Top 10 CEDI Edits for November 2019

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.

2

CSCC A7: "Acknowledgement /Rejected for Invalid Information…"
CSC 164: "Entity's contract/member number"
EIC IL:  Subscriber

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.

3

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.

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: 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.

5

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.

6

CSCC A7: "Acknowledgement /Rejectedfor Invalid Information…"
CSC 732: “Information submitted inconsistent with billing guidelines”
CSC464: “Payer assigned claim control number” 

Edit Reference: X222.196.2300.REF.010 

Payer Claim Control Number with REF01 = "F8" must not be present.

7

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.

8

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.

9

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".

10

CSCC A7: "Acknowledgement /Rejectedfor Invalid Information…"
CSC 510: “Future date”
CSC187: “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.