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CEDI Front End Edit Update

Effective today, October 6, 2008, the following changes are in effect for the electronic front-end reports returned to Trading Partners from CEDI:

  • Additional front-end edits will be added to the current CEDI GenResponse (GENRPT) report.
    NOTE: The CEDI Error Code Manual is available from the CEDI Web site at:
    http://www.ngscedi.com/outreach_materials/CEDIFrontEndReportsManual.pdf
  • Claims accepted on the CEDI GenResponse Report will be delivered to the appropriate DME MAC.
  • Claims delivered to the DME MAC will continue to edit against the DME MAC Level II edits as they do currently.
  • Claims accepted on the DME MAC Level II reports will be assigned a Claim Control Number (CCN) that will be attached to the claim as it enters the DME MAC for processing.
  • Level II reports created by the DME MACs will continue to be delivered back to the Trading Partners through CEDI.
  • Most, if not all, claims that reject will be returned on the GenResponse Report. It will be extremely important for Trading Partners to monitor the GenResponse Report for rejected claims in order to correct and resubmit the claims to CEDI.

Effective Mid-November 2008 the following changes will occur:

  • All electronic front-end claim editing will be done through CEDI and all front end rejections will be returned on the CEDI GenResponse (GENRPT) Report.
  • The additional GenResponse edits that were implemented on October 6, 2008 will replace the DME MAC Level II edits and Trading Partners will no longer receive Level II reports from the DME MACs.
  • Claims accepted on the GenResponse Report will be assigned a Claim Control (CCN) and these will be indicated on a report that will go back to the Trading Partner from CEDI. This CCN will be attached to the claim as it enters the appropriate DME MAC for processing.
  • DME MACs will continue to produce the CMN Reject and this report will be returned to Trading Partners through CEDI.

CEDI is monitoring the DME MAC Level II reports to identify any claims that should have rejected with the new CEDI front end edits and make any modifications to the CEDI front end edits.

CEDI is also monitoring the CEDI front end rejections to identify any situations where a CEDI front end edit has inappropriately caused a claim to reject. As part of this monitoring, CEDI has identified an issue with the edits listed below and turned off these edits so that they did not go into effect on October 6, 2008.

Claims that would have rejected at CEDI with an edit below will receive the rejection on the DME MAC Level II report, if the claim does not reject at CEDI with other edits. We are currently planning to have the updated logic implemented and will turn on these edits on Sunday October 19, 2008.

The following are the CEDI edits and the related DME MAC edit number:
CEDI    DME MAC
C172    40022
C173    40023
C174    40024
C175    40094
C177    40026
C178    40095
C179    40036
C180    40037
C181    40073
C183    40052
C184    40086
C185    40087
C186    40093
C188    40066

Post Date 10/06/08

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