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

Transcription

1 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 General Infrmatin abut 5010A1/D.0 Electrnic Frnt-End Reprts/Acknwledgements NCPDP D.0 Claims PECOS Electrnic Remittance Advice Claim Status Inquiry and Electrnic Funds Transfer PC-ACE Pr32 Sftware Supprt Identificatin Numbers fr CEDI DME MAC Jurisdictins Enrllment 1. Is there a standardized EDI enrllment frm fr use with CEDI? Yes. CEDI maintains the EDI enrllment frms fr all fur DME MAC Jurisdictins. T enrll with CEDI fr electrnic DME transactin, yu nly need t submit ne instance f the required CEDI frm r frms. CEDI will prcess the frm(s) the same way in all fur Last Revisin: Octber 10, 2014 P a g e 1 f 29

2 DME MAC Jurisdictins. The CEDI enrllment frms are lcated n the CEDI Web site at These frms are submitted electrnically and must be cmpleted and submitted nline. After submitting nline, print the frm(s), sign and date, and then fax all pages t CEDI at Nte: Yu will nly need t submit ne set f frms and CEDI will prcess them fr all fur DME MAC Jurisdictins. 2. 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 either: Cmplete the CEDI Enrllment Agreement Frm t register all PTAN/NSC numbers with CEDI. If yu submit claims thrugh a clearinghuse r third party biller, yu will need t cmplete the Supplier Authrizatin Frm as well as the CEDI Enrllment Agreement Frm. The CEDI Enrllment Agreement Frm and the Supplier Authrizatin Frm can be accessed thrugh the CEDI Web site ( under CEDI Enrllment Frms. Last Revisin: Octber 10, 2014 P a g e 2 f 29

3 - OR - If yu have an existing CEDI Enrllment Agreement Frm n file with CEDI fr yur PTAN/NSC, yu may submit an t cedienrllment@wellpint.cm with the Subject line reading: Reasn/Remark Cde Supplier Nt Authrized fr EDI. Please include the fllwing within yur request: Trading Partner/Submitter ID Trading Partner/Submitter Name Address Cntact Name NPI number The new PTAN/NSC that received the errr. CEDI will add yur PTAN/NSC and ntify yu via when this has been cmpleted. Once yur CEDI enrllment has been cmpleted, yu can resubmit yur claims. 3. Hw d I link my PTAN/NSC number t my NPI? 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 Last Revisin: Octber 10, 2014 P a g e 3 f 29

4 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. 5. 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. 6. I will be submitting my wn claims t CEDI and d nt currently have an electrnic Trading Partner/Submitter ID. What frms d I need t cmplete and submit? Suppliers wh will be exchanging any electrnic transactins (claims, electrnic remittance advice, and/r claims status inquiry/respnse) directly with CEDI must g t the CEDI Web site at and cmplete the fllwing frms: Submitter Actin Request Frm CEDI Enrllment Agreement Frm CEDI ERA Enrllment Frm (if requesting electrnic remittance advice) Enrllment frms must be cmpleted and submitted n-line. After cmpleting the frm(s) nline, yu must print the frm(s), sign and date, and then fax all pages t CEDI at Nte: Yu will nly need t submit ne set f frms and CEDI will prcess them fr all fur DME MAC Jurisdictins. 7. I will be submitting my claims t a third party (e.g. a billing service r clearinghuse) and the third party will be submitting my claims t CEDI. What frms d I need t cmplete? Suppliers wh will be using a third party t exchange any electrnic transactins (claims, electrnic remittance advice, and/r claims status inquiry/respnse), must g t the CEDI Web site at and cmplete the fllwing frms: Supplier Authrizatin Frm Last Revisin: Octber 10, 2014 P a g e 4 f 29

5 CEDI Enrllment Agreement Frm CEDI ERA Enrllment Frm (if requesting electrnic remittance advice) Enrllment frms must be cmpleted and submitted n-line. After cmpleting the frm(s) nline, yu must print the frm(s), sign and date, and then fax all pages t CEDI at Nte: Yu will nly need t submit ne set f frms and CEDI will prcess them fr all fur DME MAC Jurisdictins. 8. I am a third party (e.g., a billing service r clearinghuse) and need t be setup with CEDI. What frms d I need t cmplete? Third party billers (billing services and/r clearinghuses) wh will be exchanging any electrnic transactins (claims, electrnic remittance advice, and/r claims status inquiry/respnse), must g t the CEDI Web site at and cmplete the fllwing frm: Submitter Actin Request Frm Frm(s) must be cmpleted and submitted nline. After cmpleting the frm(s) nline, yu must print the frm(s), sign and date, and then fax all pages t CEDI at Nte: Yu will nly need t submit ne set f frms and CEDI will prcess them fr all fur DME MAC Jurisdictins. 9. I cmpleted CEDI enrllment frms n-line. D I have t als fax them t CEDI? Yes. Once yu cmplete and submit the CEDI enrllment frm(s) nline, the cmpleted frm(s) will appear n yur cmputer screen in an HTML frmat. Yu must print the frm(s), sign and date, and fax all pages t CEDI at Please retain a cpy fr yur recrds. 10. D I have t use the n-line CEDI Enrllment frms r can I use a frm I used previusly? Only the n-line frms 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. Last Revisin: Octber 10, 2014 P a g e 5 f 29

6 11. My enrllment frms were rejected. Why? CEDI Enrllment has guidelines t which yur cmpleted enrllment frms must cnfrm. The tp reasns why we return paperwrk are: The NPI(s), PTAN(s) and/r Trading Partner ID(s) are missing r invalid The entire hard cpy f the CEDI Enrllment Agreement Frm was nt received The supplier s name and address n the frm d nt match the recrds at the Natinal Supplier Clearinghuse The signee is nt authrized t sign n behalf f the supplier The supplier s authrized signature(s) is missing The NPI r PTAN/NSC is nt registered thrugh NPPES Web site and is nt n the NPI crsswalk The hard cpy fax was nt received by CEDI Enrllment within 10 days f submissin f the nline applicatin The Supplier Authrizatin Frm is required There is nt a CEDI Enrllment Agreement Frm n file fr the supplier s NPI and PTAN/NSC entered n the Supplier Authrizatin Frm. The Submitter Actin Request Frm was nt submitted t request a NEW Submitter ID. Review the Hw t Avid Cmmn CEDI Enrllment Errrs n the CEDI Web site ( under Enrllment Infrmatin fr mre infrmatin n hw t reslve these issues. T ensure that paperwrk des nt get returned, review it carefully befre faxing it t the CEDI Enrllment department. If frms are returned, all enrllment frms riginally submitted must be re-entered electrnically thrugh the CEDI Web site prir t being faxed back t the CEDI Enrllment Department. Resubmit all enrllment frms required t cmplete the request, nt just the frm(s) cntaining the errr. Nte: All enrllment frms must be signed, dated by the prvider, and faxed t enrllment within 10 business days. 12. 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 apprpriate enrllment frms nline and fax them t the CEDI Enrllment Department t cmplete the requests. The frms can be fund n the CEDI Web site at under CEDI Enrllment Frms. Last Revisin: Octber 10, 2014 P a g e 6 f 29

7 13. 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@wellpint.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 and cmplete and submit the Submitter Actin Request Frm t reapply fr a new Trading Partner/Submitter ID r t have yur previus Trading Partner/Submitter ID reinstated. 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, a billing service r a clearinghuse. Suppliers wh use a third party (billing service r clearinghuse) t exchange transactins will nt cmplete the recertificatin frm. 3. Hw d I recertify? The 2014 Recertificatin Prcess began July 1, Trading Partners will need t cmplete the 2014 CEDI Recertificatin Frm lcated n the CEDI Web site at 4. I just cmpleted my 2013 CEDI Recertificatin; d I need t cmplete the frm again fr 2014? Yes. All Trading Partners must cmplete the 2014 CEDI Recertificatin Frm regardless f when they cmpleted the 2013 frm t maintain the Trading Partner ID. 5. D I need t fax r the 2014 CEDI Recertificatin Frm? Last Revisin: Octber 10, 2014 P a g e 7 f 29

8 N. The 2014 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. 6. What is the deadline t submit the 2014 CEDI Recertificatin Frm? Frms must be submitted by December 31, What will happen if I dn t submit the 2014 CEDI Recertificatin Frm? Any Trading Partners wh have nt submitted their 2014 CEDI Recertificatin Frm by December 31, 2014 will have their access t CEDI suspended n January 2, Testing Prcess 1. Wh must test with CEDI, the electrnic Trading Partner/Submitter r the sftware vendr? 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@wellpint.cm. Please include in the the name f the sftware, a cntact name, phne number, fax number, and 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 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. Last Revisin: Octber 10, 2014 P a g e 8 f 29

9 4. I am a sftware vendr r in-huse prgrammer, where can I get infrmatin n the CEDI cmmunicatins? Natinal Gvernment Services CEDI requires the use f a Netwrk Service Vendr fr cnnectivity t the CEDI Gateway t exchange electrnic transactins. Netwrk Service Vendrs 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 under Resurces. 6. Where can I receive a cpy f the 5010 frmat 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 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 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 Pr32 will I need t cmplete any testing? N, the CEDI sftware PC-ACE Pr32 has already been tested by the develpers and CEDI. Be sure yu are using the current versin f the PC-ACE Pr32 sftware by checking the CEDI Web site ( fr upgrades. Last Revisin: Octber 10, 2014 P a g e 9 f 29

10 ICD-10 Implementatin 1. Will I be able t test ICD-10? Yes. CEDI will ffer bth acknwledgment testing as well as limited end t end testing. Acknwledgment testing thrugh the CEDI frnt end edits will ccur during the weeks f Nvember 17-21, 2014, March 2-6, 2015, and June 1-5, This testing week will give submitters access t real-time help desk supprt and allws CMS t analyze testing data. Test claims with ICD-10 diagnsis cdes must be submitted with current dates f service since testing will nt supprt future dated claims. Test claims will receive the TRN, 999 and 277CA acknwledgements as apprpriate, t cnfirm if the claim wuld be accepted r rejected in the system. Testing will nt cnfirm claim payment r prduce remittance advice. Registratin will nt be required fr the Acknwledgement Testing Week. CEDI Trading Partners, Sftware Vendrs and In-Huse prgrammers will have the pprtunity t participate in limited end t end testing. Details regarding this testing will be prvided via CEDI listservs and n the CEDI Web site. Registratin will be required fr this testing. Questins regarding ICD-10 acknwledgement and end t end testing shuld be sent t the CEDI Help Desk at ngs.cedihelpdesk@wellpint.cm. 2. 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. 3. What qualifier d I use fr ICD-10 diagnsis cdes? 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. 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. Last Revisin: Octber 10, 2014 P a g e 10 f 29

11 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. 4. 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. Patients with claims requiring an ICD-9 cde and claims requiring an ICD-10 cde will need t be sent as separate claims. Cmmunicatins 1. What cmmunicatins methds can I use t cnnect t CEDI? Natinal Gvernment Services CEDI requires the use f a Netwrk Service Vendr fr cnnectivity t the CEDI Gateway t exchange electrnic transactins. Netwrk Service Vendrs prvide fast and reliable cnnectins in a secure envirnment. Mre infrmatin is available n the CEDI Web site ( under Telecmmunicatins. 2. 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. 3. 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@wellpint.cm The subject must be: CEDI Request fr Zipped Files Include the fllwing infrmatin Trading Partner/Submitter ID Trading Partner/Submitter Name Cntact Name Cntact Phne Number Last Revisin: Octber 10, 2014 P a g e 11 f 29

12 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@wellpint.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. Passwrd must cntain a special character; fr #, $ 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. The ID histry retains the last nine passwrds the user has chsen. These cannt be reused. Passwrds must nt be stred in scripts, files, r applicatins unless cmpensating cntrls are in place Passwrds are nly gd fr 60 days, at which time the user will be required t change their passwrd. Last Revisin: Octber 10, 2014 P a g e 12 f 29

13 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 cmplete the apprpriate frms n the CEDI Web site ( t advise ur CEDI Enrllment team 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? 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 Last Revisin: Octber 10, 2014 P a g e 13 f 29

14 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. 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. Last Revisin: Octber 10, 2014 P a g e 14 f 29

15 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). General Infrmatin abut 5010A1/D.0 1. What types f claims can be sent using the NCPDP versin D.0? Only retail pharmacy drug claims can be submitted using the NCPDP frmat. All ther DME supply claims must be transmitted using the ASC X12 versin. 2. What are the currently supprted HIPAA versins? The HIPAA transactins and versins currently supprted by CEDI are: Transactins Versin 837 Health Care Claim: Prfessinal X222A1 835 Health Care Claim Payment/Advice X221A1 276/277 Status Inquiry and Respnse X Implementatin Acknwledgment Fr Health Care Insurance 277CA Claim Acknwledgement X231A X214 Last Revisin: Octber 10, 2014 P a g e 15 f 29

16 Natinal Cuncil fr Prescriptin Drug D.0 April 2009 Prgrams (NCPDP) Versin D.0 f the Telecm Standard 3. Will the 5010A1 frmat allw claims t be billed using the ICD-10 cde set? The implementatin f versin 5010A1 was necessary t accmmdate the expansin fr ICD-10 since it allws fr the ICD-10 cdes where 4010A1 did nt. 4. Are the ICD-10 cdes available fr billing? N. Fr mre infrmatin cncerning the implementatin f ICD-10, please view 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) 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. Last Revisin: Octber 10, 2014 P a g e 16 f 29

17 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 999 NCPDP Frnt-End Edit 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? Examples f these transactins are available n the CEDI Web site. They can be accessed at the fllwing link; under 5010 Acknwledgements. This reprt will be sent in the 5010A1 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 Reprt Dcumentatin. 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). Last Revisin: Octber 10, 2014 P a g e 17 f 29

18 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@wellpint.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. 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 d the NCPDP D.0 Transmissin Respnse transactin lk like? The NCPDP D.0 Cmpanin Dcument available n the CEDI website ( has examples f the NCPDP Transmissin Respnse transactin. 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. Last Revisin: Octber 10, 2014 P a g e 18 f 29

19 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 and sign the apprpriate frm n the CEDI Web site ( and return t CEDI fr prcessing. Suppliers using a third party (e.g., a clearinghuse r billing service) must cmplete the Supplier Authrizatin Frm. Nte: The Supplier Authrizatin Frm cannt be signed by a third party. This frm MUST be signed by the supplier. The CEDI Enrllment Agreement Frm and CEDI ERA Enrllment Frm may be required. 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. Last Revisin: Octber 10, 2014 P a g e 19 f 29

20 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. 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. Last Revisin: Octber 10, 2014 P a g e 20 f 29

21 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 Level Syntax Edit Reprt CEDI NCPDP Transmissin Respnse Reprt 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 Reprt Dcumentatin. PECOS 1. Hw can I check t see if my rdering physician is listed in PECOS? CMS has made available a file that cntains the Natinal Prvider Identifier (NPI) and the name (last name, first name) f all physicians and nn-physician practitiners wh are f a type/specialty that is eligible t rder and refer in the Medicare prgram and wh have current enrllment recrds in Medicare (i.e., they have enrllment recrds in PECOS that cntain an NPI). This file is dwnladable frm the Medicare prvider/supplier enrllment Web site Last Revisin: Octber 10, 2014 P a g e 21 f 29

22 Click n Ordering & Referring Infrmatin n the left-hand side Scrll t the bttm f the page and select Medicare Ordering and Referring File Nte: This.pdf file cntains apprximately 800,000 recrds. Due t the large size f this PDF file CEDI suggests yu right click and select Save as befre attempting t pen this file. 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 DME MAC supplier must cntact the apprpriate DME MAC fr the standard paper remittance (SPR). T btain a 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: Octber 10, 2014 P a g e 22 f 29

23 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 that receive this denial and d nt have their PTAN/NSC number n recrd with CEDI must either: If yu submit claims directly t CEDI and d nt use a third party (e.g. clearinghuse r billing service), cmplete the CEDI Enrllment Agreement Frm t register all PTAN/NSC numbers with CEDI. If yu submit claims thrugh a third party (e.g. clearinghuse r billing service), yu will need t cmplete the Supplier Authrizatin Frm as well as the CEDI Enrllment Agreement Frm. The CEDI Enrllment Agreement Frm and the Supplier Authrizatin Frm can be accessed thrugh the CEDI Web site under CEDI Enrllment Frms. OR If yu have an existing CEDI Enrllment Agreement Frm n file with CEDI fr yur NPI, yu may submit an t cedienrllment@wellpint.cm with the Subject line reading: Reasn/ Remark Cde Supplier Nt Authrized fr EDI. Please include the fllwing within yur request: Trading Partner/Submitter ID Trading Partner/Submitter Name Last Revisin: Octber 10, 2014 P a g e 23 f 29

24 Address Cntact Name NPI number The new PTAN/NSC that received the errr. CEDI will add yur PTAN/NSC and ntify yu via when it is cmplete. Once the CEDI enrllment has been cmpleted, the claims that received the errr may be resubmitted. Claim Status Inquiry and Electrnic Funds Transfer 1. Wh d I cntact t enrll in Claim Status Inquiry (CSI) r Electrnic Funds Transfer (EFT)? Fr CSI r EFT enrllment, suppliers must cntact the apprpriate DME MAC Jurisdictin. 2. 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. 3. 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 Pr32 Sftware 1. I use the PC-ACE Pr32 sftware. What is needed t update my sftware t cmmunicate with CEDI? All new 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 Pr32 users shuld use the current versin f the sftware lcated n the CEDI Web site at Last Revisin: Octber 10, 2014 P a g e 24 f 29

25 2. What versin f PC-ACE Pr32 shuld I be using? The current versin fr PC-ACE Pr32 can be dwnladed frm the CEDI Web site. The installatin cde t dwnlad PC-ACE Pr32 will be ed t the address entered n the request frm. T dwnlad PC-ACE Pr32, g t If yu are experiencing prblems with dwnlading PC-ACE Pr32, cntact the CEDI Help Desk at ngs.cedihelpdesk@wellpint.cm. 3. Where can I get a manual fr the PC-ACE Pr32 sftware? T btain the PC-ACE Pr32 User Guide, g t the CEDI Web site at and select PC-ACE Pr32. The User Guide is lcated under the heading PC-ACE Pr32 Dcumentatin Technical Dcuments. Als, within the PC-ACE Pr32 sftware, the F1 key can be used. The F1 key will display the manual that is built int the sftware. Supprt 1. What is the respnse time n s sent t the CEDI Help Desk at ngs.cedihelpdesk@wellpint.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). Last Revisin: Octber 10, 2014 P a g e 25 f 29

26 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. 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@wellpint.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 Last Revisin: Octber 10, 2014 P a g e 26 f 29

27 Free/Lw Cst Sftware Supprt PC-ACE Pr32 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) Supprt fr NCPDP D.0 Transmissin Respnse Reprt (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 Last Revisin: Octber 10, 2014 P a g e 27 f 29

28 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 NPI Natinal Prvider Identifier PTAN/NSC ICN/CCN Unique supplier NSC. number assigned by the Number assigned t claims accepted by CEDI t be used t track claims prcessed by the DME MACs. 10 digits typically ending with 0001, 0002, 0003 r smething similar DME MAC Jurisdictins Jurisdictin Cmpany States Supprted A B NHIC, Crp. Natinal Gvernment Services, Inc. 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, C CGS Administratrs, LLC Alabama, Arkansas, Clrad, Flrida, Gergia, Luisiana, Mississippi, New Last Revisin: Octber 10, 2014 P a g e 28 f 29

29 Jurisdictin Cmpany States Supprted Mexic, Nrth Carlina, Oklahma, Puert Ric, Suth Carlina, Tennessee, Texas, Virgin Islands, Virginia, West Virginia D Nridian Healthcare Slutins, LLC 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: Octber 10, 2014 P a g e 29 f 29