Attention All CEDI Trading Partners, Suppliers, Billing Services, Clearinghouses, and Vendors

Common Electronic Data Interchange (CEDI) Front-end Editing for Ordering/Referring Providers

 

In compliance with the Centers for Medicare and Medicaid Services (CMS) Change Request, CR6421, and as supplement to the information provided within the MLN Matters article - Expansion of the Current Scope of Editing for Ordering/Referring Providers, MM6421, previously communicated, the following are new edits that will appear on the CEDI GenResponse Report (GENRPT) should one of the situations described be encountered. 

 

These edits/errors will set as a WARNING message until January 1, 2010, after which time, if the edit is received, the claim will be rejected. 

If one of the errors is received, and there are no other errors on the claim(s) that would result in a rejection, the claim(s) will appear in the CLAIMS WITH WARNINGS section of the CEDI GENRPT and the assigned Claims Control Number/ Internal Control Number (CCN/ICN) will appear in the ICN field beneath the claim information in this section and will not be found within the CLAIMS WITHOUT ERRORS section.

If one of the below errors is received and there are other error(s) on the claim(s) that resulted in the claim(s) being rejected, these warning errors will appear listed with the other claim error(s) in the CLAIMS WITH ERRORS section of the CEDI GENRPT and a CCN/ICN will not be assigned.

 

After January 1, 2010 these edits will no longer be WARNINGS and will result in claim rejection and be returned in the CLAIMS WITH ERRORS section.

Although these errors are only being returned as a WARNING and will not be rejecting claims at this time, it is imperative that these warnings be followed up on by Providers and/or Trading Partners and action taken to ensure the Providers/Suppliers being used to Order/Refer services are on file with Medicare Provider Enrollment, Chain and Ownership System (PECOS) as authorized to do so. 

 

Edit/Error Code C200 shall set at the 2310A (Referring Provider), if present, and the submitted NPI (NM1-09) and name (NM1-03/04) are not found on the CMS supplied file of Providers/Suppliers who are authorized to Order/Refer services for Medicare

 

-Error Description: REFERRING PROVIDER NOT AUTHORIZED

 

Edit/Error Code C201 shall set at the 2310F (Referring Provider), if present, and the submitted NPI (NM1-09) and name (NM1-03/04) are not found on the CMS supplied file of Providers/Suppliers who are authorized to Order/Refer services for Medicare

 

-Error Description: REFERRING PROVIDER NOT AUTHORIZED

 

Edit/Error Code C202 shall set at the 2420E (Ordering Provider), if present, and the submitted NPI (NM1-09) and name (NM1-03/04) are not found on the CMS supplied file of Providers/Suppliers who are authorized to Order/Refer services for Medicare

 

-Error Description: ORDERING PROVIDER NOT AUTHORIZED 

 

For more information, view the MLN article by clicking on the link below or pasting the following into your Internet browser:

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6421.pdf

 

For more information about the edits, please contact the CEDI Help Desk at ngs.cedihelpdesk@wellpoint.com or at 866-311-9184.

 

Thank you,
National Government Services, Inc.
Corporate Communications

 

If you want to update your profile or unsubscribe from any of our lists, you will first need to set up a password for your account. To do this, click on the Login link from the Listserv page on the www.NGSMedicare.com Web site, then select one of the following:

 

§        Login - existing / transferred subscribers can obtain a new password and subscribe or unsubscribe from lists

§        Manage Account - change personal information such as your address or phone number

§        Join - new subscribers can create an account and subscribe to lists 

 

Please do not reply to this e-mail. National Government Services' Listserv is for outgoing messages only. Please do not respond back to messages as your response will not be answered, as this is not an authorized mode of communication at this time.

 

 CONFIDENTIALITY NOTICE: This e-mail message, including any attachments, is for the sole use of the intended recipient(s) and may contain confidential and privileged information or otherwise be protected by law. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message.