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 on the 277CA for 5010A1 Claim Files

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"
 
The Procedure Code must be a valid HCPCS Code for the Service Date.

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”
 
The beneficiary ID number 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 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).
 

5
 
 
 

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".
 

6
 
 
 

CSCC A7: "Acknowledgement /Rejected for Invalid Information…"
CSC 255: "Diagnosis code"

Edit Reference: X222.226.2300.HI02-2.080

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

All ICD-10-CM Diagnosis codes entered on the claim must be valid for all dates of service included in the claim based on the ICD-10-CM Diagnosis Code list table. 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.
 

7
 
 
 

CSCC A8: "Acknowledgement/Rejected for relational field in error"
CSC 306: "Detailed description of service"

Edit Reference: X222.351.2400.SV101-7.020

DDE Error Report will indicate “Required Note Missing”

HCPCS Code sent requires a description/additional information. This description must be entered in the “NOC Description” field on the services tab and not in the general Note field.
 

8
 
 
 

CSCC A7: "Acknowledgement /Rejected for Invalid Information…"
CSC 400: "Claim is out of balance"
CSC 672: "Payer’s payment information is out of balance"

Edit Reference: X222.157.2300.CLM02.090

DDE Error Report will indicate “Failed relationship check”

The total claim level and line level adjustment amounts plus the primary paid amount must equal the total for all submitted charges. 
 

9
 
 
 

CSCC A7: "Acknowledgement /Rejected for Invalid Information…"
CSC 255: "Diagnosis code""

Edit Reference: X222.226.2300.HI04-2.080

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

All ICD-10-CM Diagnosis codes entered on the claim must be valid for all dates of service included in the claim based on the ICD-10-CM Diagnosis Code list table. 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.
 

10
 
 
 

CSCC A8: "Acknowledgement /Rejected for Invalid Information…"
CSC 510: "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 patient’s state code in the address provided on the claim.
 


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: 07/07/2021