J15 EDI Frequently Asked Questions
- Q. My DDE password needs to be reset who do I contact?
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?
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?
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?
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
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
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
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?
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.
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?
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?
A. This process can take from one hour up to 48 hours.
- Q. How often is the PC -ACE Pro32 software upgraded?
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?
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
A. The subscriber Group Name (SBR04/2000B) element must be empty. The group number which is element SBR03/2000B must also be empty.