Update on the CEDI Front-End Editing Process

National Government Services, Common Electronic Data Interchange (CEDI) is in the process of changing the current front-end editing process for ANSI X12 837 claims and 276 claim status request transactions.

 All new edits have been added to the CEDI Front-End Reports Manual. This manual is available on the CEDI Web site at http://www.ngscedi.com/outreach_materials/outreachindex.htm.  

Please note the following edits are currently in place at CEDI on the GenResponse (GENRPT) report:

 

NGS005	C065	C125
NGS006	C072	C131
NGS008	C077	C137
B108	C086	C141
C007	C087	C143
C015	C088	C147
C055	C089	C157
C060	C090

 

The changes to the front-end editing process will occur in two stages.

 Stage 1 - Implementation will begin on Friday, January 9, 2009

• On Friday, January 9, 2009 at 3:00 p.m. ET, the CEDI Gateway will be brought down until Sunday, January 11, 2009 at 6:00 p.m. ET to implement the additional CEDI edits.
   ** During this time, Trading Partners will not be able to connect to CEDI to transmit or receive electronic transactions and/or reports.
• The additional front-end edits for 837 claims will be added to the current CEDI GenResponse (GENRPT) report.
• 837 claims shown as accepted on the GenResponse Report will be delivered to the DME MACs.
• Claims delivered to the DME MACs will continue to edit against the DME MAC Level II edits as they do currently.
• Claims accepted on the DME MAC Level II reports will be assigned a Claim Control Number (CCN) that will be attached to the claim as it enters the DME MAC for processing.
• CEDI will deliver the DME MAC Level II reports to the Trading Partner.
• Claims rejected on the DME MAC Level II report must be corrected and resubmitted to CEDI.
• 837 claims rejected on the GenResponse Report will not be delivered to the DME MACs. These claims must be corrected and resubmitted to CEDI.
• Most, if not all, claims that reject will be returned on the GenResponse Report. It will be extremely important for Trading Partners to monitor the GenResponse Report for rejected claims in order to correct and resubmit the claims to CEDI.
• The additional CEDI front end edits will be implemented for the 276 claim status request transactions.
• 276 transactions that reject at CEDI will be reported back on a 277 claim status response.
• 276 transactions accepted by CEDI will be delivered to the DME MACs.
• 276 transactions delivered to the DME MACs will continue to edit against the DME MAC Level II edits as they do currently.
• 276 transactions accepted on the DME MAC Level II reports will be sent to the DME MAC for processing to produce the 277 to report the claim status back to the Trading Partner. 

Stage 2 - Implementation will occur on January 30, 2009

• On Friday, January 30, 2009 at 3:00 p.m. ET, the CEDI Gateway will be brought down until Sunday, February 1, 2009 at 6:00 p.m. ET for the DME MACs to remove their front end edits for 837 claims and 276 claims status transactions.
  ** During this time, Trading Partners will not be able to connect to CEDI to transmit or receive electronic transactions and/or reports.
• The DME MACs will remove their front end edits and all electronic front-end editing for the X12 837 claims and 276 claim status transactions will be done through CEDI
• 837 claim front-end rejections will be returned on the CEDI GenResponse (GENRPT) report.
• 276 claims status request front-end rejections will be returned on the 277 claims status response transaction. 
• The additional GenResponse edits that were implemented in Stage 1 will replace the DME MAC Level II edits and Trading Partners will no longer receive Level II reports from the DME MACs.
• Claims accepted on the GenResponse Report will be assigned a Claim Control Number (CCN) and these will be indicated on a report that will go back to the Trading Partner from CEDI. This CCN will be attached to the claim as it enters the appropriate DME MAC for processing.
• All electronic front-end editing for the X12 276 claim status request transaction will be done through CEDI and all front-end rejections will be returned on the 277 transaction.

Note: The CCN assignment changes scheduled for Stage 2 may occur at a later stage. If this occurs, notification will be sent via the CEDI Listserv.

CMN Rejection Report: The process for DME MACs to edit CMNs submitted on the 837 claims will not change. Any CMN rejections will be returned on the CMN Rejection Report produced by the DME MACs and delivered to the Trading Partners CEDI mailbox in the RPT file.

NCPDP Claims: NCPDP claims are not affected by these changes. CEDI will continue to receive the NCPDP claims from the Trading Partner and forward the claims to the DME MACs. The DME MACs will perform all front end editing and assign the Claim Control Number (CCN) to accepted NCPDP claims.

Please contact the CEDI Help Desk at 866-311-9184 or by e-mail at ngs.cedihelpdesk@wellpoint.com if you have questions about the upcoming changes or the CEDI front end edits.

All CEDI Listservs are posted to the News section of the CEDI Web site at http://www.ngscedi.com/news/newsindex.htm.  

Thank you,
National Government Services, Inc.
Corporate Communications

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