In order to simplify reporting, the Manufacturer Dispute Resolution Report will no longer report the status of rejected disputes. A rejected dispute is a dispute that was not accepted into the system at time of submission due to file or formatting issues or because the dispute was submitted after the dispute submission deadline.
To accommodate this update, certain minor changes were made to the file layout of the Manufacturer Dispute Resolution Report.
On the TPAMT record, two fields were removed: Field #12 Total Detail Record Count – Denied, Rejected on Error and Field No. 12 Total Detail Record Count – Denied, Received After 60 Days. Field No. 13 changes position and length due to the removal of the two aforementioned fields.
On the DETDR record, Field No. 24 Dispute Disposition will now only report two codes: 1 – Upheld or 2 – Denied. The other two fields, 3 – Denied, Rejected on Submission Format Error and 4 – Denied, Received after 60 Days, will no longer be reported.
These updates are effective with the release of the Q2 2013 Manufacturer Dispute Resolution Report on 12/30/2013.
Manufacturers can continue to obtain information regarding the status of a rejected dispute (i.e. whether it was rejected or accepted upon submission) via the Dispute Return File.
The new file layout can be found on the TPA website. If you have any questions or concerns, please contact TPA Support Center either by Email at
tpaoperations@tpadministrator.com, or by telephone at 1-877-534-2772, Option 1.