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Part A FAQs – EDI

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  1. My DDE password needs to be reset; whom should I contact?

    • If you need to have your DDE User ID password reset, please contact the CGS Security Administration Team at 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
      Provider Transaction Access Number (PTAN), if available
      Error message

      Note: Be sure to change your password every 29 days to avoid having to have it reset.

      Reviewed: 9/12/2019
  2. When completing the Provider On-line Inquiry form, do I need to include my current User ID or any previous User IDs I have had?

    • Yes. Submitting this information on the form will assist CGS in determining whether we need to assign you a new user ID.

      Reviewed: 9/12/2019
  3. Will I be able to obtain Electronic Remittance Advices (ERAs) for checks that were issued prior to my setup?

    • 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. Remits issued prior to the set up date may be available through myCGS or the CGS Part A IVR.

      Reviewed: 9/12/2019
  4. 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

    • Ensure that you are using a valid 9-digit ZIP code for the service facility location (2310E Claim level).

      Reviewed: 9/12/2019
  5. I am receiving the following Claim Status Code and EIC Code on my 277CA. What do these codes mean?

    496 – Submitter not approved for electronic claims submissions on behalf of this entity
    85 - Billing provider

    • These messages indicate that you are not set up to bill electronically in the ANIS 5010 format. Please contact the EDI Help Desk prior to moving to production (866.590.6703, option 2).

      Reviewed: 9/12/2019
  6. My claim is rejecting with a 306 message on my 277CA report. What corrections do I need to make to my claim?

    306 – Detailed description of service

    • If the procedure is a non-specific code (e.g., a "not otherwise classified" (NOC) code), submit a description of the service in SV202-7. Other phrases that indicate non-specific codes are:

      • Unlisted
      • Unspecified
      • Unclassified
      • Other
      • Miscellaneous
      • Prescription Drug, Generic
      • Prescription Drug, Brand Name
      Reviewed: 9/12/2019
  7. I sent in a 5010 claim file and I have not received my 277CA report. Is something wrong with my claim file?

    • Your file may have rejected on the 999 Functional Acknowledgment. If your file rejected on the 999 report, you will not receive a 277CA. Check 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. Correct the errors, then resubmit the file.

      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 refer to the CGS 5010 job aidPDF.

      Reviewed: 9/12/2019
  8. I received a payer acknowledgement/Acceptance report from my clearinghouse. Does this mean you accepted my claims?

    • CGS returns back to the submitter a 999 report, and if the 999 was accepted, a 277CA report is generated. 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.

      Reviewed: 9/12/2019
  9. Once I submit a 5010 837 claim file, how long should it take to get a 999 and/or 277CA?

    • This process can take from one hour up to 48 hours.

      Reviewed: 9/12/2019
  10. How often is PC-ACE Pro32 software updated?

    • The software is updated quarterly. Please visit our website for the latest version. Please note: you may only upgrade one version before the current version.

      Reviewed: 9/12/2019
  11. I am missing an Electronic Remittance Advice (ERA). How do I request a duplicate?

    • 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. You may also access remits through my CGS, and you may obtain paper copies through the IVR.

      Reviewed: 9/12/2019
  12. 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

    • The subscriber Group Name (SBR04/2000B) element must be empty. The group number (element SBR03/2000B) must also be empty.

      Reviewed: 9/12/2019
  13. We have multiple providers with multiple NPIs. All of our EDI transactions are submitted through one submitter ID. Can we receive a separate 835 ERA for each NPI, and if so, how do we accomplish this?

    • If each NPI has an assigned PTAN, you can receive a separate ERA for each NPI. If you are not using a clearinghouse to receive ERAs, follow these steps:

      1. Fill out an EDI application indicating that you are requesting a new submitter ID and click submit. (The system will then direct you to the provider authorization form). The online form and other agreement information is available on the CGS website.
      2. Fax the provider authorization form.
      3. Repeat Steps 1 & 2 for each PTAN/NPI combination

      Note: it may take up to 7 calendar days to process each application. Please fax all applications at the same time. The above option will create multiple submitter IDs, but you will receive separate ERAs for each NPI.

      Reviewed: 9/12/2019
  14. How do we get AARP co-insurance to cross over to Medicare? Is there a problem with that for CGS?

    • AARP is a supplemental insurance and may pay secondary to (after) Medicare. Here is how the crossover process works: an eligibility file is sent from the Trading Partner (supplemental insurance company) to the BCRC. The file contains data to identify the Health Insurance Claim (HIC) numbers and claims criteria, specified by the Trading Partner, for crossovers. Each Trading Partner is issued a COBA ID. The COBA ID and eligibility file data, along with information specific to that trading partner, are stored in Medicare's Common Working File (CWF). When claims are processed, CWF compares each COB trading partner's claims selection criteria against the Medicare claims. If the claim matches the Trading Partner's claims criteria and HICN in the trading partner's eligibility file, the claim information is automatically, electronically forwarded to the Trading Partner.

      Reviewed: 9/12/2019
  15. Our remit area has a few concerns when contacting CGS for missing remits. When we call about a missing remit, they normally want to restore an entire day's file without confirming if one check number was actually present within the file to be restored. What do we need to provide to make sure that we are getting the correct information?

    • Some files submitted, especially by your Clearinghouse or Billing Entity have thousands of claims within the file, this would be a lengthy process for our EDI Help Desk Representatives to look for one remit.

      Another alternative would be to register for myCGS which gives you the opportunity to view each remit separately.

      We recommend that you have the following information available when you contact the EDI Help Desk Desk at 866.590.6703 (Option 2) to have remits restored:

      1. PTAN
      2. NPI
      3. Last 5 digits of your Tax ID
      4. Check/EFT number
      5. Check/Remittance Date
      6. Check Amount
      Reviewed: 9/12/2019
  16. Where can I go to get a correct remit? Do the EDI Help Desk representatives have access to confirm whether a certain check was present?

    • First and second level EDI analysts have access to view certain check/remit information. They can assist providers with check/remit information as long as the provider is able to share valid information (PTAN, NPI and last 5 digits of Tax ID)

      Additionally, by registering for myCGS you would have instant access to view all of your remits.

      Reviewed: 9/12/2019
  17. How do I sign up for Direct Data Entry?

    • Sign up through the CGS website. From the website, select EDI from the left side of the page and select the EDI Enrollment Packet link. Should you need assistance completing the J15 DDE PPTN Application/ReactivationPDF for DDE, call 866.590.6703 (select Option 2).

      Reviewed: 9/12/2019
  18. I received a 277CA report with errors. How can I identify these errors?

    • The 277CA Edit look-up tool will allow you to view your errors in easy to understand descriptions.

      Reviewed: 9/12/2019
  19. Do I have recertify my DDE user ID?

    • Each year, Medicare providers are required to recertify their Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) user access. You must verify all User IDs, sign, and date the Annual DDE PPTN Recertification FormPDF at the bottom. Notification for DDE recertification is sent out via listserv.

      Published: 6/6/2019
      Reviewed: 9/12/2019
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