CEDI Logo CEDI News

Common Electronic Data Interchange (CEDI)
Electronic Front-End Reports and Top Rejections

It is essential that all Trading Partners/Electronic Submitters download and review all front end reports returned by CEDI.

Level I Reports
National Government Services CEDI creates and delivers the following Level I reports for each claim file that is submitted:

  • TA1 (NOTE: Some systems may generate a TA1 report for accepted and rejected files, others will only generate a TA1 if the file rejects. Check with your software vendor to determine if your system generated both an accepted and/or rejected TA1.)
  • TRN
  • 997
  • GenResponse (GENRPT)

For more information on the Level I reports, access the CEDI Front End Reports Reference Document under the Resource Materials section of the CEDI Web site at http://www.ngscedi.com/outreach_materials/outreachindex.htm

Questions regarding rejections on the TA1, TRN and/or 997 should be directed to your software vendor. Your software vendor will know what needs to be corrected in order to pass these edits.

CEDI will provide support for the GenResponse (GENRPT) report.

Level II Reports
Electronic trading partners/submitters will also receive a Level II report from each DME MAC that received claims in the file(s) sent to CEDI. These Level II reports are created by the DME MACs, but delivered by CEDI.

Electronic Trading Partners/Submitters should first review the DME MAC Front End Edit Error Code Manual to identify the cause of the error before contacting the CEDI Help Desk. For more information on the DME MAC Level II errors, descriptions and report examples, access the DME MAC Front End Edit Error Code Manual under the Resource Materials section of the CEDI Web site at http://www.ngscedi.com/outreach_materials/outreachindex.htm

The edit codes below are the top rejections received by CEDI electronic trading partners/submitters. These edits are included in the DME MAC Front End Edit Error Code Manual. The information included below provides the description from the DME MAC Front End Edit Error Code Manual as well as additional information that can be used to resolve these rejections.

Edit # Edit Description ANSI Reference Edit Explanation
20359 ORDERING PROVIDER SECONDARY ID INVALID 2420E.
REF01
 DME MAC Front End Edit Code Manual states:
As of May 23, 2008, the qualifier “1C” (Medicare Provider Number) or “1G” (Provider UPIN Number) will no longer be allowed.

Additional Information:
This REF segment should not be sent and should be removed from the electronic file. The NPI for the Ordering Provider must be reported in the NM109 only, with an “XX” qualifier in the NM108. This would apply to all loops with a REF segment for DME MAC electronic claims.

NOTE: The REF segment was used prior to May 23, 2008 to report legacy identification numbers.

Express Plus Users: See instructions below titled “Express Plus Users – Steps to ensure the software program is only transmitting NPI numbers”

PC-ACE Pro32 Users: See instructions below titled “PC-ACE Pro32 Users – Steps to ensure the software program is only transmitting NPI numbers”

Suppliers using a software vendor, billing service or clearinghouse: Contact your vendor, billing service or clearinghouse for assistance.
40014 ORDERING PROV INFO MISSING 2420E. REF01
or
2420E.
NM108
 DME MAC Front End Edit Code Manual states:
The ordering provider information is missing. This loop must be present for each service line of a DME MAC claim.

Additional Information:
Due to the NPI implementation on May 23, 2008, all legacy ID numbers are no longer accepted on any Medicare claims.

Electronic claims must be submitted with an NPI number for the ordering provider. In the ANSI format, the NM108 must equal qualifier “XX”. The “XX” qualifier identifies that an NPI is being submitted. The NM109 must contain the 10-digit NPI.

Express Plus Users: See instructions below titled “Express Plus Users – Steps to ensure the software program is only transmitting NPI numbers”

PC-ACE Pro32 Users: See instructions below titled “PC-ACE Pro32 Users – Steps to ensure the software program is only transmitting NPI numbers”

Suppliers using a software vendor, billing service or clearinghouse: Contact your vendor, billing service or clearinghouse for assistance.
40022 PROCEDURE CODE MODIFIER INVALID 2400. SV101-2 DME MAC Front End Edit Code Manual states:
The procedure code or modifier is invalid. Verify the HCPCS and modifier combination is valid. Make sure the first position does not contain a space.

Additional Information:

  1. Suppliers should check the validity of the procedure code/modifier combination by using the Pricing, Data Analysis and Coding (PDAC) Web site www.dmepdac.com.
  2. The supplier should check the Local Coverage Determination (LCD) at the DME MACs for guidelines on procedure codes and modifier usage specific for that LCD.
    Jurisdiction A: www.medicarenhic.com/dme
    Jurisdiction B: www.NGSMedicare.com
    Jurisdiction C: www.cignagovernmentservices.com/jc
    Jurisdiction D: www.noridianmedicare.com/dme
  3. The supplier can reference the supplier manual at the DME MAC Jurisdiction where they received the front end rejection.
    Jurisdiction A: www.medicarenhic.com/dme
    Jurisdiction B: www.NGSMedicare.com
    Jurisdiction C: www.cignagovernmentservices.com/jc
    Jurisdiction D: www.noridianmedicare.com/dme
  4. . If the supplier cannot determine what is wrong with their HCPCS code and modifier combination, they should contact the Customer Care department at the Jurisdiction where they received the front end rejection.
    Jurisdiction A: 1-866-590-6731
    Jurisdiction B: 1-866-590-6727
    Jurisdiction C: 1-866-270-4909
    Jurisdiction D: 1-866-243-7272
20364 RENDERING PROVIDER SECONDARY ID INVALID 2310B.
REF01
 DME MAC Front End Edit Code Manual states:
As of May 23, 2008, the qualifier “1C” (Medicare Provider Number) or “1G” (Provider UPIN Number) will no longer be allowed.

Additional Information:
The Rendering Provider information is used primarily for Medicare Part B claims, to indicate a physician within a group. DME MAC suppliers can do either of the following:

  1. Do not submit any information in the Rendering Provider Loops.
  2. If submitting the Rendering Provider information, make sure the Rendering (2310B) and Billing Provider (2010AA) loops are identical. The REF segments in these loops should not be sent and should be removed from the electronic file. The NPI must be reported in the NM109 only, with an “XX” qualifier in the NM108. This would apply to all loops with a REF segment for DME MAC electronic claims.

NOTE: The REF segment was used prior to May 23, 2008 to report legacy identification numbers.

Express Plus Users: See instructions below titled “Express Plus Users – Steps to ensure the software program is only transmitting NPI numbers”

PC-ACE Pro32 Users: See instructions below titled “PC-ACE Pro32 Users – Steps to ensure the software program is only transmitting NPI numbers”

Suppliers using a software vendor, billing service or clearinghouse: Contact your vendor, billing service or clearinghouse for assistance.
40068 QUESTION NUMBER/
LETTER INVALID
 2440. FRM01 DME MAC Front End Edit Code Manual states:
If edits 40066, 40067, and 40068 are present on one charge line, verify the procedure code actually requires the attached CMN. If 40022 is also present as a rejection on the charge line, these edits may all be caused by an invalid procedure code/modifier combination.

If the procedure code does require the attached CMN, the question number entered is not valid for the DME MAC CMN sent with this claim line.

Additional Information:
Most of the time this edit (40068) fires with 40066 and 40067 because the HCPCS code submitted on the charge line does not require a CMN.
20269 POINTER 1 DIAG INVALID 2400.
SV107.1
 DME MAC Front End Edit Code Manual states:
The diagnosis code pointed to by Diagnosis Code Pointer 1 (SV107-1) is invalid for the claim line date of service.

Additional Information:
Use this diagnosis pointer for the first diagnosis code pointer (primary diagnosis for this service line). Acceptable values for DME MAC are 1, 2, 3 or 4.

Express Plus Users – Steps to ensure the software program is only transmitting NPI numbers

Reminder: Effective May 23, 2008, electronic claims should list a National Provider Identifier (NPI) ONLY. If a legacy number is listed, the claim will reject on the electronic front end.

To ensure that only the NPI is submitted on claims, Express Plus users must complete the following instructions:

To remove the National Supplier Clearinghouse (NSC)/Provider Transaction Access Number (PTAN) number from the Express Plus software for the primary provider field:

  1. Go to the File Maintenance Menu
  2. Click on Provider Maintenance
  3. Select a Provider and then click on Edit
  4. Make sure the supplier’s NPI number is listed under the field titled “NPI”
  5. Add the Tax ID or Social Security Number associated with the NPI. The Tax ID number will be entered into the field titled “Tax ID”. The Social Security Number will be entered into the field titled “SSN”. NOTE: The corresponding Tax ID or SSN must be entered for the NPI listed on this screen.
  6. Remove the NSC supplier number listed under the field titled “Medicare ID”
  7. Click on “Save” and your information will be updated

Complete the steps above for each provider listed under Provider Maintenance in the Express Plus software.

To remove the UPIN number from the Express Plus software for the secondary provider field:

  1. Go to the File Maintenance Menu
  2. Click on Ordering Physician Maintenance
  3. Select a Provider and then click on Edit
  4. Make sure the ordering physician’s NPI number is listed under the field titled “NPI”
  5. Remove the UPIN number listed under the field titled “UPIN ID”
  6. Click on “Save” and your information will be updated

Complete the steps above for each provider listed under the Ordering Physician Maintenance Menu in the Express Plus software.


PC-ACE Pro32 Users - Steps to ensure the software program is only transmitting NPI numbers

Reminder: Effective May 23, 2008, electronic claims should list a National Provider Identifier (NPI) ONLY. If a legacy number is listed, the claim will reject on the electronic front end.

To ensure that only the NPI is submitted on claims, PC-ACE Pro32 users must complete the following instructions:

  1. Make sure you are using PC-ACE Pro32 Version 1.94. PC-ACE Pro32 Version 1.94 and download instructions are available at the CEDI Web site www.ngscedi.com under Software Downloads.
  2. Verify that your Billing Provider’s NPI and Tax ID numbers are located in the Provider (Professional) tab under Reference File Maintenance. This will also require an entry for the PTAN/legacy number in the Provider field, but PC-ACE Pro 32 will not send the PTAN/legacy number in the claims file.
  3. Verify that your Ordering Provider’s NPI is located in the Physicians area of the Codes/Misc tab. This tab is found under Reference File Maintenance. PC-ACE Pro32 only requires the NPI under this tab, so the first entry (formerly used for the UPIN number) can be left blank. If the UPIN is included in this first entry field, PC-ACE Pro32 will not send it in the claims file.



Post Date 09/09/08

© 2008 www.ngscedi.com