Smart Edits Listing and 277CA Enhancement

Published 06/07/2024

Palmetto GBA has 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 of 277CA Smart Edits Listing (PDF): 

 Line Number  Smart Edits #  Smart Edits Message Smart Edits Description
 #  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. 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 (PDF). If you are currently using a clearinghouse or billing service to submit your claims, please share this information with them.

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