Smart Edits Listing and 277CA Enhancement

Palmetto GBA is excited to announce we have successfully implemented all enhancements to the 277CA report, as part of Smart Edits. Smart Edits is a process that returns pre-adjudicated claims information through claim acknowledgement transaction reports based on the Medicare 277CA. This system populates the STC*12 segment in the 2220D loop of the 277CA.

Example Smart Edit:

 Line Number  Smart Edits #  Smart Edits Message  Smart Edits Description
 24.  CPT Procedure code XXXXX is invalid. (CPT) Invalid Procedure Code
The CPT System Rule identifies claim lines that do not contain a valid procedure code. A valid procedure code is one that is present in the system and is effective.

 
All direct submitters will receive the Medicare 277CA report with these new Smart edits. A list of the Smart Edits appears in the link below. Claims rejecting the pre-adjudication editing process are not forwarded to the claims adjudication system. If you choose not to correct the claim, then just resubmit the claim for processing.

Other examples of how the segment will appear can be found in our current GPNet Communications Manual (see link below). If you are currently using a clearinghouse or billing service to submit your claims, please share this information with them.

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