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Top Ten Edits Received on the 277CA for 5010A1 Claim Files |
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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. |
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CSCC A7: "Acknowledgement /Rejected for Invalid Information…" CSC 164: "Entity's contract/member number" EIC IL: “Subscriber” Edit Reference: X222.121.2010BA.NM109.030 The subscriber's Medicare ID number is invalid. The 2010BA NM109 must be an MBI. |
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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. |
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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. |
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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 the information you are submitting matches the information on file with the NPPES and NSC. |
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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. |
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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. 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. |
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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. To establish a crosswalk, verify the supplier's information listed on the NPPES web site matches the information at the NSC. If you have questions about these matches please contact NPPES at 800-465-3203 or the NSC at 866-238-9652. Note: PECOS can also affect your crosswalk. 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. |
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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. |
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CSCC A7: "Acknowledgement /Rejected for Invalid Information…" CSC 480: "Other Carrier Claim filing indicator is missing or invalid" Edit Reference: X222.295.2320.SBR09.020 Claim Filing Indicator Code must not = ""MA"" or ""MB"". Non-Medicare insurances will need to choose a valid code for the type of insurance being included in the claim file. ""MA"" and ""MB"" are not valid for Non-Medicare insurances. |