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Top Ten Edits Received on the 277CA for 5010A1 Claim Files
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1
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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 Jurisdiction where the claim
will be processed.
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2
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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 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.
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3
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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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4
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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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5
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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 that the information you are submitting matches the information on
file with the NPPES and NSC.
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6
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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.
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7
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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 the
same.
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8
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CSCC
A7: "Acknowledgement /Rejected for Invalid Information…"
CSC 732: “Claim frequency code”
Edit Reference: X222.157.2300.CLM05-3.020
Claim Frequency Code must be "1".
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9
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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
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.
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10
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CSCC
A7: "Acknowledgement /Rejected for Invalid Information…"
CSC 510: “Future date”
CSC 187: “Date(s) of service”
Edit Reference: X222.380.2400.DTP03.080
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.
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