Front End Edits & Reports

277CA Edit Tool Page Link

Manuals

5010A1 CEDI Front-End Acknowledgements and Reports Manual Internal PDF (1 MB) (08/04/2020)

CEDI NCPDP D.0 Front End Edits Internal PDF (1 MB) (02/18/2021)

 

Current Front End Edits

CMS 5010 Edit Spreadsheet Internal Excel Document (Effective for claims with date of receipt 01/06/2020 through 10/01/2021)

CMS 276/277 Edit Spreadsheet Internal Excel Document (Effective for claim status requests with date of receipt 07/03/2017 through 10/01/2021)

CMS NCPDP Edit Spreadsheet Internal Excel Document (Effective for claims with date of receipt 07/03/2017 through 10/01/2021)

 

Upcoming Front End Edits

CMS 5010 Edit Spreadsheet Internal Excel Document (Effective for claims with date of receipt 10/04/2021 through 04/01/2022)

 

Front End Edits Statistics

CEDI Monthly Edit Statistics Internal Excel Document (09/02/2021)

CEDI Quarterly Edit Statistics Internal Excel Document (07/07/2021)

 

DME MAC HCPCS/Modifier Tools

CGS offers an Advanced Modifier Engine to assist suppliers in billing proper Healthcare Common Procedure Coding Systems (HCPCS) codes and modifier combinations. The tool includes Durable Medical Equipment Prosthetics Orthotics and Supplies (DMEPOS) commonly billed HCPCS with billing scenarios. Based on the specific HCPCS entered and the billing scenario, the tool recommends modifiers for claim submission.

For Jurisdiction B, the AME tool is located at https://www.cgsmedicare.com/medicare_dynamic/jb/advanced_modifier_engine External Link

For Jurisdiction C, the AME tool is located at https://www.cgsmedicare.com/medicare_dynamic/jc/advanced_modifier_engine/ External Link

Noridian Healthcare Solutions offers a Modifier Lookup Tool to assist suppliers in determining potential modifiers that may be used in billing DMEPOS HCPCS codes.  Many pricing and informational modifiers can be found by utilizing this tool.

For Jurisdiction A, the Modifier Lookup Tool is located at https://med.noridianmedicare.com/web/jadme/topics/modifiers/modifier-lookup External Link

For Jurisdiction D, the Modifier Lookup Tool is located at https://med.noridianmedicare.com/web/jddme/topics/modifiers/modifier-lookup External Link

NGS CEDI cannot offer assistance or advice regarding correct HCPCS and modifiers to submit on DMEPOS claims.  Please contact the appropriate DME MAC for assistance with their tools or questions regarding HCPCS codes and modifiers.

 

 

Post Date: September 02, 2021