The Spring 2015 EDI Connection is now available
Contents
1. CSCC AT Acknowledgement Rejected for Invalid Information CSC 562 Entity s National Provider Identifier NPI EIC 85 Billing Provider This Claim is rejected for Invalid Information in the Billing Provider s NPI National Provider ID CSCC AT Acknowledgement Rejected for Invalid Information CSC 500 Entity s Postal Zip Code EIC IL Subscriber This Claim is rejected for Invalid Information for the Subscriber s Postal Zip Code Resolution Please verify the Billing Provider NPI matches the information on file with Provider Enrollment at CGS Your Billing provider NPI must be a valid NPI on the Crosswalk when evaluated with Receiver ID in 1000B NM109 The zip code must be a valid zip code Top 10 ANSI 5010 Claim Rejections J15 Home Health amp Hospice 2 3 Edit Number X223 449 2410 LINO3 015 X223 112 2010BA NM109 020 X999 DUPE Al X223 090 2010AA REF0O2 050 X223 341 2310E NM109 020 x223 424 2400 SV202 2 020 X223 424 2400 SV202 7 025 X223 153 2300 CL103 015 X223 322 2310A PRV03 020 x223 220 2300 HI02 2 010 Business Edit Message CSCC AT Acknowledgement Rejected for Invalid Information CSC 218 NDC Number This claim is rejected for an invalid National Drug Code NDC number CSCC AT Acknowledgement Rejected for Invalid Information CSC 164 Entity s c2. SPRING 2015 EDI Connection Index Direct Data Entry DDE 0000e en Direct Data Entry DDE Professional Provider Telecommunications Network PPTN Onlinelnquiry Form Process Tips Commonly Associated with Errors for Completing the EDI Applications Submitting a Part B Medicare Secondary Payer MSP eClaim EDI TIP OF THE MONTH Why Was My EDI Application Returned 3 My CGS POAT seccreenere seas assesses REENER Do You Need a Remit Restored 4 Submitting NDC Codes N PC ACE PIOS Se ee Why Your User ID in myCGS Expired Provider Taxonomy Code 05 Top 10 ANSI 5010 Claim Rejections Ohio amp Kentucky Part B Top 10 ANSI 5010 Claim Rejections J15 Home Health amp Hospice PAGE 1 2015 Copyright CGS Administrators LLC Direct Data Entry DDE Direct Data Entry DDE user should refer to the following chapters of the DDE Manual for detailed information about the Fiscal Intermediary Standard System FISS and how to correct and enter claims check claim status and eligibility The DDE manual may be found on the CGS website https www cgsmedicare com Chapter One FISS Overview https www cgsmedicare com parta edi pdf DDE_Chapter1 pdf This chapter provides a FISS overview including information about d
3. 262 2310B NM109 030 X222 094 2010AA REF02 050 X222 430 2420A NM109 030 Business Edit Message CSCC AT Acknowledgement Rejected for Invalid Information CSC 507 HCPCS This Claim is rejected for relational field Information within the HCPCS CSCC A7 Acknowledgement Rejected for Invalid Information CSC 453 Procedure Code Modifier s for Service s Rendered This Claim is rejected for relational field Information within the Procedure Code Modifier s for Service s Rendered CSCC A8 Acknowledgement Rejected for relational field in error CSC 496 Submitter not approved for electronic claim submissions on behalf of this entity EIC 85 Billing Provider This Claim is rejected for relational field due to Billing Provider s submitter not approved for electronic claim submissions on behalf of this Billing Provider CSCC A7 Acknowledgement Rejected for Invalid Information CSC 164 Entity s contract member number EIC IL Subscriber This Claim is rejected for Invalid Information for a Subscriber s contract member number CSCC A7 Acknowledgement Rejected for Invalid Information CSC 21 Missing or Invalid Information CSC 153 Entity ID Number EIC PR Payer CSC 153 Entity ID Number EIC 40 Receiver This Claim is rejected for Invalid Information for a Missing or Invalid Information with the Payer s I
4. Purchase Price DME Rental Price DME Rertal Unit Price Ind PAGE 5 SPRING 2015 Unspecified Codes e Description of the procedure is required to be reported V101 7 Description Even though the NDC is reported in LINO3 does not negate the need to report a description Compound Drugs e Each drug component is reported on a separate service line LINO2 LINO3 CTP04 and CTP0O5 are reported for each compound in the drug REF Prescription or Compound Drug Association Number must be reported Why Your User ID in myCGS Expired CGS and CMS are dedicated to keeping your information safe To achieve this access to myCGS must be limited to users who use the system on a regular basis As a result a user ID will expire and be disabled when it has not been used in 60 days For this reason CGS recommends that all Provider Administrators and all Providers Users sign into myCGS at least once every 30 days This is especially important for Provider Administrators If a Provider Administrator ID has expired not only is the Provider Administrator s access disabled but all Provider User IDs established by that Provider Administrator are also disabled IMPORTANT To ensure your myCGS access is current log into myCGS at least once every 30 days If your User ID has been disabled you will receive the following message Your myCGS access has expired and your user ID is now invalid If you are a Provider Administrator please regi
5. in 2430 SVDO2 and the sum of all line adjustments found in 2430 CAS Adjustment Amounts Error Message Code CSCC A7 Acknowledgement Rejected for Invalid Information CSC 400 Claim is out of balance CSC 583 Line Item Charge Amount CSC 643 Service Line Paid Amount Resolution 2300 CLM02 must equal the sum of all 2320 amp 2430 CAS amounts and the 2320 AMT02 AMT01 D Error Message Code CSCC A7 Acknowledgement Rejected for Invalid Information CSC 400 Claim is out of Balance CSC 672 Payer s payment information is out of balance myCGS Portal myCGS is a Web based application developed specifically to serve the needs of health care providers and their staff in Jurisdiction 15 Access to myCGS is available 24 7 and is free of charge to all CGS providers To use myCGS providers must have an EDI Enrollment Agreement on file with CGS The EDI Enrollment Agreement is very simple to fill out and submit http www cgsmedicare com partb myCGS J15_EDI_EnrollAgreement2014RE pdf Only one person from each PTAN NPI needs to register for myCGS This person can then create additional users for your organization A wide range of information and features are available through myCGS including e Claim Submission and information e Remittance Advices e Beneficiary Eligibility e Financial Tools e Messaging e Forms Redetermination Requests Reopening Requests Offse
6. valid formats are NNNNNNNNNA or NNNNNNNNNAA or NNNNNNNNNAN where A represents an alpha character and N represents a numeric digit If the patient s Medicare number is not in one of these formats your claim will reject on the 277CA The receiver ID in the Payer name 2010BB NM109 must be the same number in the Receiver Name 1000B loop in NM109 Please verify that the Rendering Provider NPI at the claim level 2310B matches the information on file with Provider Enrollment at CGS Your Rendering Provider NPI information must also be linked with the Billing Provider NPI and Tax Identification ID If rendering provider NPI is not correct or linked this will cause your claims to reject Please verify the Tax Identification ID and Billing Provider NPI corresponds with our information on file with Provider Enrollment at CGS Your claims will reject if the Tax ID and Billing Provider NPI information is not identical Please verify that the Rendering Provider NPI at the line level 2420A matches the information on file with Provider Enrollment at CGS Your Rendering Provider NPI information must also be linked with the Billing Provider NPI and Tax Identification ID If rendering provider NPI is not correct or linked this will cause your claims to reject 2015 Copyright CGS Administrators LLC Edit Number X222 087 2010AA NM109 030 10 x222 125 2010BA N403 020 EDI Connection Business Edit Message
7. 1 Ext Details 3 Line 1 MSP COB Line 1 Diagnosis Codes 1 9 03 LN om thw PS EMG Pioc 1 2 Diagnosis Charges Grks EPFP AT Rendeng Phys 1 paana oa fT fee ff mo sof T fir fies ff eo re Pp eo ss a ey es AA D E a a ee a EOE E es Ee oe ee I eee ee ee 28 Total Charge 100 00 Recalculate 23 Patient Amourt Paid 0 00 30 Balance Due 100 00 Segments within the ANSI 837 file e SV1 drug procedure code HC qualifier in SV101 1 V101 2 procedure code V103 unit qualifier V104 units e LIN segment LINO2 value code N4 LINO3 NDC number e CTP segment required when reporting the NDC in the LIN segment CTP04 NDC unit count required CTPO5 unit of measure required Professional Claim Form Patient Info amp General Insured Information Biling Line Items Ext Patient General Ext Pat Gen 2 Ext PayerAnsured Line Item Details Extended Details Line 2 Ext Details 2 Line 2 Ext Details 3 Line 2 MSP COB Line 2 Line level Miscellaneous Information Proc Type Dese HC EXAMPLE Fac ty Name Obstetric Anesthesia Additional Unis 0 000 Faciity Address National Drug Code or UPN Type 00004035239 na National Drug Unit Price EEO ene L EE Nat Drug or UPN Units Type 1 000 UN FacIDs Types E Drug Ref No Type Drug Prescription Date rea Fe aT Line level Reference IDs Types Payer IDs DME Length of Need Days DME
8. D Number and Reciever s ID Number CSCC A7 Acknowledgement Rejected for Invalid Information CSC 562 Entity s National Provider Identifier NPI EIC 82 Rendering Provider This Claim is rejected for Invalid Information for a Rendering Provider s National Provider Identifier NPI CSCC A8 Acknowledgement Rejected for relational field in error CSC 562 Entity s National Provider Identifier NPI CSC 128 Entity s tax id EIC 85 Billing Provider This Claim is rejected for relational field Billing Provider s NPI National Provider ID and Tax ID CSCC A7 Acknowledgement Rejected for Invalid Information CSC 562 Entity s National Provider Identifier NPI EIC 82 Rendering Provider This Claim is rejected for Invalid Information within the Rendering Provider s National Provider Identifier NPI PAGE 6 SPRING 2015 Resolution Please verify that the HCPCS code is valid and active for the date of service sent on your claims electronically Some HCPCS codes are no longer valid or active for Medicare Please verify that the HCPCS Modifier codes are valid and active for the date of service sent on your claims electronically Some HCPCS Modifier codes are no longer valid or active for Medicare Please verify that the Billing Provider s Submitter ID has been approved to submit claims in production with CGS Medicare numbers can only be 10 to 11 characters The
9. aim C ces A CELERIAN GROUP COMPANY CMS CENTERS FOR MEDICARE amp MEDICAID SERVICES EDI Connection Direct Data Entry DDE Professional Provider Telecommunications Network PPTN Online Inquiry Form Process CGS EDI would like to share with you how your Online Inquiry Form request is processed from the time we receive your form to the time you receive your IDs The EDI department receives your form directly into our system whether faxed or submitted from our website Once the EDI representative views your form they verify that the PTAN NPI Practice Name and Tax ID on the form match the information in our system If the information does not match or if one of the items listed below is missing it is mailed back to you with an explanation e PTAN e NPI e Practice Name e Tax ID EIN e First and Last Name of individual requesting access If all the information is correct the EDI representative will forward the information to our Security department The Security department checks their system to see if the individual requesting access has an existing user ID or is setup with the user ID listed on the form If the individual is setup with the user ID listed on the form request is completed promptly If the individual does not have a user ID listed on the form and security does not see a user ID in the system for the individual the request is submitted to the Data Center for assignment of a us
10. e Make sure to always use the most recent forms from the CGS medicare website 2015 Copyright CGS Administrators LLC EDI Connection e Any forms requiring a signature should be signed by a fully authorized official from the office The signature binds you to the agreement and changes requested Online Inquiry Form e The EDI Contact Person should be the individual you have deemed authorized to receive information about the forms contents submitted to CGS e The Group Practice Provider Name Group Provider Number and Group NPI must match what is listed on file e In the Existing ID PIN field please include the existing ID PIN on those users whom an ID has already been established so that we may add access for the PTAN s requested If this is a new user please leave blank or indicate new in the Existing ID PIN If you are attempting to delete a users access please indicate delete in this field Submitting a Part B Medicare Secondary Payer MSP eClaim The myCGS eClaim option allows all Medicare Part B providers to submit electronic claims via the Web portal This option is available to all providers regardless of whether your office or practice currently submits Part B claims to CGS via Electronic Data Interchange EDI using PC ACE Pro32 electronic filing software or if you are still approved to file paper claims Please visit our website for instructions on submitting MSP claims via eClaim http devinternet par
11. ent the EDI forms from being returned for errors e llegible forms have been increasing This typically occurs from refaxing documents many times or bleeding of the inked letters from copies made over and over ALL information on the form must be legible This includes CGS print script phone numbers Provider information Trading Partner information disclaimer and agreement information If any of this information cannot be read your entire form and paperwork along with it will be returned e Using the most updated forms from the http www cgsmedicare com website will ensure you have the most recent and legible forms e Please make sure all Profiles are accompanied by a Provider Authorization form unless you are only using an approved 5010 software and requesting your own submitter ID number be assigned to your office EDI forms may be found by accessing http www cgsmedicare com In the Medicare tab select the line of business for your segment then choose the EDI icon to the left In the section of text within the middle of the page select the ED Enrollment Packet link e Choose only one Line of Business per Application e The PTAN name and address for the Provider must match what is listed in our system before setup can be completed The Multiple Provider List form is only required when there are multiple Group PTAN NPI numbers Enrollment forms are only needed if your provider has never setup to file electronic claims
12. er Authorization Form Software or Network Service Vendor missing or not approved Provider Name or address does not match our system Tax ID Number invalid or missing Helpful Tools to avoid application returns e Please read the instruction page from the EDI Enrollment packet before completing paper works http www cgsmedicare com pdf edi_enroll_packet pdf List of approved Network Service Vendors http www cgsmedicare com partb edi nsv_list html 5010 Trading Partner Directorys http www cgsmedicare com partb edi 5010trading_partners html Contact Provider Enrollment to authenticate Provider Name and Addresss http www cgsmedicare com partb enrollment index html CGS is committed to making sure the EDI Enrollment process is efficient with limited issues Please begin using our New EDI Application revised September 2014 http www cgsmedicare com pdf edi_enroll_ packet pdf 2015 Copyright CGS Administrators LLC EDI Connection myCGS does not currently support simultaneous use of the portal on multiple browser Use of myCGS in Multiple Tabs of Browser tabs Using myCGS in more than one browser tab at the same time may cause errors in your submissions To avoid delays in processing of your request please limit your usage of myCGS to one tab in your internet browser Top Error Messages When Submitting MSP Claims in eClaims Resolution SV102 must the sum of all payer amounts paid found
13. er ID Once the Data Center assigns the user ID security attaches the user ID to the individual and PTANs requested Security sends the completed request to EDI EDI e mails confirmation of the completed request to the contact on the form If an e mail address was not provided on the form EDI will call the contact on the form Note CGS EDI has up to 20 business days from the date of receipt to complete a request Tips Commonly Associated with Errors for Completing the Online Inquiry Form The following tips will ensure accuracy and prevent the form from being returned for errors e Make sure to always use the most recent forms from http www cgsmedicare com PAGE 2 SPRING 2015 e The EDI Contact person should be the individual you have deemed authorized to receive information about the forms contents submitted to CGS e The Group Practice Provider name and Group PTAN NPI must match what is listed on file In the EXISTING ID PIN field please include the existing ID on those users whom an ID has already been established so that we may add access for the PTAN s requested If this is a NEW user please leave blank or indicate New in the EXSITING ID PIN If you are attempting to DELETE a user s access please indicate Delete in this field Choose only one Line of Business per form Tips Commonly Associated with Errors for Completing the EDI Applications The following tips will ensure accuracy and prev
14. irect access to Direct Data Entry DDE system sign on sign off procedures menu options function keys shortcuts and common status and locations Chapter Two Checking Beneficiary Eligibility https www cgsmedicare com parta edi pdf DDE_Chapter2 pdf This chapter explains how to access beneficiary eligibility information via the Common Working File CWF screen ELGA to verify and ensure correct information is submitted on your Medicare claim Screen examples and field definitions are provided Chapter Three Inquiry Menu https www cgsmedicare com parta edi pdf DDE_Chapter3 pdf Chapter Three provides information about the inquiry options available in FISS such as checking the status of claims including how to check for Additional Development Requests ADRs claim count summary Medicare check history and viewing inquiry screens to check the validity of diagnosis codes revenue codes and HCPCS codes Chapter Four Claims and Attachments Menu https www cgsmedicare com parta edi pdf DDE_Chapter4 pdf This chapter includes instructions screen illustrations and field descriptions on how to enter UB 04 claim information including roster bill data entry Chapter Five Claims Correction https www cgsmedicare com parta edi pdf DDE_Chapter5 pdf Access this chapter for instructions screen illustrations and field descriptions on how to correct claims that are in the Return to Provider RTP file adjust claims and cancel a cl
15. ity s specialty taxonomy code EIC 71 Attending Physician This Claim is rejected for Invalid Information within the Attending Physician s specialty taxonomy code CSCC AT Acknowledgement Rejected for Invalid Information CSC 255 Diagnosis Code This Claim is rejected for containing Invalid Information within the Diagnosis Code PAGE 7 SPRING 2015 Resolution 2410 LIN National Drug Code must be 11 bytes alpha numeric Medicare numbers can only be 10 to 11 characters Here are the valid formats NNNNNNNNNA or NNNNNNNNNAA or NNNNNNNNNAN where A represents an alpha character and N represents a numeric digit If the patient s Medicare number is not in these formats your claim will reject on the 277CA If you have previously submitted this file to CGS please create a new file to submit to CGS You must submit a new control number in ISA13 BHT03 ST and SE 02 Please verify the Tax Identification ID and Billing Provider NPI corresponds with our information on file with Provider Enrollment at CGS Your claims will reject if the Tax ID and Billing Provider NPI information is not identical Please verify the Service Facility Location NPI is a valid NPI on the NPI crosswalk If the Service facility Location NPI is not correct this will cause your claims to reject Please verify that the HCPCS code is valid and active for the date of service sent on your claims electronically Some HCPCS codes are n
16. o longer valid or active for Medicare A description is required on the service line item SV202 7 when a non specific procedure code is submitted When a patient status code 20 40 41 or 42 expired is present a occurrence code of 55 is required Please submit a valid Provider Taxonomy Code for the attending Physician Please verify the Diagnosis code is valid and active for the date of service sent on your claim electronically Some Diagnosis codes are no longer valid or active for Medicare 2015 Copyright CGS Administrators LLC
17. ontract member number EIC IL Subscriber This Claim is rejected for containing Invalid Information within the Subscriber s contract member number Rejected due to duplicate ST SE submission CSCC A8 Acknowledgement Rejected for relational field in error CSC 562 Entity s National Provider Identifier NPI CSC 128 Entity s tax id EIC 85 Billing Provider This Claim is rejected for a relational field in error within the Billing Provider s National Provider Identifier NPI and Billing Provider s Tax ID CSCC AT Acknowledgement Rejected for Invalid Information CSC 562 Entity s National Provider Identifier NPI EIC 77 Service Location This Claim is rejected for Invalid Information within the Service Location s National Provider Identifier NPI CSCC AT Acknowledgement Rejected for Invalid Information CSC 507 HCPCS This Claim is rejected for Invalid Information within the HCPCS CSCC A8 Acknowledgement Rejected for relational field in error CSC 306 Detailed description of service This Claim is rejected for a relational field in error for Service s Rendered CSCC AT Acknowledgement Rejected for Invalid Information CSC 234 Patient discharge status This Claim is rejected for Invalid Information with the Patient discharge status CSCC AT Acknowledgement Rejected for Invalid Information CSC 145 Ent
18. portunity to view each remit separately For more information on how to register for myCGS please visit the myCGS Web Portal Registration Checklist at http www cgsmedicare com partb myCGS myCGS_Checklist pdf We recommend that you have the following information below before you contact the EDI Help Desk to have remits restored 1 PTAN 2 NPI 3 Last 5 digits of your Tax ID 4 Check EFT number 5 Check Remittance Date 6 Check Amount ERA will be available on a daily basis based on claim finalization and is only available for 45 days electronically Only one Submitter receiver can be sent the ERA per PTAN NPI A provider may have multiple submitters for claims however the remittance files can only be sent to one submitter receiver ID 2015 Copyright CGS Administrators LLC EDI Connection Submitting NDC Codes In PC ACE Pro32 e Reporting of NDC and its related information on Professional claims is sometimes confusing Many customers have had questions about where this information is located in PC ACE Pro32 and are seeking clarification e The billing line items are entered as normal When line items are completed click on the Ext Details 2 Line the line number changes according to which line item is chosen Patient Info amp General Insured Information Billing Line Items Ext Patiert General Ext Pat Gen 2 Ext Payer nsured Line Item Detaits Extended Details Line 1 Ext Detais 2 Line
19. ster again If you are a Provider User please contact your Provider Administrator for access You must login at least once every 60 days to keep your user Id Valid If you are a Provider User contact your Provider Administrator Your Provider Administrator must add you again as a new user You will receive a new user ID from your Provider Administrator If you a Provider Administrator you must register for myCGS again You will receive a new myCGS user ID You must also add any Provider Users to myCGS as new users 2015 Copyright CGS Administrators LLC Provider Taxonomy Code Providers are not required to use a taxonomy code on their electronic claims However if a taxonomy code is used it must be a valid code or the claim will reject A list of taxonomy codes may be accessed by choosing the Health Care Provider Taxonomy Code EDI Connection Set link found on the Washington Publishing Company s website http www wpc edi com reference The taxonomy code is entered in the 2310B or 2420A loop in the PRV segment for the rendering provider The taxonomy code for the rendering provider is allowed in one loop only The claim may reject if the code is placed in both loops Top 10 ANSI 5010 Claim Rejections Ohio amp Kentucky Part B Edit Number X222 351 2400 SV101 2 020 X222 351 2400 SV101 3 010 X222 087 2010AA NM109 050 x222 121 2010BA NM109 020 K222 133 2010BB NM109 025 x222
20. t Requests The myCGS User Manual http www cgsmedicare com myCGS Manual html provides detailed information about accessing and obtaining information from the myCGS Web portal The User Manual is aligned with the various Tabs available in myCGS PAGE 4 SPRING 2015 The myCGS Web portal is designed to allow for easy self registration without having to contact CGS Before calling the CGS EDI Help Desk you should use your myCGS Registration Checklist http www cgsmedicare com partb mycgs checklists html read the FAQs http www cgsmedicare com partb mycgs fags html and or refer to the myCGS User Manual http www cgsmedicare com mycgs manual html The CGS EDI Help Desk can assist with technical support during registration or with connectivity issues If you have questions or concerns with claim status financial information or eligibility questions you should call the Provider Contact Center that serves your contract Contact information is available at http www cgsmedicare com Do You Need a Remit Restored Many files submitted especially by your Clearinghouse or Billing Entity may have thousands of claims within the file When the electronic remittance advice ERA is available it may also include a large amount of claims EDI requires your Clearinghouse or Billing Entity to contact the EDI help desk to have the ERA restored Another alternative would be to register for myCGS which gives you the op
21. tb pubs news 2015 0215 cope28475 html Tips when submitting a MSP claim in eClaim e Claim Submission Tab must select Secondary e MSP claims require that the Patient Relationship to Insured and Insured Information fields be completed Additional fields will display under the Miscellaneous Claim Information section e Identify line items individually MSP claims will display a field to enter the Primary Insurance Paid Amount and the Adjudication Date or Payment Date e Reason remark codes from the primary insurance explanation of benefits EOB are required in the Line Adjustments section Coincides with the CAS Segment of an electronic claim The Group Codes available are CO Contractual Obligation OA Other Adjustment PR Patient Responsibility Note When you drop down the Group Codes they Corresponds with the CAS codes found on the Other Insurance EOB The Reason Code is located on the Other Insurance EOB You can also access the Adjustment Reason Codes from http www wpc edi com PAGE 3 SPRING 2015 EDI TIP OF THE MONTH Why Was My EDI Application Returned Tips to Avoid Multiple Send Backs Are you annoyed by multiple returned applications CGS has ascertained in most instances something was overlooked or not completed entirely The list below point to types of trends from recent returned documentation e Multiple Lines of Business LOB s checked e Signature missing from Enrollment page or Provid
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