EDI Frequently Asked Questions
I am getting error message 496 on my 277CA when I switched to 5010. Why am I getting this message as I have been billing in the past and did not receive this error message?
See the information as it appears on your 277CA below.
- First part: Claim Status Category Code = "A8" – Acknowledgement / Rejected for relational field error
- Second part: Claim Status Code = "496" – Submitter not approved for electronic claim submissions on behalf of this entity
- Third part: Entity Identifier Code = "85" – Billing Provider
This message, "A8:496:85," utilizes the Washington Publishing Company (WPC)-maintained National Code values and relays that the claim was rejected for a relationship error between the submitter and the Billing Providers NPI.
Have you requested a move to 5010 production for 837 claims and for 835 electronic remittance notices (ERN) if receiving electronic remits?
Are you linked to a clearinghouse/vendor submitter in our CGS Medicare's system?
In addition to the provider and clearinghouse/vendor linkage issue, the 496 edit can also occur because of the following National Provider Identifier (NPI) billing issues:
- Using a Rendering Provider's NPI instead of the Billing Provider NPI (Rendering Provider is not associated with the clearinghouse/vendor submitter)
- Billing Part B services for a provider associated with a Group under his/her Individual NPI when it should be billed under the Group NPI
My software vendor has completed testing. Do I need to inform you or can I just begin sending 5010 claims?
No you must notify CGS before you begin sending in 5010 production claims.
I am getting error message 306 on my 277CA.
For 5010, if the description of the procedure code includes the following:
Required when SV202-2 is a non-specific Procedure Code.
You are required to complete 2400-SV202-7 with a description on the service rendered.
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. The current list of NOC codes used for 5010 editing can be found at http://www.CMS.gov/ElectronicBillingEDITrans/40_FFSEditing.asp
I have submitted an EDI application to CGS. What is the time frame for this to be completed?
CGS has 20 days to complete an EDI application. You will receive a letter or email from CGS confirming its completion.
How do I sign up for Direct Data Entry?
Providers can access our Web site at http://www.cgsmedicare.com/J15 or contact the EDI Help Desk directly to sign up for Direct Data Entry. From the Web site, select EDI then EDI Enrollment Packet, select J15 EDI Online Inquiry PDF document. To contact J15 EDI Help desk by telephone, you may call 866-590-6703.
Who do I contact if my DDE password needs resetting?
J15 Home Health and Hospice and Part A providers who currently uses a Direct Data Entry (DDE) function to check eligibility, claims status, or enter or modify claims (ELGA, ELGH, FISS, etc.) and you experience any security issues with that access or need to have your password reset, please email the CGS Security Administration Team at CGS.Medicare.OPID@cgsadmin.com. Please include the user ID that is experiencing problems and the first and last name of the user to which that ID is assigned in your email request.
Who does CGS currently contract with as approved 5010 vendors for claims submission?
We have published, and will continue to update, our 5010 Trading Partner List on our Kentucky and Ohio Part A Webpage for your reference.
When do I have to be 5010 compliant?
April 1, 2012 you must be 5010 compliant.
I do not understand the error report I am receiving for my 5010 claims.
Your vendor or clearinghouse should be providing you with a readable report for your claims submitted to Medicare. They should assist you with questions about these reports.
I am missing my 277CA reports from CGS.
If you go through a clearinghouse please check with them for your reports. They may not have distributed them to you yet, or the file may have rejected at the 999 level. We cannot repost a 277CA to a clearinghouse unless the request comes from the clearinghouse. Please have the file number from ISA13 and the time the file was transmitted available when calling.
If you do not go through a clearinghouse please verify that your file did not reject at the 999 level. This could prohibit you getting a 277CA report.
If I am using PC Ace Pro32 Software, can I submit 5010 Test claims?
The PC Ace Pro32 Software is 5010 compliant and it not necessary to test this software. You may test if you wish but it is not required. You will need to notify CGS before you begin sending in 5010 production claims using the PC Ace Pro32 software. CGS will need to update your system access to send 5010 production claims.
What is the password for the PCACE Pro32 software update?
The password is CGS1.
Does CGS support dial-up?
Can there be two separate Medicare EDI Submitter IDs for a provider who uses the same Tax ID for two lines of business, each sent from a separate system?
Yes, this is possible, but please keep in mind GPNet can only handle one receiver of remits.
Can we find out if the outpatient therapy cap has been met through the Direct Data Entry system?
Outpatient therapy cap amounts can be found on Page 1 of both the Health Insurance Query A (HIQA) and the Health Insurance Query for Home Health Agencies (HIQH), both of which are accessible through DDE. The full cap amount is shown for both physical therapy, which also includes speech therapy, and occupational therapy. When Medicare pays for services, these amounts will decrease until the entire cap has been met. See below for an example:
Patient A has not had any outpatient therapy services. HIQA/HIQH will reflect the following information:
PT TBM 1740.00 OT TBM 1740.00
Patient B has received some outpatient therapy. HIQA/HIQH will reflect the following information:
PT TBM 1174.81 OT TBM 1324.45
How do I enter three modifiers in Direct Data Entry (DDE)?
A. There is no room to report the third modifier on Page 2 when keying a claim on DDE. You should key the first two modifiers on Page 2 of DDE as usual. Then PF11 once to get to Page 31. Tab to the modifiers field, and key any additional modifiers. Then PF10 to get back to Page 2 to key the next line of the claim.