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April 30, 2020

277CA Report CGS ACE Smart Edits Enhancements

CGS is excited to announce we have successfully implemented several enhancements to the 277CA report, as part of our CGS Advance Communication Engine (ACE) Smart Edits. CGS ACE 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.

Most claims hitting the CGS ACE pre-adjudication editing process are not forwarded to the claims adjudication system. After reviewing these claims, you will decide if you should update or not update the claim and then, just resubmit it for processing. Some claims may hit a CGS ACE Informational Smart Edit that returns important messaging for your practice while allowing the claim to forward to the claims processing system. We encourage you to review your 277CA report for these messages. A list of the active CGS ACE Smart Edits is found below.

All direct submitters will receive the Medicare 277CA report with these new Smart edits. If you are currently using a clearinghouse or billing service to submit your claims, please share this information with them and make sure they are providing you a detailed 277CA report. Examples of how the segment will appear can be found in our current GPNet Communications ManualPDF.

CGS Advance Communication Engine (ACE) Smart Edits List As Returned on the 277CA

Claims hitting these CGS ACE pre-adjudication Smart Edits are not forwarded to the claims adjudication system. Please review the claim and if you choose not to change the claim, then just resubmit it for processing.

Smart Edits # Smart Edits Message Smart Edits Description
INFO A potential coding error was identified with this claim; please see STC 2220D Loop for specific information. If you wish to continue without updates, please resubmit the claim in its current state to bypass additional Smart Editing. (INFO) Informational Edit
An informational message the submitter will receive when a review flag sets on a claim.
NEW! ISX Diagnosis code(s) XXXXX typically would not be reported for a patient whose gender is X. (ISX) Diagnosis Not Typical with Patient Gender

This edit identifies claim lines that contain a diagnosis code not typical for a patient's gender.
MBI Medicare will only accept MBIs after December 31, 2019. Use our myCGS portal if your patients do not have their Medicare cards at the time of service. Please refer to the MBI Look-Up Tool job aid for help. If not registered to use myCGS, please refer to the myCGS webpage. (MBI) Medicare Beneficiary Identifier The MBI rule identifies claims that are not submitted with a MBI.
mTF The date of service is past Medicare timely filing guidelines. (mTF) Medicare Timely Filing
The mTF timely filing rule will fire on claims when submitted past the timely filing requirements established by The Centers for Medicare and Medicaid Services (CMS).
NEW! NPT The patient received care by this provider within the last three years. An established patient E/M code should be used. (NPT) New Patient Code Billed for Established Patient Claim History

This edit coincides with CPT definition of "New Patient." It will hit when the patient history indicates he/she has been seen by the same provider within three years of the current claim line's beginning date of service.
PCM Modifier -26 is not appropriate with Procedure Code XXXXX because that procedure is defined as 100% professional or 100% technical. (PCM) Invalid Professional Component Modifier
The PCM edit identifies claim lines that contain a procedure code that is considered 100% technical and modifier 26 is appended.
POS Procedure Code XXXXX is not typically performed by a provider in Place of Service XX. (POS) Place of Service Not Typical with Procedure
The POS System Rule identifies claim lines that contain a place of service that the specified procedure is not typically performed in.
PVN1 Your Medicare enrollment record is due for revalidation. Failure to respond may result in a hold on payments and possible deactivation of your enrollment. (PVN1) Enrollment Record Revalidation
An informational message the submitter will receive when your Medicare enrollment record is due to revalidation.
PVN2 Your Medicare enrollment record is due for revalidation. Failure to respond may result in a hold on payments and possible deactivation of your enrollment. (PVN2) Enrollment Record Revalidation
An informational message the submitter will receive when your Medicare enrollment record is due to revalidation.
PVNE Your Medicare enrollment record is due for revalidation. Failure to respond may result in a hold on payments and possible deactivation of your enrollment. (PVNE) Enrollment Record Revalidation
An informational message the submitter will receive when your Medicare enrollment record is due to revalidation.
PVNF Your Medicare enrollment record is due for revalidation. Failure to respond may result in a hold on payments and possible deactivation of your enrollment. (PVNF) Enrollment Record Revalidation
An informational message the submitter will receive when your Medicare enrollment record is due to revalidation.

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