Top 10 Edits in October 2024

1

CSCC A7: “Acknowledgement /Rejected for Invalid Information…”
CSC 507: “HCPCS”

Edit Reference: X222.351.2400.SV101-2.020

When the Product or Service ID Qualifier in the 2400.SV101 = "HC", the Procedure Code in the 2400.SV101-2 must be a valid HCPCS Code for the Service Date in the 2400.DTP03 (DTP01 = "472").

The HCPCS can be verified with the PDAC.

This rejection can also be caused by sending an invalid HCPCS and modifier combination.  If additional information is needed concerning the validity of the combination, please contact the DME MAC Jurisdiction where the claim will be processed.

2

CSCC A8: “Acknowledgement /Rejected for Invalid Information…”
CSC 496: “Submitter not approved for electronic claim submission on behalf of this entity”
EIC 85: “Billing Provider”

Edit Reference: X222.087.2010AA.NM109.050

The Billing Provider’s NPI in the 2010AA.NM109 is not associated with the submitter in the 1000A.NM109. Therefore, the Trading Partner/Submitter ID is not authorized to submit claims for the supplier.

If this error is received, the supplier must complete and submit the appropriate form on the CEDI website https://www.ngscedi.com.

Suppliers who use a third party (e.g. a clearinghouse or billing service) must complete the Supplier Authorization Form.

Suppliers who submit their own claims and do not use a third party biller must complete the CMS EDI Enrollment Agreement.

3

CSCC A8: “Acknowledgement/Rejected for relational field in error”
CSC 562: “Entity’s National Provider Identifier (NPI)”
CSC 128: “Entity’s tax id”
EIC 85: “Billing Provider”

Edit Reference: X222.094.2010AA.REF02.050

Billing Provider Tax Identification Number in the 2010AA.REF must be associated with the Billing Provider’s NPI in the 2010AA.NM109.

Verify the information you are submitting matches the information on file with the NPPES and the NPEAST or NPWEST.

4

CSCC A7: “Acknowledgement /Rejected for Invalid Information…”
CSC 562: “Entity’s National Provider Identifier (NPI)”
EIC 85: “Billing Provider”

Edit Reference: X222.087.2010AA.NM109.030

Billing Provider Identifier must be a valid NPI on the Crosswalk. Verify that the NPI and DME PTAN are linked together. PECOS can affect your crosswalk. PECOS is the system used by the NPEAST and NPWEST for DME suppliers to enroll in Medicare. Suppliers can log in to PECOS at https://pecos.cms.hhs.gov/pecos/login.do
and verify their NPI is listed correctly. For assistance with PECOS, call 866-484-8049. Suppliers can also contact the NPEAST at 866-520-5193 or NPWEST at 866-238-9652.

5

CSCC A7: “Acknowledgement /Rejected for Invalid Information…”
CSC 164: “Entity's contract/member number”

EIC IL: “Subscriber”

Edit Reference: X222.121.2010BA.NM109.030

This Claim is rejected for Invalid Information for a Subscriber's contract/member number. If the HICN/MBI format is valid, 2010BA NM109 must be a HICN format pre-SSNRI transition. 2010BA NM109 may be either a HICN (Part B or RRB format) or MBI during the SSNRI transition period. 2010BA NM109 must be an MBI format post-SSNRI transition.

6

CSCC A7: “Acknowledgement /Rejected for Invalid Information…”
CSC 164: “Entity's contract/member number”
EIC IL: “Subscriber”

Edit Reference: X222.121.2010BA.NM109.020

The subscriber’s Medicare ID number is invalid.  Verify the MBI is entered correctly.

The MBI must be 11 positions formatted C A AN N A AN N A A N N, (without spaces) where: "C" is numeric 1-9, "A" is alphabetic characters A-Z (excluding S, L, I, O, B, Z), "N" is numeric 0-9 and "AN" is either alphabetic A-Z (excluding S, L, I, O, B, Z), or numeric 0-9.

7

CSCC A8: “Acknowledgement/Rejected for relational field in error”
CSC 218: “NDC Number”
CSC 507: “HCPCS”

Edit Reference: X222.423.2410.LIN03.040

This Claim is rejected for relational field Information within the NDC number and HCPCS.  For dates of service 10/01/2024 and after, there are new billing instructions for Capecitabine Oral Anticancer Drugs (J8520 and J8521) based on Local Coverage Determination (LCD) L33826. Bill these drugs with HCPCS J8999 (Prescription drug, oral, chemotherapeutic, NOS) until J8522 (Capecitabine (Xeloda) is implemented in the DME MAC systems. HCPCS J8999 must be submitted in the 2400 SV101-2 element. Do NOT submit the NDC in the 2410 LIN03 element, or your claim will be rejected by CEDI. Until further notice, the 2300 NTE Claim narrative must include the drug name (Capecitabine or Xeloda) Dosage, and NDC.

8

CSCC A7: “Acknowledgement /Rejected for Invalid Information…”
CSC 562: “Entity’s National Provider Identifier (NPI)”
EIC 82: “Rendering Provider”

Edit Reference: X222.262.2310B.NM109.030

Rendering Provider Identifier must be a valid NPI on the Crosswalk when evaluated with Receiver Primary Identifier. Medicare DME claims do not require the Rendering Provider information to be sent. It is recommended that the information is removed from the claim. For more information on how to remove the information, please contact your software vendor, billing service, or clearinghouse.

9

CSCC A7: “Acknowledgement /Rejected for Invalid Information…”
CSC 453: “Procedure code modifier(s) for service(s) rendered”

Edit Reference: X222.351.2400.SV101-3.040

The procedure code modifiers in SV101 must not be duplicated within the same detail service line.

10 

CSCC A7: “Acknowledgement /Rejected for Invalid Information…”
CSC 254: “Primary diagnosis code”

Edit Reference: X222.226.2300.HI01-2.050

One of the diagnosis code's effective dates falls entirely outside the claim’s dates of service. Questions regarding the effective dates of a diagnosis code should be directed to the DME MAC where the claim would be processed based on the patient’s state code in the address provided on the claim.