Top 10 CEDI Edits for December 2019
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…” |
2 | CSCC A8: "Acknowledgement /Rejected for Invalid Information…" |
3 | CSCC A7: "Acknowledgement /Rejected for Invalid Information…" |
4 | CSCC A8: "Acknowledgement/Rejected for relational field in error" |
5 | CSCC A7: "Acknowledgement /Rejected for Invalid Information…" |
6 | CSCC A7: "Acknowledgement /Rejected for Invalid Information…" |
7 | CSCC A7: "Acknowledgement /Rejected for Invalid Information…" |
8 | CSCC A7: "Acknowledgement /Rejected for Invalid Information…" |
9 | CSCC A7: "Acknowledgement /Rejected for Invalid Information…" |
10 | CSCC A8: "Acknowledgement/Rejected for relational field in error" |
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