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October 2019 EDI Front-End Quarterly Release: New and Modified Edits

Please note that there are no new, modified, or deleted edits changes for Part B within the October 2019 Release. The Part A edit changes are listed below: 

Part A Edit Changes

Edit Reference Number
Change
Reason for Change Trading Partner/Results
X223.284.2300.HI01-2.030

If Code List Qualifier code is "BE" the Value codes within this Value Code Information segment must not contain the values 17-20, 62 - 65, 70 - 79 or Q0 - Q9, or QA - QZ.
Revised 277C edit Updates to edit logic to include Payer User Only Value Codes identified in CR 10966.    277CA Received with:

CSCC A7:
"Acknowledgement /Rejected for Invalid Information…"

CSC 725: "NUBC Value Code(s)"
X223.294.2300.HI01-2.030

If Code List Qualifier code is "BG" the Condition codes within this  this Condition Code Information segment must not contain the values 12-16, 60 -65, 98, EY, M0-MZ or UU.
Revised 277C edit
Updates to edit logic to include Payer User Only Condition Codes identified in CR 10966.   
277CA Received with:

CSCC A7:
"Acknowledgement /Rejected for Invalid Information…"

CSC 460: "NUBC Condition Code(s)
X223.384.2330B.NM109.030

Each iteration of Other Payer Name Primary Identifier must be unique for Medicare tertiary claims.
New 277C edit
When submitting a Medicare tertiary claim, the payer identifiers submitted in the Other Payer Name must be unique to support the claim balancing edit logic.
277CA Received with:

CSCC A7:
"Acknowledgement /Rejected for Invalid Information…"

CSC 732: "Information submitted inconsistent with billing guidelines."

CSC 479: “Other Carrier payer ID is missing or invalid”

Additional CRs

Please be advised that while the CMS-mandated quarterly release for October 2019 will be installed the weekend of 10/6/2019, the code set updates included with this release will not be effective in the EDI front-end processing system until Wednesday, 10/9/2019. EDI claims sent prior to 10/9/2019 that include any of the new or updated codes will reject in the EDI front-end.

Title and Description Purpose Trading Partner Impact
CR11252

Subject: RARC, CARC, MREP and PC Print Update MLN Matters Article: MM11252
This CR instructs Medicare system maintainers to update MREP and PC Print with the CARC and RARC updates as posted on the WPC website on or about 7/1/2019. Trading Partners should review the MedLearn Matters  article for this CR so that they are aware of the modifications that have been made to MREP and PC Print software to reflect the 7/1/2019 CARC and RARC changes.

There is a new MREP Codes.ini file, which will be available for download from the CMS website. There is a new version of PC Print V7.1.1, which may be downloaded from our website under the Claims & Appeals tab > Electronic Data Interchange > Electronic Data Interchange Software link.
CR11321

Subject: Implement Operating Rules - Phase III ERA EFT: CORE 360 Uniform Use of CARC and RARC Rule - Update from CAQH MLN Matters Article: MM11321
This CR instructs the contractors and Shared System Maintainers (SSMs) to update systems based on the CORE 360 Uniform Use of CARC and RARC Rule publication. These system updates are based on the CORE Code Combination List to be published on or about 6/4/2019. The codes and associated messages are updated updated to in the updated versions of MREP and PC Print software.
Trading Partners should review the MedLearn Matters  article for this CR  so they are aware of the Business Scenario combinations and RARC/CARC updates to the PC PRINT and MREP software.

There is a new MREP Codes.ini file, which will be available for download from the CMS website. There is a new version of PC Print V7.1.1, which may be downloaded from our website under the Claims & Appeals tab > Electronic Data Interchange > Electronic Data Interchange Software link.

Posted 9/6/2019


Last Modified: 9/6/19
October 2019 EDI Front-End Quarterly Release: New and Modified Edits
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