Top 10 CEDI Claims Portal Edits


National Government Services, Inc. (NGS) Common Electronic Data Interchange (CEDI) has identified the following top ten edits returned on claims submitted using the CEDI Claims Portal (CCP). The edit, the reference, and the description of the edit are provided below.

5010A1 edits are not specific to the definitions provided. Edit codes received can apply to multiple Edit References. If you received one of the edit codes on your Claim Acknowledgement Report (CAR) but the listed explanation does not fit your situation, please refer to the associated DDE report for more information. You can also review the CMS Edit Spreadsheet on the CEDI website for other possibilities causing your rejection. 

Note: Category A3, Status 247 is not a front end rejection. This is stating the rejection is at the line level. Please read further for subsequent error codes.

CEDI offers the 277CA Edit Tool to view easy-to-understand descriptions associated with the edit code(s). The tool allows you to enter the Claim Status Category Code (CSCC), the Claim Status Codes (CSCs), and the Entity Identifier Code (EIC) for the edit and returns the possible explanations for the cause of the edit. The 277CA Edit Tool is located on the CEDI web site https://www.ngscedi.com under the Self-Service Tools section.
 

# Top Ten Edits Received for Claims Submitted Using the CCP

1
 
 

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

Edit Reference: X222.351.2400.SV101-2.020

DDE Error Report will indicate "Invalid CPT or HCPCS code"
 
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 A7: "Acknowledgement /Rejected for Invalid Information…"
CSC 164: "Entity's contract/member number"
EIC IL: “Subscriber”

Edit Reference: X222.121.2010BA.NM109.020

DDE Error Report will indicate “Invalid Insurance ID Number Format For Medicare”
 
This Claim is rejected for Invalid Information for a Subscriber's contract/member number. The 2010BA NM109 must be an MBI.
 

3
 
 

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

Edit Reference: X222.226.2300.HI01-2.050

DDE Error Report will indicate “Invalid Diagnosis code or bad effective date”

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 state code in the patient's address submitted on the claim.
 

4
 
 

CSCC A8: "Acknowledgement /Rejected for Invalid Information…"
CSC 496: "Future date"
CSC 187: “Date(s) of service”

Edit Reference: X222.380.2400.DTP03.080

DDE Error Report will indicate “Service date greater than Receipt date”
 
The service end/to date is greater than the date this claim was received.  Questions regarding proper billing policy should be directed to the DME MAC where the claim would be processed based on the state code in the patient's address submitted on the claim.
 

5
 
 

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

DDE Error Report will indicate “Billing Tax ID or Billing SSN not valid for NPI”
 
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 NSC.

6
 
 

CSCC A7: "Acknowledgement /Rejected for Invalid Information…"
CSC 145: "Entity's specialty/taxonomy code"
EIC 85: “Billing Provider”

Edit Reference: X222.083.2000A.PRV03.020

DDE Error Report will indicate “Must be a valid Provider Taxonomy Code”
 
Provider Taxonomy Code must be a valid. Verify the taxonomy code submitted is valid according to the taxonomy code list published by Washington Publishing Company.
 
To obtain a copy of the taxonomy code list, visit their Web site at https://www.wpc-edi.com/. 
 

7
 
 

CSCC A7: "Acknowledgement /Rejected for Invalid Information…"
CSC 535: "Claim frequency code"

Edit Reference: X222.157.2300.CLM05-3.020

DDE Error Report will indicate “Claim Frequency must be Admit through Discharge”
 
Claim Frequency Code must be "1".
 

8
 
 

CSCC A7: "Acknowledgement /Rejected for Invalid Information…"
CSC 187: “Date(s) of service”

Edit Reference: X222.380.2400.DTP03.090

DDE Error Report will indicate “Invalid HCPCS Code or Proc Option on Miniace”
 
The procedure code submitted for this line does not allow for spanned dates of service. Verify the start/from and end/to dates for this line are equal.
 

9
 
 

CSCC A7: "Acknowledgement /Rejected for Invalid Information…"
CSC 562: "Entity's National Provider Identifier (NPI)"
EIC DK: “Ordering Physician”

Edit Reference: X222.454.2420E.NM109.020

DDE Error Report will indicate “Invalid NPI”
 
Ordering Provider Identifier must be a valid NPI.
 

10
 
 

CSCC A7: "Acknowledgement /Rejected for Invalid Information…"
CSC 732: "Information submitted inconsistent with billing guidelines”
CSC 480: "Entity's claim filing indicator”
EIC PR: “Payer”

Edit Reference: X222.116.2000B.SBR09.010

DDE Error Report will indicate “Only Medicare B is allowed”
 
Claim Filing Indicator Code must be "MB" (Medicare Part B).
 


For more information regarding the front end edits, please send an e-mail to the CEDI Help Desk at ngs.cedihelpdesk@anthem.com.

Post Date: 06/07/2021