Durable Medical Equipment Common Electronic Data Interchange (CEDI) Frequently Asked Questions

Transcription

1 Durable Medical Equipment Cmmn Electrnic Data Interchange (CEDI) Frequently Asked Questins Tpics Cvered Click a tpic t see frequently asked questins. New tpics are indicated by a red star. Enrllment Trading Partner Recertificatin Testing Prcess ICD-10 Implementatin Cmmunicatins Lgging In and Passwrds Exchanging Electrnic Transactins with CEDI Electrnic Frnt-End Reprts/Acknwledgements NCPDP D.0 Claims PECOS Electrnic Remittance Advice Claim Status Inquiry and Electrnic Funds Transfer PC-ACE Sftware Supprt Identificatin Numbers fr CEDI DME MAC Jurisdictins Enrllment 1. I cmpleted CEDI enrllment frms n-line. D I have t als fax them t CEDI? N. Once yu cmplete and submit the CEDI enrllment packet nline, the frms are submitted t CEDI fr prcessing. 2. Is there a standardized EDI enrllment frm fr use with CEDI? Last Revisin: January 22, 2016 P a g e 1 f 24

2 Durable Medical Equipment Cmmn Electrnic Data Interchange (CEDI) Frequently Asked Questins Yes. CEDI maintains the EDI enrllment frms fr all fur DME MAC Jurisdictins. T enrll with CEDI fr electrnic DME transactins, yu nly need t submit ne instance f the required CEDI frm r frms. All required frms will be submitted t CEDI in a packet and the packet will be prcessed the same way in all fur DME MAC Jurisdictins. The CEDI enrllment packet is lcated n the CEDI Web site at Nte: The enrllment packet is cmpleted and submitted nline. It will NOT be faxed t CEDI fr prcessing. Nte: Yu will nly need t submit ne packet f frms and CEDI will prcess them fr all fur DME MAC Jurisdictins. 3. I signed up with CEDI and registered my NPI. My claims are accepted by CEDI but are nw being rejected n my remittance advice ntice with Reasn/Remark Cdes indicating Claim service lacks infrmatin which is needed fr adjudicatin and/r Electrnic interchange agreement nt n file fr prvider/submitter. If yu are a DME Supplier wh has received a new PTAN/NSC Supplier number, yu must ntify CEDI Enrllment f the new PTAN/NSC number and its assciated NPI. The new PTAN/NSC number must als be linked t the NPI in NPPES. If yu d nt enrll the new PTAN/NSC number with CEDI and register it with NPPES, claims assciated with this new PTAN/NSC number will be rejected. Claims submitted withut a valid PTAN/NSC match n the NPI crsswalk, will be rejected with CEDI edit A7:562:85. Nte: PECOS can als affect yur crsswalk. PECOS is the system used by the NSC fr DME suppliers t enrll in Medicare. Suppliers can lg in t PECOS at and verify that their NPI is listed crrectly. Fr assistance with PECOS, call Claims submitted with an NPI linked t a PTAN/NSC nt enrlled with CEDI will be returned n the supplier s Electrnic Remittance Advice r Standard Paper Remittance with the Reasn/Remark Cdes t indicate the Claim service lacks infrmatin which is needed fr adjudicatin and/r Electrnic interchange agreement nt n file fr prvider/submitter. T reslve Remittance Reasn/Remark Cdes, suppliers must: Cmplete a new CEDI enrllment packet fr the submissin f Health Care Claim (837) transactins with CEDI. The guided enrllment prcess can be accessed thrugh the CEDI Web site ( under CEDI Enrllment. 4. Hw d I link my PTAN/NSC number t my NPI? Last Revisin: January 22, 2016 P a g e 2 f 24

3 Durable Medical Equipment Cmmn Electrnic Data Interchange (CEDI) Frequently Asked Questins If yu are having difficulties establishing the crsswalk between yur NPI (Natinal Prvider Identifier) and PTAN/NSC numbers, the fllwing infrmatin needs t be verified with bth the NSC (Natinal Supplier Clearinghuse) and the NPPES Web site. Fr Individuals: The Scial Security number (SSN) and PTAN/NSC number entered with NPPES must match the SSN and PTAN/NSC number n file with the Natinal Supplier Clearinghuse (NSC). If a match cannt be fund, the SSN and Practice Address ZIP Cde at NPPES must match the SSN and Practice Address ZIP Cde at the NSC. If the secnd match cannt be fund, an active crsswalk recrd will nt be created. Fr Organizatins: The Tax ID number (EIN), PTAN/NSC and Practice Address ZIP Cde at NPPES must match the EIN, PTAN/NSC and Practice Address ZIP Cde at the NSC. If the match cannt be fund, an active crsswalk recrd will nt be created. Please visit the NPPES Web site at t verify the supplier s infrmatin. The PTAN/NSC number must be indicated under Issuer as MEDICARE NSC. **If yu need assistance lgging in t NPPES, please call Nte: PECOS can als affect yur crsswalk. PECOS is the system used by the NSC fr DME suppliers t enrll in Medicare. Suppliers can lg in t PECOS at and verify that their NPI is listed crrectly. Fr assistance with PECOS, call I updated my infrmatin n the NPPES Web site. Hw lng will it take befre it s effective? Updates t the NPPES can take up t 10 days t establish an effective match fr the NPI and PTAN/NSC. 6. What is the turnarund time fr CEDI t prcess enrllment requests? CEDI will prcess new CEDI enrllment requests within 10 business days f receipt. Sme requests may take lnger depending n the size f the request. 7. D I have t use the n-line CEDI enrllment prcess r can I use a frm I used previusly? Last Revisin: January 22, 2016 P a g e 3 f 24

4 Durable Medical Equipment Cmmn Electrnic Data Interchange (CEDI) Frequently Asked Questins Only the n-line enrllment prcess lcated n the CEDI Web site ( will be accepted. Nte: This des nt apply t Claim Status Inquiry (CSI) and Electrnic Funds Transfer (EFT) setups. CSI and EFT setups are accepted and prcessed by the DME MAC Jurisdictins. All ther EDI setup requests g t CEDI. 8. My enrllment packet was rejected. Why? CEDI Enrllment has guidelines t which yur cmpleted enrllment packet must cnfrm. The tp reasn why we return paperwrk is: The signee is nt authrized t sign n behalf f the supplier The authrized r delegated fficial s name entered in the DME Supplier Name field will be verified against PECOS by CEDI Enrllment. Additinal infrmatin abut the rejectin reasn returned n yur enrllment packet can be fund by using the CEDI Online Enrllment Status Tl lcated n the CEDI Web site. If the enrllment packet is rejected, a new enrllment packet must be submitted electrnically thrugh the CEDI Web site fr prcessing. 9. I have a large list f suppliers that I need t enrll. Can I this infrmatin t yu? N. The suppliers will need t cmplete the nline enrllment prcess t cmplete the requests. The nline enrllment prcess can be fund n the CEDI Web site at under CEDI Enrllment. 10. Hw lng will my Trading Partner ID be active at CEDI? Each mnth CEDI will identify Trading Partners wh are inactive. If a Trading Partner has nt lgged int CEDI in the past 60 days, their accunt will be lcked and they must cntact the CEDI Help Desk by at ngs.cedihelpdesk@anthem.cm r via telephne at t have their accunt unlcked. Trading Partners wh have nt accessed CEDI within the past 13 mnths will have their access remved. Trading Partners whse access is remved will need t visit the CEDI Web site at cmplete and submit a new enrllment packet t reapply fr a new Trading Partner/Submitter ID r t have yur previus Trading Partner/Submitter ID reinstated. Last Revisin: January 22, 2016 P a g e 4 f 24

5 Durable Medical Equipment Cmmn Electrnic Data Interchange (CEDI) Frequently Asked Questins Trading Partner Recertificatin 1. What is Trading Partner Recertificatin? CEDI recertifies all Trading Partners annually t verify the infrmatin fr the wner f the CEDI Trading Partner ID and that they are cntinuing t exchange transactins with CEDI. 2. Wh needs t recertify? All entities wh are the wners f a CEDI Trading Partner ID need t recertify. This can include suppliers wh exchange transactins directly with CEDI. Suppliers wh use a third party (billing service r clearinghuse) t exchange transactins will nt cmplete the recertificatin frm. Billing Services and Clearinghuses are required t recertify their wn CEDI Trading Partner IDs. 3. Hw d I recertify? The Recertificatin Prcess begins July 1 st and cncludes December 31 st. Trading Partners will need t cmplete the CEDI Recertificatin Frm lcated n the CEDI Web site at 4. D I need t fax r the CEDI Recertificatin Frm? N. The CEDI Trading Partner Recertificatin frm will be cmpleted and submitted electrnically n the CEDI Web site. Yu may print a cpy f the frm fr yur recrds, but the frm will nt need t be faxed r ed fr prcessing. 5. What is the deadline t submit the CEDI Recertificatin Frm? Frms must be submitted by December 31 st. If any cntact infrmatin changes, a new recertificatin frm can be cmpleted at any time t keep yur infrmatin current. 6. What will happen if I dn t submit the CEDI Recertificatin Frm? Any Trading Partners wh have nt submitted their CEDI Recertificatin Frm by December 31 st will have their access t CEDI suspended during the first week f January. Testing Prcess 1. Wh must test with CEDI, the electrnic Trading Partner/Submitter r the sftware vendr? Last Revisin: January 22, 2016 P a g e 5 f 24

6 Durable Medical Equipment Cmmn Electrnic Data Interchange (CEDI) Frequently Asked Questins The sftware vendr r in-huse prgrammer must test cnnectivity with CEDI. Once a vendr r in-huse prgrammer has successfully cnnected t CEDI, sent in a file and received an accepted 277CA frnt-end acknwledgement back, they will be apprved. Vendrs and in-huse prgrammers may cntinue t send in test files even after they are apprved t test changes t their sftware prduct. Once a vendr r in-huse prgrammer has passed testing with CEDI, their custmers can begin t mve int prductin t send claims (837), receive remits (835), send NCPDP files r 276's (Claim Status Request Transactin) and receive electrnic reprts. 2. Where d I get infrmatin t start the testing prcess? Sftware vendrs and in-huse prgrammers shuld send their cntact infrmatin in advance by t the CEDI Help Desk at ngs.cedihelpdesk@anthem.cm. Please include in the the name f the sftware, a cntact name, phne number, fax number, and e- mail address. One f the CEDI Vendr Testing Crdinatrs will send the sftware vendr/in-huse prgrammer additinal infrmatin abut the testing prcess. 3. Will vendrs and in-huse prgrammers get a specific Trading Partner/Submitter ID t use when testing? Yes, vendrs and in-huse prgrammers will be assigned a specific Trading Partner/Submitter ID t be used fr testing. This ID will be in the frmat V089#####. ** This V089 ID cannt be used t submit prductin claims. 4. I am a sftware vendr r in-huse prgrammer, where can I get infrmatin n the CEDI cmmunicatins? CEDI requires the use f a Netwrk Service Vendr (NSV) fr cnnectivity t the CEDI Gateway t exchange electrnic transactins. NSVs prvide fast and reliable cnnectins in a secure envirnment. Mre infrmatin is available n the CEDI Web site ( under Telecmmunicatins. 5. Where d I find a list f apprved CEDI vendrs, clearinghuses and billing services? The CEDI Apprved Entities list is psted t the CEDI Web site at 6. Where can I receive a cpy f the X Implementatin Guide? The ASC X12 versin 5010 and errata dcuments are nw knwn as Technical Reprts Type 3 (r TR3s) and are available fr purchase at Last Revisin: January 22, 2016 P a g e 6 f 24

7 Durable Medical Equipment Cmmn Electrnic Data Interchange (CEDI) Frequently Asked Questins 7. Where can I receive a cpy f the NCPDP D.0 guide? NCPDP guides are available fr purchase frm the NCPDP rganizatin at 8. Where can I review the X A1 and NCPDP D.0 Cmpanin Guides? The Cmpanin Guides fr the X A1 and NCPDP D.0 are available n the CEDI Web site under Technical Specificatins. Technical Specificatins 9. Can I submit test and/r NCPDP D.0 claims and receive back a test 835 Electrnic Remittance Advice (ERA)? N. The testing f claims is separate frm the testing f the ERA. Test claims will nly pass thrugh the CEDI frnt end edits and return the frnt end transactins. Test claims will nt be sent t the DME MACs fr prcessing. 10. If I am using the CEDI sftware PC-ACE will I need t cmplete any testing? N, the CEDI sftware PC-ACE has already been tested by the develpers and CEDI. Be sure yu are using the current versin f the PC-ACE sftware by checking the CEDI Web site ( fr upgrades. Nte: While testing is nt required, CEDI des recmmend that all new users submit a test file t familiarize themselves with the sftware. ICD-10 Implementatin 1. I have questins abut ICD-10 cding r hw claims will prcess with an ICD-10 cde. Wh d I cntact t get mre infrmatin? Questins regarding the ICD-10 cdes r hw claims will be prcessed will be answered by the DME MAC where the claim wuld be prcessed fr payment. Questins regarding the frnt end edits received during testing will be addressed by the CEDI Help Desk. 2. What qualifier d I use fr ICD-10 diagnsis cdes? Last Revisin: January 22, 2016 P a g e 7 f 24

8 Durable Medical Equipment Cmmn Electrnic Data Interchange (CEDI) Frequently Asked Questins In the X A1 HI01-1 field fr the Cde List Qualifier Cde, yu will need t use the cde ABK t indicate an ICD-10 diagnsis cde is being sent as the principal diagnsis cde. When sending mre than ne diagnsis cde, use the cde ABF fr the Cde List Qualifier Cde t indicate additinal ICD-10 diagnsis cdes that are sent. In the NCPDP D WE field fr the Diagnsis Cde Qualifier, yu will need t use the cde 02 t indicate an ICD-10 diagnsis cde is being sent. 3. Can I send ICD-9 and ICD-10 cdes in the same claim? N, ICD-9 and ICD-10 cdes cannt be sent in the same claim. Claims requiring an ICD-9 cde and claims requiring an ICD-10 cde will need t be sent as separate claims. Cmmunicatins What cmmunicatins methds can I use t cnnect t CEDI? CEDI requires the use f a Netwrk Service Vendr (NSV) fr cnnectivity t the CEDI Gateway t exchange electrnic transactins. NSVs prvide fast and reliable cnnectins in a secure envirnment. Mre infrmatin is available n the CEDI Web site ( under Telecmmunicatins. Can zipped files be sent t CEDI? Yes. Zipped files can be sent t CEDI. Trading Partners d nt need t send ntificatin t CEDI prir t sending a zipped file. Nte: All zipped files must be submitted in Binary mde. Will CEDI send zipped utbund files t the Trading Partners/Submitters? Yes. When requested, zipped files can be received by Trading Partners/Submitters frm CEDI. The default setup fr all Trading Partners/Submitters is fr their utbund files t be returned unzipped. T request utbund files delivered in a zipped frmat, submit an e- mail request t the CEDI Enrllment Team as fllws: The address is: cedienrllment@anthem.cm The subject must be: CEDI Request fr Zipped Files Include the fllwing infrmatin Last Revisin: January 22, 2016 P a g e 8 f 24

9 Durable Medical Equipment Cmmn Electrnic Data Interchange (CEDI) Frequently Asked Questins Trading Partner/Submitter ID Trading Partner/Submitter Name Cntact Name Cntact Phne Number Cntact Address Yu will be ntified via when yur request has been cmpleted. 4. Is there a limit t the length f a filename sent t CEDI? Yes. Filenames sent t CEDI cannt be lnger than 30 characters. Lgging In and Passwrds 1. Hw d I reset my CEDI passwrd? Passwrds can be reset n the CEDI Gateway Self-Service Passwrd prtal lcated at Trading partners can als call the CEDI Help Desk and select ptin 3 r requests t ngs.cedihelpdesk@anthem.cm. T cmplete the request, the CEDI Help Desk will need the Trading Partner/Submitter ID, NPI, and PTAN/NSC number. The persn making the request will als need t be an authrized cntact persn as indicated n the CEDI Trading Partner Recertificatin Frm. 2. What are the guidelines/requirements t fllw when changing a passwrd with CEDI? Passwrds are case sensitive and will expire every 60 days. The system will alert yu when yur passwrd has expired. Fllw the guidelines belw when changing yur passwrd with CEDI: Passwrds must be eight (8) characters in length; n mre and n less. Passwrds must cntain a cmbinatin f numeric and alpha characters. Passwrds must include at least 1 uppercare and 1 lwercase letter Passwrd must cntain a special character; fr #, $ Passwrds cannt cntain dictinary wrds. Passwrds must cntain a minimum f fur (4) characters different than the previus passwrd. Passwrds must be different than the last nine (9) passwrds. Last Revisin: January 22, 2016 P a g e 9 f 24

10 Durable Medical Equipment Cmmn Electrnic Data Interchange (CEDI) Frequently Asked Questins The CEDI Gateway is case sensitive. Hw yu enter yur passwrd in the prtal is hw yu must enter yur passwrd at the gateway. After three (3) incrrect lgin attempts, the accunt will be lcked. Please cntact the CEDI Help Desk at t have yur passwrd Reset. Passwrds cannt be changes mre than nce within a rlling 24 hur perid. If a passwrd needs t be reset mre than nce in a rlling 24 hur perid, please cntact the CEDI Help Desk at t have yur passwrd reset. Passwrds must nt be stred in scripts, files, r applicatins unless cmpensating cntrls are in place Nte: Trading Partner (Submitter) IDs will autmatically be suspended after 60 days f inactivity and becme inactive after 13 mnths f inactivity Nte: CMS infrmatin security plicy strictly prhibits the sharing r laning f Medicare assigned IDs and passwrds. Users shuld take apprpriate measures t prevent unauthrized disclsure r mdificatin f assigned IDs and passwrds. Vilatin f this plicy will result in revcatin f all methds f system access, including but nt limited t EDI frnt-end access r EDC RACF user access. The Medicare cntractr shall ntify all affected prviders as well as reprting the system revcatin t CMS. 3. Can I change my passwrd befre the system prmpts me? Yes. Yu can use the CEDI Gateway Self-Service Passwrd prtal lcated at t change yur passwrd befre the passwrd expires. Exchanging Electrnic Transactins with CEDI 1. Can I submit with ne Trading Partner/Submitter ID but have my Electrnic Remittance Advice (ERA) returned t anther ID? Yes. Please indicate the apprpriate transactin ptins yu wish t use with yur Trading Partner ID when cmpleting the nline enrllment prcess n the CEDI Web site ( By selecting the apprpriate transactin ptins ur CEDI Enrllment team will knw hw t setup yur supplier numbers fr Electrnic Remittance Advices (ERAs). 2. D I have t submit separate files t CEDI fr claims ging t each DME MAC Jurisdictin? Last Revisin: January 22, 2016 P a g e 10 f 24

11 Durable Medical Equipment Cmmn Electrnic Data Interchange (CEDI) Frequently Asked Questins Trading Partners/Submitters sending ANSI 837 and/r NCPDP claim files can send ne file t CEDI with claims fr multiple Jurisdictins. CEDI will rute all 837 and NCPDP claims t the apprpriate DME MAC Jurisdictin based n the beneficiary address n each claim. The 276/277 Claim Status Request/Respnse transactins must be submitted in separate files fr each DME MAC Jurisdictin where the claim was submitted. The 276 frmat des nt prvide the beneficiary address s CEDI cannt perfrm the same ruting as is dne fr claims transactins. 3. What cntractr cde d I use when submitting my claim file t CEDI? All incming ANSI X12N 837 claim files t CEDI can be submitted with any ne f the fur DME MAC Jurisdictin s cntractr cde. The DME MAC Cntractr Cdes are: Jurisdictin A Jurisdictin B Jurisdictin C Jurisdictin D I cnnect t CEDI multiple times because I have s many files t dwnlad. D I have t cnnect and dwnlad nly ne frnt-end reprt r ERA at a time? Trading Partners/Submitters can cnnect t CEDI and dwnlad all reprts and ERAs at ne time withut discnnecting. If yur system is nly allwing yu t dwnlad ne file at a time, it wuld be a limitatin within yur sftware. Cntact yur sftware vendr t determine if they can update yur system t allw dwnlading f all files frm CEDI at ne time. 5. When d I need t send my claims t receive a receipt date n my electrnic claims fr the same day? Claims received befre 5:00 p.m. at CEDI Eastern Time (ET) n a business day will get the receipt date f that business day. Claims received after 5:00 p.m. at CEDI (ET) n a business day will get the next day f receipt: If the next day is a Saturday r Sunday, claims will have Mnday's date f receipt If the next day is a hliday, r the Mnday fllwing the weekend is a hliday, the next business day is used as the receipt date Claims can be submitted t CEDI 24 hurs a day/ 7 days a week. Last Revisin: January 22, 2016 P a g e 11 f 24

12 Durable Medical Equipment Cmmn Electrnic Data Interchange (CEDI) Frequently Asked Questins 6. Hw d I send claims that have n rdering physician? Fr claims with n rdering physician and an EY mdifier (n physician r ther licensed health care prvider rder fr this item f service) is used, enter the rendering supplier s name and NPI as the rdering. The electrnic claims frmat will nly allw a persn's name t be submitted fr the rdering prvider. If a supplier needs t submit their wn name in an electrnic claim in accrdance with the general instructins fr the EY mdifier, and the name f the supplier is a business name instead f the name f a persn, the CMS advises entering an X in bth the first and last name fields fr the rdering prvider. This is in the NM103 and NM104 elements in Lp 2420E. If the supplier has btained a physician s rder fr sme, but nt all, f the items prvided t a particular beneficiary, the supplier must submit a separate claim fr the items dispensed withut a physician s rder. Claims submitted with an EY mdifier n ne charge line but nt n all charge lines will be rejected by CEDI. 7. What is the difference between an NPI and a PTAN? CMS released MLN Matters Special Editin Article #SE1216, Explaining the Difference Between a Natinal Prvider Identifier (NPI) and a Prvider Transactin Access Number (PTAN). This article is available fr dwnlad frm their Web site at MLN/MLNMattersArticles/Dwnlads/SE1216.pdf. This article prvides educatin n the differences between a Natinal Prvider Identifier (NPI) and a Prvider Transactin Access Number (PTAN). It includes infrmatin abut new enrllees, revalidatin, the relatinship between the NPI and PTAN, and hw prviders can prtect their identity in the Prvider Enrllment Chain & Ownership System (PECOS). Electrnic Frnt-End Reprts/Acknwledgements 1. Hw many reprts will I receive frm CEDI fr each electrnic claim file submitted? CEDI will prvide the fllwing reprts fr each ANSI X12 versin 5010A1 claim file submitted: TA1 (NOTE: Sme systems may generate a TA1 reprt fr accepted and rejected files, thers will nly generate a TA1 if the file rejects. Check with yur sftware vendr t determine if yur system generates bth accepted and rejected TA1 reprts) Last Revisin: January 22, 2016 P a g e 12 f 24

13 Durable Medical Equipment Cmmn Electrnic Data Interchange (CEDI) Frequently Asked Questins TRN Reprt 999 Acknwledgement 277CA (Claim Acknwledgement) DME MAC reprts (RPT files) are created by the DME MACs and delivered by CEDI. The DME MAC reprt nly shws accepted claims. All claim frnt-end rejectins are reprted n the CEDI 277CA. CMN rejectins will be reprted in the CMN Rejectin Reprt sectin f the RPT file. If the CMN is rejected n the DME MAC reprt, the claim will cntinue int the DME MAC system fr prcessing. Hwever, the CMN will be remved frm the claim and will nt be cnsidered in prcessing. If a supplier receives a CMN rejectin and they have questins, they must cntact the DME MAC where the CMN was rejected. Nte: Infrmatin cncerning the abve acknwledgements and reprts is included in the 5010A1 CEDI Frnt-End Acknwledgements and Reprts Manual and is available n the CEDI Web site at: CEDI will prvide the fllwing reprts fr each NCPDP versin D.0 claim file submitted: TRN NCPDP Transmissin Respnse Reprt Nte: The CEDI NCPDP Frnt-End Manual is available n the CEDI Web site at 2. What d the X and 277CA transactin acknwledgements lk like? These acknwledgement files will be sent in the X12 frmat and sftware vendrs will be respnsible fr prducing a readable reprt fr their custmers. 3. Where can I get mre infrmatin abut the acknwledgement files and edits? CEDI has psted a 5010A1 CEDI Frnt-End Acknwledgements and Reprts Manual as well as a CEDI 277CA Edit Reference Guide t the CEDI Web site ( under Frnt End Edits & Reprts. Last Revisin: January 22, 2016 P a g e 13 f 24

14 Durable Medical Equipment Cmmn Electrnic Data Interchange (CEDI) Frequently Asked Questins 4. I submit claims thrugh a billing service and I dn t understand my electrnic reprt frm CEDI, wh shuld I call? Trading Partners/Submitters using a third party (e.g. clearinghuse r billing service) t send claims t CEDI shuld wrk directly with their clearinghuse r billing service cncerning the fllwing items: Assistance with an Electrnic Reprt Electrnic reprts are returned t the submitter f the electrnic file (clearinghuse r billing service). As the submitter, the clearinghuse r billing service will cntact the CEDI Help Desk t reslve any issues with the electrnic reprts. Electrnic Remittance Advices (ERA) If the DME MAC supplier elects t have a clearinghuse r billing service retrieve their Electrnic Remittance Advice (ERA), the clearinghuse r billing service will cntact the CEDI Help Desk fr ERA supprt (i.e., t recreate an ERA). When the clearinghuse r billing service is exchanging electrnic transactins n behalf f a DME MAC supplier, the clearinghuse r billing service will cntact the CEDI Help Desk directly fr assistance with the items listed abve. The CEDI Help Desk can be cntacted by calling r via at ngs.cedihelpdesk@anthem.cm. 5. What is the best way t track which acknwledgement transactins are related t the 837 file we sent? CEDI recmmends the use f unique numbering fr several envelping cntrl / reference numbers built int the Versin 5010 claims transitins. Using unique numbering fr the ISA13, ST02, and BHT03 data elements n the inbund 837 Prfessinal claims will allw CEDI Trading Partners t easily match submitted claims with the acknwledgement transactins. Examples f thse pairing include: 837 ISA13 is mapped t the TA1 respnse transactin and lcated in the TA101 data element The implementatin guide fr the TA1 (ASC X12 TA1 TR3) states fr TA101: This is the value in ISA13 frm the interchange t which this TA1 is respnding. 837 ST02 is mapped t the 999 respnse in the 2000.AK202 data element The implementatin guide fr the 999 (ASC X TR3) states fr AK202: Use the value in ST02 frm the transactin set t which this 999 transactin set is respnding. Last Revisin: January 22, 2016 P a g e 14 f 24

15 Durable Medical Equipment Cmmn Electrnic Data Interchange (CEDI) Frequently Asked Questins 837 BHT03 is mapped t the 277CA respnse in the 2200B.TRN02 data element The implementatin guide fr the 277CA (ASC X12 277CA TR3) states fr TRN02: This element cntains the value submitted in the BHT03 data element frm the What des the NCPDP D.0 Transmissin Respnse lk like? The NCPDP D.0 Cmpanin Dcument available n the CEDI Web site under Technical Specificatins has examples f the NCPDP Transmissin Respnse. Hwever, sample files fr dwnlad are nt available. This reprt will be sent in the NCPDP D.0 frmat and sftware vendrs will be respnsible fr prducing a readable reprt fr their custmers. 7. Hw lng will Frnt-End Edit Reprts and ERAs be available at CEDI fr me t retrieve? Frnt-End Edit Reprts and ERAs are available n yur CEDI lgin fr 45 days. 8. When dwnlading the DME MAC Frnt End Reprt frm CEDI, will I be able t determine which Jurisdictin created that reprt? Reprts delivered by CEDI that were created by the DME MAC Jurisdictins begin with RPT in the file name. Trading Partners/Submitters will have t pen the reprt t determine which DME MAC Jurisdictin created it. Nte: CEDI will create a 277CA reprt that will indicate the DME MAC Jurisdictin cntractr cde where the claims were delivered. The DME MAC Cntractr Cdes are: Jurisdictin A Jurisdictin B Jurisdictin C Jurisdictin D Can yu explain the A8:496:85 errr cde? CEDI validates that the supplier s NPI n the claim file is linked t the Trading Partner/Submitter ID under which the claims were submitted. If the NPI is nt linked t the Trading Partner/Submitter ID, the claims will reject at CEDI with the A8:496:85 edit. If the A8:496:85 edit is received, the supplier must cmplete the nline enrllment packet n the CEDI Web site ( befre resending claims. Last Revisin: January 22, 2016 P a g e 15 f 24

16 Durable Medical Equipment Cmmn Electrnic Data Interchange (CEDI) Frequently Asked Questins 10. I am receiving a 999 rejectin indicating a DTP segment, what shuld I check fr? If yu are a supplier, yu will want t cntact yur sftware vendr t verify the cause f the rejectin. Hwever, ne cause fr a 999 rejectin relating t DTP segments is the adjudicatin date (DTP*573) n Medicare Secndary Payer (MSP) claims. The adjudicatin date (DTP*573) n MSP claims can nly be sent at the claim r charge line level, nt bth. Verify that this infrmatin is nly being sent nce. 11. I am receiving a rejectin fr the Rendering Prvider s NPI nt being n the crsswalk, what shuld I d? The Rendering Prvider Lp(s) 2310B r 2420A shuld nt be submitted in Medicare DME claims. The rendering prvider infrmatin is verified in the 5010A1 frmat where it was nt verified in the 4010A1 frmat. Sending this infrmatin can cause a frnt-end rejectin. The NPI f the rendering prvider must be n the DME supplier crsswalk. Since the rendering prvider is typically an individual prvider and nt listed n the DME supplier crsswalk, this can cause a frnt-end rejectin if sent. The rendering prvider infrmatin is a sub-set f the billing prvider infrmatin which is nly used in Medicare Part B claims t indicate the physician that saw the patient. Medicare DME des nt use sub-sets making the rendering prvider infrmatin identical t the billing prvider 12. Which lps require the full 9 digit ZIP Cde t be sent and which allw the 5 digit ZIP Cde? There are frnt end edits fr the ZIP Cdes in the fllwing lps where it must be the 9 digit ZIP Cde (ZIP+4): 2010AA Billing Prvider 2310C Lab/Facility 2420C Lab/Facility The 4-digit extensin cannt be filled with all zers. Address infrmatin can be lked up n if yu d nt knw the 4-digit extensin. The ther lps with a ZIP Cde will allw the 5 digit ZIP. Last Revisin: January 22, 2016 P a g e 16 f 24

17 Durable Medical Equipment Cmmn Electrnic Data Interchange (CEDI) Frequently Asked Questins 13. Can I send my P.O. Bx fr my billing prvider s address? N. The address in the Billing Prvider 2010AA lp must be the physical street address and cannt be a P.O. Bx. 14. What cding is used in the SV101-1 and SV101-2 fields when submitting a Natinal Drug Cde (NDC) that des nt have an assigned HCPCS? The 2400 SV101-1 shuld cntain the value HC and the 2400 SV101-2 shuld cntain the value f S5000 r S5001. The S5000 is used fr generic NDCs and the S5001 is used fr name brand NDCs. The NDC is then reprted in the 2410 LIN segment. 15. I am missing claims n my DME MAC RPT reprt. Claims that receive an errr n the 277 Claims Acknwledgement (277CA) will nt appear n the DME MAC RPT reprt. Please review the 277CA fr all errrs. NCPDP D.0 Claims 1. What is NCPDP? The Natinal Cuncil fr Prescriptin Drug Prgrams (NCPDP) is the frmat used by retail pharmacies t submit DME MAC drug claims electrnically. The NCPDP frmat can nly be used fr drug claims frm retail pharmacies. 2. What reprts can I expect fr NCPDP D.0 claims submitted t CEDI? CEDI will return the fllwing reprts: CEDI TRN Acknwledgement Reprt CEDI NCPDP Transmissin Respnse Nte: The CEDI reprts are returned in real time and are typically delivered t the Trading Partner within 30 minutes. Hwever, the size f the claim files will determine hw lng it takes t prduce the reprts. 3. Where can I get mre infrmatin abut the NCPDP frnt-end edits? NCPDP errr cdes can be fund in the CEDI NCPDP D.0 Frnt End Edits manual lcated n the CEDI Web site at under Frnt End Edits & Reprts. Last Revisin: January 22, 2016 P a g e 17 f 24

18 Durable Medical Equipment Cmmn Electrnic Data Interchange (CEDI) Frequently Asked Questins PECOS 1. Hw can I check t see if my rdering physician is listed in PECOS? CMS has made infrmatin available n their Web site. Select the fllwing link r cpy and paste it int yur web brwser: Select Ordering & Referring Infrmatin n the left-hand side. 2. What is PECOS? PECOS is the Prvider Enrllment, Chain and Ownership System implemented by the Centers fr Medicare & Medicaid Services (CMS) fr Internet-based prvider enrllment. Electrnic Remittance Advice 1. Hw lng will electrnic remittance advice (ERA) files be available at CEDI fr retrieval? ERA files will be available n yur CEDI lgin fr 45 days. ERA files cannt be re-created by CEDI fr DME MAC Trading Partners/Submitters after the 45 day timeframe. T btain a remittance after the 45-day timeframe, the supplier must cntact the apprpriate DME MAC fr the standard paper remittance (SPR). T btain an SPR, cntact the apprpriate DME MAC IVR r Custmer Service/Prvider Cntact Center: Jurisdictin A, NHIC, Crp. Custmer Service: Autmated IVR Phne System: Jurisdictin B, Natinal Gvernment Services, Inc. Prvider Cntact Center: Autmated IVR Phne System: Jurisdictin C, CGS Administratrs, LLC Custmer Service: Autmated IVR Phne System: Jurisdictin D, Nridian Healthcare Slutins, LLC Supplier Cntact Center and IVR: Last Revisin: January 22, 2016 P a g e 18 f 24

19 Durable Medical Equipment Cmmn Electrnic Data Interchange (CEDI) Frequently Asked Questins 2. When dwnlading my Electrnic Remittance Advice (ERA/835) Files frm CEDI, will I be able t determine which Jurisdictin created that ERA? The ERA files delivered by CEDI will have the cntractr cde fr the DME MAC that created the file in the ISA06. The Jurisdictin s cntractr cde will nt be in the file name. The DME MAC Cntractr Cdes are: Jurisdictin A Jurisdictin B Jurisdictin C Jurisdictin D Hw can I reslve Reasn/Remark Cdes indicating Claim service lacks infrmatin which is needed fr adjudicatin and/r Electrnic interchange agreement nt n file fr prvider/submitter. received n my Electrnic Remittance Advice r Standard Paper Remittance? Suppliers wh receive this denial and d nt have their PTAN/NSC number n recrd with CEDI must cmplete an nline enrllment packet which can be accessed thrugh the CEDI Web site under CEDI Enrllment. Claim Status Inquiry and Electrnic Funds Transfer 1. What is the difference between Claims Status Inquiry (CSI) and the 276/277 transactins? CSI is a methd f interfacing directly with the DME MAC s prcessing system t btain status f yur DME claims. CEDI des nt supprt this functin. Cntact yur DME MAC jurisdictin fr mre infrmatin. Anther methd f btaining claim status infrmatin is by use f the HIPAA X12 276/277 electrnic transactins. The 276 request fr claim status and the 277 respnse are exchanged thrugh CEDI althugh the status infrmatin is pulled frm the DME MAC system. Questins regarding the X12 276/277 electrnic claim status transactin shuld be directed t the CEDI Help Desk. Questins regarding the actual status f yur claims shuld be directed t the DME MAC. 2. Wh d I cntact t enrll in Claim Status Inquiry (CSI) r Electrnic Funds Transfer (EFT)? Last Revisin: January 22, 2016 P a g e 19 f 24

20 Durable Medical Equipment Cmmn Electrnic Data Interchange (CEDI) Frequently Asked Questins Fr CSI r EFT enrllment, suppliers must cntact the apprpriate DME MAC Jurisdictin. 3. I have a questin n the infrmatin in the CSI system, where d I call fr supprt? Questins n infrmatin within the CSI system shuld be addressed by the apprpriate DME MAC Jurisdictin. CEDI des nt handle CSI enrllment r supprt issues. 4. If I have cnnectin prblems with CSI, wh d I call? Fr CSI cnnectin issues, suppliers shuld cntact the apprpriate DME MAC Jurisdictin. CEDI des nt handle CSI enrllment r supprt issues. PC-ACE Sftware 1. I use the PC-ACE sftware. What is needed t update my sftware t cmmunicate with CEDI? All Trading Partners must use a Netwrk Service Vendr (NSV) t cnnect t the CEDI Gateway fr exchanging transactins. Mre infrmatin abut getting setup with a NSV can be fund n the CEDI Web site under Telecmmunicatins: Nte: PC-ACE users shuld use the current versin f the sftware lcated n the CEDI Web site at 2. What versin f PC-ACE shuld I be using? The current versin fr PC-ACE can be dwnladed frm the CEDI Web site. The installatin cde t dwnlad PC-ACE will be ed t the address entered n the request frm. T dwnlad PC-ACE, g t If yu are experiencing prblems with dwnlading PC-ACE, cntact the CEDI Help Desk at ngs.cedihelpdesk@anthem.cm. 3. Where can I get a manual fr the PC-ACE sftware? T btain the PC-ACE User Guide, g t the CEDI Web site at and select PC-ACE. The User Guide is lcated under the heading PC-ACE Dcumentatin Technical Dcuments. Als, within the PC-ACE sftware, the F1 key can be used. The F1 key will display the manual that is built int the sftware. Last Revisin: January 22, 2016 P a g e 2 0 f 2 4

21 Durable Medical Equipment Cmmn Electrnic Data Interchange (CEDI) Frequently Asked Questins Supprt 1. What is the respnse time n s sent t the CEDI Help Desk at ngs.cedihelpdesk@anthem.cm? The CEDI Help Desk will respnd t requests within hurs. Sme requests may take lnger depending n the size and/r nature f the request. 2. My crssver claims are nt getting t the secndary payer surce. Has there been an issue frwarding these claims and if s can yu advise? CEDI is nt invlved in claims prcessing, frwarding claims t the Crdinatin f Benefits Cntractr (COBC), r any prcessing dne by the COBC. Issues with crssver and/r Medigap claims shuld be addressed with the DME MACs. The fllwing is the prcess fr the DME MAC and the COBC t determine claims that will g t the secndary payer. The claim is entered int the DME MAC system and begins prcessing. The beneficiary infrmatin is crss referenced against the recrds at the Cmmn Wrking File (CWF). If a match is fund fr the beneficiary with a COBC payer, the claim is marked t g t that payer via the COBC. When the claim finalizes, it is delivered t the COBC by the DME MAC. The COBC then translates the file frm the DME MAC t be delivered t the secndary payer. The secndary payer has criteria fr what claims they want delivered. The claims criteria match ccurs at CWF. Smetimes the COBC perfrms maintenance fr a specific COBA (r secndary payer) ID. They may backdate the effective dates and/r terminatin dates and this will alter the claim selectin criteria. During the time between claim adjudicatin and the receipt f the crssver claim, a file maintenance change results in the COBC denying the crssed claim as nt meeting criteria. If a claim fails t meet thse criteria, it is prduced n a reprt that is sent t the supplier by the DME MAC cntractr. This reprt will state that althugh the claim stated it was sent t the secndary payer, it was nt sent. Claims that pass the criteria are delivered t the secndary payer with the supplier s NPI. Last Revisin: January 22, 2016 P a g e 21 f 24

22 Durable Medical Equipment Cmmn Electrnic Data Interchange (CEDI) Frequently Asked Questins If a supplier s NPI is nt n file with the secndary payer r cannt be successfully matched, the claim will nt be prcessed. 3. When d I cntact CEDI versus the DME MAC fr EDI questins? The CEDI Help Desk is available frm 9:00 a.m. 7:00 p.m. (ET) Mnday thrugh Friday and can be reached via at ngs.cedihelpdesk@anthem.cm r via telephne at The CEDI Help Desk will prvide supprt fr electrnic transactins exchanged with CEDI including claims, reprts, ERAs and 276/277 transactins. The CEDI Help Desk will answer questins and prvide supprt fr the fllwing: CEDI Enrllment Status X Claims NCPDP Claims CEDI Passwrd Resets X Claim Status Request X Electrnic Remittance Advice X Claim Status Respnse Free/Lw Cst Sftware Supprt PC-ACE MREP Verificatin f the receipt f files Supprt fr Electrnic Frmats X Claims NCPDP Claims X Claim Status Request X Electrnic Remittance Advice X Claim Status Respnse Supprt fr CEDI TA1, TRN, 999 and 277CA transactins fr X versin 5010A1 claims (NOTE: Sftware vendrs will be respnsible fr prviding these transactins in readable frmats fr their custmers.) Supprt fr DME MAC Receipt and CMN Reject Reprts (RPT Reprts) Last Revisin: January 22, 2016 P a g e 22 f 24

23 Durable Medical Equipment Cmmn Electrnic Data Interchange (CEDI) Frequently Asked Questins Supprt fr NCPDP D.0 Transmissin Respnse (NOTE: Sftware vendrs will be respnsible fr prviding these transactins in readable frmats fr their custmers.) Testing Supprt fr Vendrs and Trading Partners (Electrnic Submitters) The DME MAC Jurisdictins will cntinue t prvide supprt fr the fllwing: Claim Status Inquiry (CSI) Enrllment r setup status Lgn r User ID Passwrd resets Educatin Electrnic Funds Transfer (EFT) Setup Status Questins regarding payments r banking infrmatin Questins regarding rdering/referring prvider (PECOS) edits Questins regarding CMNs received by CEDI but rejected by the DME MAC as shwn n the RPT file returned t the Trading Partner by CEDI. Status f claims in the Jurisdictin A, B, C and/r D DME MAC prcessing system Questins regarding the adjudicatin f claims Questins regarding ICD-10 cdes and prcessing with ICD-10 cdes Questins regarding the cntent f an Electrnic Remittance Advice Amunt paid n a claim Deductible r c-pays applied Denied claims Requests fr cpies f paper remittance advices Identificatin Numbers fr CEDI Name Definitin Example Submitter ID Unique identifier used by the Trading Partner (Submitter/Sender) assigned by CEDI. A08XXXXXX, B08XXXXXX, C08XXXXXX, D08XXXXXX Last Revisin: January 22, 2016 P a g e 23 f 24

24 Durable Medical Equipment Cmmn Electrnic Data Interchange (CEDI) Frequently Asked Questins Name Definitin Example NPI Natinal Prvider Identifier PTAN/NSC ICN/CCN Unique supplier number assigned by the NSC. Number assigned t claims accepted by CEDI t be used t track claims prcessed by the DME MACs. In the 277CA, the CCN is preceeded by the DME MAC cntractr cde. 10 digits typically ending with 0001, 0002, 0003 r smething similar ICN: CA ICN: DME MAC Jurisdictins Jurisdictin Cmpany States Supprted A B C D NHIC, Crp. Natinal Gvernment Services, Inc. CGS Administratrs, LLC Nridian Healthcare Slutins, LLC Cnnecticut, Delaware, District f Clumbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New Yrk, Pennsylvania, Rhde Island, Vermnt Illinis, Indiana, Kentucky, Michigan, Minnesta, Ohi, Wiscnsin, Alabama, Arkansas, Clrad, Flrida, Gergia, Luisiana, Mississippi, New Mexic, Nrth Carlina, Oklahma, Puert Ric, Suth Carlina, Tennessee, Texas, Virgin Islands, Virginia, West Virginia Alaska, Arizna, Califrnia, Guam, Hawaii, Idah, Iwa, Kansas, Missuri, Mntana, Nebraska, Nevada, Nrth Dakta, Oregn, Suth Dakta, Utah, Washingtn, Wyming, Mariana Islands, American Sama Last Revisin: January 22, 2016 P a g e 24 f 24