Front End Edits & Reports
5010A1 CEDI Front-End Acknowledgements and Reports Manual (1 MB) (12/14/2022)
CEDI NCPDP D.0 Front End Edits (1 MB) (04/25/2022)
Current Front End Edits
CMS 837P Claims Edit Spreadsheet (Effective for claims with date of receipt on or after 01/03/2023)
CMS 276/277 Edit Spreadsheet (Effective for claim status requests with date of receipt on or after 01/03/2023)
CMS NCPDP Edit Spreadsheet (Effective for claims with date of receipt on or after 07/03/2017)
Upcoming Front End Edits
There are no upcoming front end edit changes.
Front End Edits Statistics
CEDI Monthly Edit Statistics (06/05/2023)
CEDI Quarterly Edit Statistics (04/05/2023)
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
For Jurisdiction C, the AME tool is located at https://www.cgsmedicare.com/medicare_dynamic/jc/advanced_modifier_engine/
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
For Jurisdiction D, the Modifier Lookup Tool is located at https://med.noridianmedicare.com/web/jddme/topics/modifiers/modifier-lookup
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: June 05, 2023