Frequently Asked Questions
- What is the NGS-ACE System Edit Module?
Answer: The NGS-ACE System Edit Module is a front-end edit that applies when an issue with a claim is identified.
- What type of claims and which providers do the NGS-ACE edits apply to?
Answer: NGS-ACE edits apply to all Part B claims in Jurisdiction 6 (Illinois, Minnesota and Wisconsin), for all direct submitters, as well as those who transmit claims via clearinghouses/billing services.
- Why is NGS implementing NGS-ACE edits?
Answer: NGS is implementing NGS-ACE edits as a result of identifying that claims are submitted with information that cause denial or rejection once processed through the MCS, our Medicare Part B claims processing system.
- How do NGS-ACE edits affect me?
Answer: NGS-ACE edits inform the provider/submitter up front that there is a potential issue with the claim submission. NGS defines these as smart edits, as they use plain language to detail the identified issue and offer resources to educate the provider/submitter so they may resubmit the claim before it processes through the MCS system.
If you choose not to change any information on the claim, you may resubmit in the original format and the claim will pass to the claims adjudication system for processing.
NGS-ACE is incorporated in your normal EDI stream, there are no additional downloads or software required.
- How will I know if an NGS-ACE edit applied to a claim?
Answer: NGS-ACE edits are identified on the 277CA transaction that you currently receive.
- Please explain the 277CA.
Answer: The 277CA is a report created by NGS after a claim file is received electronically.
The 277CA provides claim-level acknowledgement of all claims received in the EDI processing system allowing you to see any errors in the file that should be corrected and resubmitted.
- A 277CA will acknowledge all accepted or rejected claims in the file.
- Claims with identified errors are not forwarded to the MCS system.
- A 277CA for an accepted claim will contain the claim number (ICN).
- Use the ICN for future claim status inquiries. Use returned claim numbers for future claim status inquiries.
- The 277CA return time varies, depending on the volume of files submitted.
- The 277CA is created after your claim file generates the 999.
- If the 999 rejected, a 277CA will not be generated.
- The 277CA is available for you to retrieve for 45 calendar days only.
If you submit via clearinghouse/billing service, the 277CA is sent directly to them. It’s important to communicate with them to be sure you are set up to receive the 277CA.
Note: This report is available for test file transmissions, however, the accepted claims will not be forwarded for processing.
- Can you provide an example of a NGS-ACE smart edit?
Answer: Smart Edits Number: mAS
Message: Medicare statutory payment restriction for assistants at surgery applies to the procedure XXXXX.
Description: (mAS) Medicare No Payment for Assistant Surgeons
The mAS edit identifies claim lines that contain an assistant surgeon modifier and a procedure that Medicare typically does not allow reimbursement for surgical assistants.
Resources: To learn more about billing for Co-Surgery/Team Surgery/Assistant Surgery Modifiers, please visit Co-Surgery/Team Surgery/Assistant Surgery Modifiers.
- Who do I contact if I have questions regarding an NGS-ACE edit I received?
Answer: If you have questions related to a NGS-ACE edit that was received on your 277CA report, contact your clearinghouse/billing service. NGS provides a comprehensive list of NGS-ACE edits on the EDI Solutions web page for your reference.
Note: NGS-ACE edits are EDI front-end edits that do not process through the MCS, therefore, our PCC is not able to access or assist with related questions.
- What is the time frame you have to make the correction and resubmit claims that are rejected with one of these front end edits?
Answer: You will want to be sure the claim is resubmitted within the Timely Filing limit.
- Will NGS auto accept a claim that was rejected on the front end after a certain amount of time?
Answer: No, NGS will not auto accept a claim; it is the responsibility of the provider to get the claim resubmitted.
- Are these claim edits in real-time?
Answer: The 277CA is created after your claim file generates the 999; if the 999 rejected a 277CA will not be generated. The CMS requirement is to return the 277CA within 24 hours, however typically the 277CA is returned within two hours after receiving the 837 claim file. The NGS-ACE Claim Editing module is a batch process.
Note: The 999 report is used to confirm that a file was received and may advise the files were Accepted (A), Rejected (R) or Accepted with errors (E)
- If a claim is submitted with multiple line items will just the line item that incurs the ACE edit be returned and the rest of the lines move forward into MCS for processing?
Answer: No, the entire claim will be rejected. The 277CA (Claim Acknowledgement transaction) will include the specific lines that cause the rejection indicating the claim is rejected. A value in the 277CA, STC12 element will indicate an ACE edit.