Medicare Monthly Review Details

Fourth Quarter Top Ten Part A EDI Edits 2021

National Government Services EDI has identified the following top ten CEM edits that were received during the fourth quarter of 2021 on the 277CA (Claims Acknowledgement) report for 837I 5010A1 formatted claims. The edit, its description, the edit logic and the Technical Report Type 3 (837I Implementation Guide) edit reference are provided below.

Edit Status Information Segment Description How to Correct/Avoid
X999.DUPE

Logic



 
N/A

Rejected due to duplicate ST/SE.
 
ST/SE cannot be a duplicate submission.

X223.090.2010AA.REF02.050

Logic
 

A8:562:128:85

Billing Provider Secondary Reference ID must be associated with the Billing Provider Reference ID number.

2010AA.REF must be "associated" with the provider identified in 2010AA.NM109.
​​​​​

The tax ID must be the tax ID submitted on the 855 form when enrolling the provider with Medicare.

X223.109.200B.SBR09.010

Logic 
 

 

A7:732:480:PR

Claim Filing Indicator Code must be Medicare Part A (MA). 

The Contractor Code must match SBR09.

X223.084.2010AA.NM109.050

Logic

A8:496:85

Billing providers NPI is not associated with the submitter ID number. The Trading Partner/Submitter ID is not authorized to submit claims for the provider.

2010AA.NM109 billing provider must be “associated” to the submitter (from a trading partner management perspective) in 1000A.NM109.

The provider must be enrolled with EDI for claims submission by this submitter.

X223.424.2400.SV202- 7.025

Logic

A8:306

Procedure Code sent requires a description/additional information. This description field is different than the general narrative (NTE) field.

Please add the description for the Procedure Code.

X223.354.2320.SBR09.020

Logic
A7:480:PR

Other subscriber claim filing indicator code must not be Medicare Part A (MA) for Medicare Part B (MB).
 
2320.SBR09 must not be = "MA" or "MB"
X223.112.2010BA.NM109.020

Logic

A7:164:IL

Invalid subscriber ID MBI must be valid format of 11 positions with CA AN N A AN N A A N N where C is a constrained numeric 1-9 A is alpha character A-Z excluding S L O I B Z N is numeric 0-9 AN represent A or N.

2010BA.NM109 must be 7‒12 positions in the format of:
ANNNNNN               AANNNNNN
AAANNNNNN          NNNNNNNNNA
ANNNNNNNNN       AANNNNNNNNN
NNNNNNNNNAA    NNNNNNNNNAN
or AAANNNNNNNNN
where A represents an alpha character and N represents a numeric digit.

If MBI: 2010BA.NM109 must be 11 positions in the format of C A AN N A AN N A A N N where C represents a constrained numeric 1 through 9, A represents alphabetic character A‒Z but excluding S, L, O, I, B, Z, N represents numeric 0 through 9 and AN represents either A or N.

Verify that the HIC or MBI billed is valid as it appears on the beneficiary’s Medicare ID card.

X223.112.2010BA.NM109.040

Logic

A7:164:IL

If Serv Loc Fac Code is not = 11X 32X or 41X. Or Claim Freq Type is not = 7 8 or Q Subscriber ID must be valid HICN or MBI based on submission date.

If the HIC/MBI format is valid and 2300 CLM05-1 is not = 11X, 32X or 41X OR 2300 CLM05-3 is not = 7, 8 or Q, then 2010BA.NM109 must be a valid HICN prior to the MBI transition start date, must be a valid HICN or valid MBI on or after the MBI transition start date, must be a valid MBI after the MBI transition end date based on the date in the +RC DTP segment.

Verify that you are submitting an MBI.

X223.143.2300.CLM05-1.020

A7:228

Facility Type Code must be a valid Uniform Bill Type Code.

Facility Type Code must be the 1st and 2nd positions of a valid Uniform Bill Type Code.

X223.423.2400.LX01.030

Logic

 

A3:121

​​​​​​​Service Line must be > 0 and <=449.
Do not submit more than 449 service lines on a claim.

For more information regarding the 5010A1 Front-end edits, please contact the EDI Help Desk by email by using the E-mail Inquiry Form.