Top 10 Edits in December 2022

1

CSCC A7: “Acknowledgement /Rejected for Invalid Information…”
CSC 698: “Form Type Identifier”

Edit Reference: X222.492.2440.LQ02.030

The CMN form number must be a valid DMERC CMN Form. CMS has discontinued Certificates of Medical Necessity (CMNs) and DME Information Forms (DIFs) for date of service January 1, 2023 and after. For services on or after January 1, 2023: CEDI will reject any electronic claims submitted with a CMN or DIF. For services before January 1, 2023: Submit CMN and DIF forms or their electronic claim data elements with the claims if required. Questions regarding the CMN form number 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.

2

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.

3

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.

MBI: 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.

4

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.

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. The 2010BA NM109 must be an MBI.

6

CSCC A7: “Acknowledgement /Rejected for Invalid Information…”
CSC 732: “Information submitted inconsistent with billing guidelines”
CSC 464: “Payer Assigned Claim Control Number”

Edit Reference: X222.196.2300.REF.010

The Payer Claim Control Number with the qualifier F8 must not be present.

7

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.

8

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

9

CSCC A7: “Acknowledgement /Rejected for Invalid Information…”
CSC 535: “Claim Frequency Code”

Edit Reference: X222.157.2300.CLM05-3.020

Claim Frequency Code must be "1".

10

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.