Top 10 CEDI Edits for December 2019

National Government Services Common Electronic Data Interchange (CEDI) has identified the following as the top ten edits that were received during December 2019 on the 277CA for 5010A1 formatted claims. The edit as returned on the 277CA, the edit reference and a 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 have received one of the edit codes but the listed explanation does not fit your situation, please 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 that the rejection is at the line level. Please read further into the 277CA report for subsequent error codes.

CEDI offers a tool to view easy-to-understand descriptions associated with the edit code(s) returned on the 277CA for 5010A1 claims. 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 website https://www.ngscedi.com/ under the Self-Service Tools section.

In December 2019, the following were in the Top 10 CEDI Edits; however, they are being listed separately. Prior to January 1, 2020, the HICN or MBI could be submitted on claims. Effective January, 1, 2020 ALL claims must have the MBI for the beneficiary/subscriber ID.

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 Medicare ID (MBI, HICN, or Railroad) is entered correctly.

MBI: If an MBI is submitted, it 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.

HICN Format: If a HICN is submitted, it must be 10-11 positions formatted NNNNNNNNNA or NNNNNNNNNAA or NNNNNNNNNAN where “A” is an alpha character and “N” is a numeric digit.

Railroad ID: If a Railroad ID is submitted, it must be 7-12 positions formatted ANNNNNN or AANNNNNN or ANNNNNNNNN or AANNNNNNNNN or AAANNNNNN or AAANNNNNNNNN where “A” is an alpha character and “N” is a numeric digit.

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-NMCP transition. 2010BA NM109 may be either a HICN (Part B or RRB format) or MBI during the NMCP transition period. 2010BA NM109 must be an MBI format post-NMCP transition.

#	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 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 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: 222.087.2010AA.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 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.
4	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: 222.094.2010AA.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 NSC.
5	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 Payer Claim Control Number with REF01 = "F8" must not be present.
6	CSCC A7: "Acknowledgement /Rejected for Invalid Information…" CSC 732: “Claim frequency code” Edit Reference: 222.157.2300.CLM05-3.020 Claim Frequency Code must be "1".
7	CSCC A7: "Acknowledgement /Rejected for Invalid Information…" CSC 562: "Entity’s National Provider Identifier (NPI)" EIC 85: Billing Provider Edit Reference: 222.087.2010AA.NM109.030 The Billing Provider Identifier in the 2010AA.NM109 must be valid on the NPI Crosswalk. Verify that the NPI and DME PTAN are linked together. To establish a crosswalk link, verify the supplier's information listed on the NPPES website matches the information at the NSC. If you have questions about these matches please contact the NSC at 866-238-9652. Note: PECOS can also affect your crosswalk match. PECOS is the system used by the NSC for DME suppliers to enroll in Medicare. Suppliers can log in to and verify that their NPI is listed correctly. For assistance with PECOS, call 866-484-8049.
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 187: “Date(s) of service” Edit Reference: X222.380.2400.DTP03.090 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.
10	CSCC A8: "Acknowledgement/Rejected for relational field in error" CSC 306: “Detailed description of service” Edit Reference: X222.351.2400.SV101-7.020 Procedure Code sent requires a description/additional information. This description must be sent in the SV101-7 field. Please contact your software vendor for more information on how to place the description in this field if needed. Note: This description field is different than the NTE (general narrative) field.

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: 01/08/2020