J15 EDI Frequently Asked Questions
Updated: 02.28.13
- Q. My DDE password needs to be reset who do I contact?
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A. If you need to have your password reset only, please contact the CGS Security Administration Team at 1-615-660-5444. Please have the following information ready before calling.
- User ID
- First and last name of the user to which that ID is assigned
- PIN number if available
- Error message
- Q. When filling out the Provider On-line Inquiry form do I need to include any User ID I currently use or had been issued previously?
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A. Yes submitting these IDs on the form will assist CGS in determining whether a new user ID would need to be assigned.
- Q. How do I file my notice of election electronically?
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A. NOEs can only be submitted Direct Data Entry (DDE) using the Fiscal Intermediary Standard System (FISS), or via a paper UB-04; they cannot be submitted electronically.
- Q. Will I be able to get Electronic Remittances Advice (ERA) for checks that were issued prior to my setup?
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A. ERA becomes effective the day we complete your setup in our system. You will not be able to access remittances electronically that were issued prior to completion of your setup.
- Q. I am receiving the following Claim Status Code and EIC code on my 277CA. How do I correct this error?
CSC – 500 Entity's Postal/ZIP code
EIC – 77 Service Locations
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A. The service facility location (2310C Claim level ) loop requires a 9 digit zip code.
- Q. I am receiving the following Claim Status Code and EIC Code on my 277CA. What do these codes entail and who do I contact for assistance?
496 – Submitter not approved for electronic claims submissions on behalf of this entity
85 - Billing provider
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A. You are not setup to bill 5010 electronically when you receive this message. You must contact the EDI Help Desk prior to moving to production.
- Q. My claim is rejecting with a 306 message on my 277CA.
306 – Detailed description of service
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A. If the procedure is a non-specific code you must submit a description of the procedure code in SV202-7. Non-specific codes may include in their descriptors terms such as:
Not Otherwise Classified (NOC); Unlisted; Unspecified; Unclassified; Other; Miscellaneous; Prescription Drug, Generic; or Prescription Drug, Brand Name.
- Q. Is there a comprehensive list of 5010 edits?
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A. A current list of all edits can be found on the CMS website. These edits are updated quarterly.
- Q. I sent in a 5010 claim file and I have not received my 277CA.
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A. Your file may have rejected on the 999 Functional Acknowledgment. If your file rejected on the 999 report you will not receive a 277CA. You will need to look at the IK5 and IK9 segments of the 999:
Rejected File: IK5*R*5 (5 = one or more segments in error) IK9*R This transaction will NOT be forwarded for further processing. The errors will need to be corrected and the file resubmitted.
Accepted file: IK5*A IK9*A This transaction will be forwarded for further processing and a 277CA will be generated.
For more information on how to read the 999 please visit our website.
- Q. I received a payer acknowledgement/Acceptance report from my clearinghouse. Does this mean you accepted my claims?
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A. CGS returns back to the submitter in this case the clearinghouse a 999, and if the 999 was accepted a 277CA report. The 277CA report will include ICN/DCN number for accepted claims. Please contact your clearinghouse if you are not receiving these acknowledgement/acceptance reports in a readable format.
- Q. Once I submit a 5010 837 claim file how long should it take to get a 999 and /or 277CA?
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A. This process can take from one hour up to 48 hours.
- Q. How often is the PC -ACE Pro32 software upgraded?
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A. The software is upgraded quarterly. Please visit our website for the latest version. Please note you may only upgrade one version before the current version.
- Q. I am missing an Electronic Remittance Advise (ERA). How do I order a duplicate?
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A. The owner of the submitter ID must make the request. If you go through a clearinghouse that has 1 submitter ID for all their clients the clearinghouse must make the request. ERAs older than 45 days cannot be restored electronically. A paper copy can be obtained through myCGS or the IVR.
- Q. I am receiving the following CSC and EIC Code on my 277CA. How do I make the correction?
CSC- 663- Entity's Group Name
CSC- 732- Information submitted inconsistent with billing guidelines
EIC- Subscriber
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A. The subscriber Group Name (SBR04/2000B) element must be empty. The group number which is element SBR03/2000B must also be empty.
