| NHIC, Corp.DME MAC A ListServe | For Immediate Release |
| January 13, 2009 Successful Completion of the Common Electronic Data Interchange (CEDI) Implementation of Additional X12 837 and 276 Front End CEDI Edits (CEDI Message 2009-01-12)National Government Services, Common Electronic Data Interchange (CEDI) implementation of the additional X12 837 and 276 front end CEDI edits was successfully completed ahead of schedule on Saturday, January 10, 2009. At that time, the CEDI Gateway was re-opened to accept and process electronic transactions.This completes Stage 1 of the implementation of the full X12 837 and 276 front end edits at CEDI. Further communication will be provided on Stage 2 for the DME MACs to remove all front end edit logic and for CEDI to begin assigning the Claim Control Number (CCN) to accepted claims.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.htmStage 1 - Completed January 10, 2009 On Friday, January 9, 2009 at 3:00 p.m. ET, the CEDI Gateway was brought down. ** During this time, Trading Partners were not be able to connect to CEDI to transmit or receive electronic transactions and/or reports. The additional front-end edits for 837 claims have been 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 have been 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.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. |
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