Region D DAC Combined Meeting

Region D DAC Combined Meeting

CEDI Update 01.18.12

Region D DAC Combined Meeting

With the January release, the DME MACs are performing the PECOS edits and will return the remittance advice code N544 if the ordering or referring provider submitted on the claim is not found in the PECOS file. This code is a warning and the claims will not be denied by the DME MACs. The verbiage for the remittance advice code is:

Alert: Although this was paid, you have billed with a referring/ordering provider that does not match our system record. Unless, corrected, this will not be paid in the future.

The DME MAC edits will apply to both 4010A1 and 5010A1 formatted claims. The CEDI warning edits were only in place for 4010A1 claims. Because the DME MACs are now performing the PECOS edits and returning the warnings (and later the denials), CEDI will be turning off our warning edits on Sunday 1/29/12.

Any questions regarding the CEDI front end edits should be directed to the CEDI Help Desk.

Any questions regarding the DME MAC remittance advice code N544 should be directed to the DME MAC that processed the claim and produced the remittance advice.

For the transition to the 5010 and D.0 formats, CEDI is seeing over 80% of our claims in January coming in as 5010A1 or D.0. We continue to do outreach to our vendors and our PCAce Trading Partners. As a reminder, only vendors and in-house programmers are required to test with CEDI. Once they have passed testing, they can have their customers submit the migration form to begin using the 5010 and D.0 formats. Vendors who have not passed testing with CEDI are required to submit a transition plan – Trading Partners are not required to submit a transition plan. CEDI has a link on our website under “5010 and D.0 Implementation Information” at the top of the page for vendors to submit their transition plan.

The CEDI Help Desk has seen an increase in 5010A1 claim rejections and calls due to the rendering provider information being submitted on DME claims. The rendering provider information is not used by Medicare to process DME claims and is not forwarded by Medicare to secondary payers for use in processing.

The rendering provider information will be verified in the 5010A1 format where it was not being verified in the 4010A1 format. Sending this information can cause a front-end rejection.

The CEDI Help Desk recommends not sending the Rendering Provider Loop(s) 2310B or 2420A in the Medicare DME claims to avoid unnecessary front-end rejections. CEDI only requires NPIs in the Billing Provider Loop 2010AA and the Ordering Provider Loop 2420E.

CEDI has sent out a listserv today and is reaching out to the Trading Partners who are receiving a high volume of these rejections.

CEDI will be installing an upgrade to our front end gateway and translator software early this year. Please be watching for listservs with more details.

Stacy McDonald

CEDI Program Manager

National Government Services, Inc.