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Attention All CEDI Trading Partners, Suppliers, Billing Services, Clearinghouses, and Vendors Top 10 CEDI Edits for June 2009 National Government Services CEDI has identified the following edits as the top ten edits that were received on the CEDI GenResponse Report (GENRPT) during the month of June. The edit, its description and tips to resolve the error are provided below.
When C008 fires on its own, it can indicate the Tax ID (Employer Identification Number/Social Security Number) that was submitted does not match what is on file with the NPPES or the National Supplier Clearinghouse (NSC). Verify the information entered on the NPPES Web site matches what you are submitting. The NPPES Web site can be accessed at: https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart 
Note: This edit can fire with the C003 Billing NPI Not on Crosswalk. If this occurs, the Tax ID (Employer Identification Number/Social Security Number) may have been entered correctly in the claim; however, with the NPI not on the crosswalk, the Tax ID could not be verified. Please refer to edit C003 for more information for resolving this error. #3 - C003 Billing NPI Not on Crosswalk The edit C003 indicates there is no link between the NPI that was submitted and a PTAN/NSC. Verify the PTAN/NSC has been entered on the NPPES Web site as Medicare NSC and/or the supplier's information at NPPES and the NSC has the same information to create a match. The following information needs to be verified: For Individuals:
#4 - C095 Diagnosis Code Invalid - Pointer 1 The diagnosis code pointed to as the first relevant diagnosis on the claim was not valid for the date of service. This is usually, but not always, the first diagnosis code on the claim. Contact the DME MAC Jurisdiction where the claim would be processed based on the beneficiary state code for assistance with the diagnosis code entered. #5 - B108 Billing Provider Not Authorized for Submitter The NPI submitted is not linked to the Submitter ID under which the claim file was sent to CEDI. If this error is received, the supplier must complete and sign the appropriate form on the CEDI Web site (www.ngscedi.com) and return to CEDI for processing. 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 #6 - 1001 Required Loop Not Found This edit indicates a required loop was not found in the file received by CEDI. This typically occurs when loop 2420E (Ordering Provider info) is omitted as it is required on every charge line for Medicare DME. Contact your software vendor for assistance in resolving this edit. #7 - 3001 Duplicate File Found - File Not Processed This edit is received when a duplicate file has been submitted to CEDI. A duplicate file is determined by the following:
If the second scenario outlined above is being created, either add or delete a claim from the claims file. A resubmission of the claims can then be prepared and submitted. #8 - C143 Ordering Provider ID Qualifier Invalid This edit will be received if either the Ordering Provider NPI was not sent or the Ordering Provider's UPIN was sent on a charge line. Verify that the Ordering Provider's NPI is being sent on every charge line of the patient's claim. #9 - C044 Subscriber Primary ID Invalid The patient's Medicare ID (HICN) is invalid. Verify the number on the patient's red, white, and blue Medicare card. #10 - C180 Service Date Greater than Receipt Date The date of service entered in the claim is greater than the date the claim was submitted to CEDI. Verify that the date of service is valid and not a future date. For more information regarding the Front-end edits, please review the CEDI Front End Report Manual located on the CEDI Web site at the following link http://www.ngscedi.com/outreach_materials/outreachindex.htm. |
