outlined in the Technical Reports Type 3 (TR3) which recommends “that trading partners limit the size of the transaction (ST-SE envelope) to a maximum of 5,000 CLM segments.” This limitation also applies to the submission of batch 270 eligibility inquiries and 276 claim status inquiries.

Trading partners who have submitted more than 5,000 CLM segments in an EDI file and have not received a rejection via 999 or 824 AND have not received a corresponding 277CA and 835, should resubmit those claims.