The front-end editing process continues to be a successful tool for reducing the number of suspended and unprocessable Medicare claims. We continue to encourage providers to review the Response Report as soon as possible after transmission. Claims that are rejected must be corrected and resubmitted.
We have listed some of the top five rejections for review for our Medicare claims submitters.
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Edit #
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Edit Message
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Edit Logic
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| X33 |
Loop/seg err > LP =@LP#/@SEG HL = @HL# LC= @LC#
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Edit sets when the 2300 segments are not submitted in correct sequence order.
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| X40 |
Loop/seg err > LP =@LP#/@SEG HL=@HL# LC=@LC#
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Edit sets when the 2400 segments are not submitted in correct sequence order |
| VOB |
EMC Enrolllment Required HL=@HL# |
Edit sets when no EDI Enrollment Agreement is on file with EDI Operations. |
| YO3 |
Billing Provider Invalid for Submitter |
Edit sets when the provider has not been approved / enrolled with EDI Operations to submit claims via a specific submitter. |
| Y1K |
Billing Provider SSN or EIN Not on Crosswalk |
Edit sets when 2010AA segment's EIN or SSN is not on the NPI/PIN crosswalk for NPI submitted. |
If you have any questions regarding these or any other front-end edits, please contact your EDI Support Center at the number listed below:
J1 Part B - Palmetto GBA Technology Support Center: (866) 749-4301
Ohio & West Virginia Part B - EDI Technical Support Team: (866) 308-5438
SC Part B - Palmetto GBA Technology Support Center: (866) 749-4301
Railroad Medicare - Railroad Medicare EDI Operations: (866) 749-4301