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| Attention Electronic Submitters!! Effective March 20, 2009 the Common Electronic Data Interchange (CEDI) began assigning the Claim Control Number (CCN) for claims that pass all CEDI front-end edits. At this time, the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) also turned off their front-end editing. With these changes, claims accepted by CEDI that are submitted with an National Provider Identifier (NPI) and linked to a Provider Transaction Access Number (PTAN)/National Supplier Clearinghouse (NSC) but the PTAN/NSC is not enrolled with CEDI are returned on the supplier s remittance advice as unprocessable/rejected. National Government Services, the Jurisdiction B DME MAC has seen an increase in these types of claims. When an NPI and PTAN/NSC are linked but the PTAN/NSC is not enrolled with CEDI, suppliers are receiving the American National Standards Institute (ANSI) Code 16 (Claim/service lacks information for adjudication) and remark code N51 (Electronic interchange agreement not on file for provider/submitter) on their remittance advice. If you are a DME Supplier who has received a new PTAN/NSC Supplier number, you must notify CEDI Enrollment of the new PTAN/NSC number and its associated NPI. The new PTAN/NSC number must also be linked to the NPI in the National Plan and Provider Enumeration System (NPPES). If you do not enroll the new PTAN/NSC number with CEDI and register it with NPPES, claims associated with this new PTAN/NSC number will be returned as unprocessable/rejected. Note: When registering an NPI and its associated PTAN/NSC with the NPPES, it is imperative for suppliers to list their PTAN as the Medicare NSC number. If this is not listed correctly as the Medicare NSC number, suppliers will receive unprocessable/rejected claims. To resolve unprocessable/rejected claims returned on a remittance advice with the Remittance Reason/Remark Codes listed above, suppliers must either:Complete the EDI Enrollment Form to register all PTAN/NSC numbers with CEDI. If you submit claims through a clearinghouse or third party biller, you will need to complete the Supplier Authorization Form as well as the EDI Enrollment Form. The EDI Enrollment Form and the Supplier Authorization Forms can be accessed through the CEDI Web site www.ngscedi.com under EDI Enrollment. - OR - If you have an existing EDI Enrollment Form on file with CEDI for your NPI, you may submit an e-mail to cedienrollment@wellpoint.comwith the subject line reading: Reason/Remark Code Supplier Not Authorized for EDI . Please include the following within your e-mail request: Trading Partner/Submitter ID Trading Partner/Submitter Name Address Contact Name NPI number The new PTAN/NSCCEDI will add your PTAN/NSC and notify you via e-mail when this has been completed. Once your CEDI enrollment has been completed, you can resubmit your claims. Suppliers are reminded that until these steps are taken, the claims will continue to be returned on the remittance advice as unprocessable/rejected. |
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