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CEDI Top 15 5010A1 Edits
General Information
This document provides a list of the top 15 edits received by CEDI Trading Partners during the submission of production ANSI
X12 837 version 5010A1 claims. The edits are listed in numerical order by the first CSC in the edit. As a reminder, edits listed
in the Edits Received on the 277CA column can be triggered by more than one issue. We have attempted to include all
reasons that may cause the edit with the most “frequently received” as the first explanation.
These edits will be updated monthly to provide you with accurate information. This document is intended to be used as a
reference in addition to the CMS 5010 Edit Spreadsheet located on the CMS Web site http://www.cms.gov at the following link:
http://www.cms.gov/MFFS5010D0/20_TechnicalDocumentation.asp.
Edit List Table of Contents
CSCC A7: CSC 21: CSC 153: EIC PR: CSC 153: EIC 40 ..................................................................................................... 2
CSCC A7: CSC 164: EIC IL ............................................................................................................................................ 2
CSCC A7: CSC 187 ....................................................................................................................................................... 3
CSCC A7: CSC 254 ....................................................................................................................................................... 4
CSCC A8: CSC 306 ....................................................................................................................................................... 5
CSCC A7: CSC 453 ....................................................................................................................................................... 5
CSCC A7: CSC 480 ....................................................................................................................................................... 5
CSCC A8: CSC 496: EIC 85 ........................................................................................................................................... 6
CSCC A7: CSC 500: EIC IL ............................................................................................................................................ 7
CSCC A7: CSC 507 ....................................................................................................................................................... 7
CSCC A7: CSC 510: CSC 187 ......................................................................................................................................... 8
CSCC A7: CSC 535 ....................................................................................................................................................... 9
CSCC A7: CSC 562: EIC 85 ........................................................................................................................................... 9
CSCC A8: CSC 562: CSC 128: EIC 85 ........................................................................................................................... 10
CSCC A7: CSC 698 ..................................................................................................................................................... 10
Last Revision: February 6, 2015
Page 1 of 10
CEDI Top 15 5010A1 Edits
The Edit Reference column is organized in the following fashion: (TR3 document.Page #.Loop.Segment & Element.Sequence
#)
Edits Received on the
277CA
CSCC A7:
"Acknowledgement
/Rejected for Invalid
Information…"
CSC 21: "Missing or
Invalid Information"
CSC 153: "Entity ID
Number"
EIC PR: "Payer"
CSC 153: "Entity ID
Number"
CSC 40: "Receiver"
CSCC A7:
"Acknowledgement
/Rejected for Invalid
Information…"
CSC 164: "Entity's
contract/member number"
EIC IL: Subscriber
Last Revision: February 6, 2015
Edit Logic
General Description
Edit Reference
2010BB.NM109 must be the
same value as 1000B.NM109.
Payer ID sent for the
Medicare insurance
information indicated with
the patient's claim must be
the same value as the
Receiver Primary Identifier
sent for the file. Verify that
the numbers match and are
one of the following Payer
ID Numbers for Medicare
DME:
Jurisdiction A – 16003
Jurisdiction B – 17003
Jurisdiction C – 18003
Jurisdiction D – 19003
X222.133.2010BB.NM109.025
If Medicare IDs:
2010BA.NM109 must be 10 11 positions in the format of
NNNNNNNNNA or
NNNNNNNNNAA or
NNNNNNNNNAN where “A”
represents an alpha character
and “N” represents a numeric
digit.
OR
If Railroad IDs:
2010BA.NM109 must be 7 - 12
positions in the format of
ANNNNNN, AANNNNNN,
ANNNNNNNNN,
The subscriber HICN is
invalid.
Verify the HICN is entered
exactly as it appears on the
beneficiary's red, white,
and blue Medicare card.
If Medicare ID:
Subscriber Primary
Identifier must be 10 - 11
positions in the format of
NNNNNNNNNA or
NNNNNNNNNAA or
NNNNNNNNNAN where “A”
represents an alpha
character and “N”
X222.121.2010BA.NM109.020
Page 2 of 10
CEDI Top 15 5010A1 Edits
Edits Received on the
277CA
CSCC A7:
"Acknowledgement
/Rejected for Invalid
Information…"
CSC 187: "Date(s) of
service"
Last Revision: February 6, 2015
Edit Logic
General Description
AANNNNNNNNN, AAANNNNNN,
or AAANNNNNNNNN where “A”
represents an alpha character
and “N” represents a numeric
digit.
represents a numeric digit.
-ORIf Railroad ID:
Subscriber Primary
Identifier must be 7 - 12
positions in the format of
ANNNNNN or AANNNNNN or
ANNNNNNNNN or
AANNNNNNNNN or
AAANNNNNN or
AAANNNNNNNNN where “A”
represents an alpha
character and “N”
represents a numeric digit.
Reject the claim if 2400.DTP02
= "RD8" and the first date is
not = the second date and
SV101-2 is not "E0935" or
"E0936", & the proc option
"GL" or "IS" does NOT exist, &
the proc option "DF", "DI",
"DR", "LP", "OC", "OG", "OL" or
"OP does exist.
Reject the claim if
2400.DTP02=D8 or
2400.DTP02 = RD8 and the
CCYYMM portion of the first
date and the CCYYMM portion
of the second date are equal
and 2400.SV101-3, SV101-4,
SV101-5 or SV101-6 = "RR"
and 2400.SV104 is not = "1".
The procedure code
submitted for this line does
not allow for spanned dates
of service. Verify the
start/from and end/to dates
for this line are equal.
X222.380.2400.DTP03.090
The number of services
entered for this line is
invalid. In general, rentals
can only have one unit of
service.
Questions regarding proper
billing policy of rental items
should be directed to the
DME MAC where the claim
would be processed based
X222.380.2400.DTP03.070
Page 3 of 10
Edit Reference
CEDI Top 15 5010A1 Edits
Edits Received on the
277CA
Edit Logic
If 2400.DTP02 is RD8, the first
date listed in 2400.DTP03 must
be a date prior to the second
date listed in 2400.DTP03.
CSCC A7:
"Acknowledgement
/Rejected for Invalid
Information…"
CSC 254: "Primary
diagnosis code"
If 2400.SV107-1, SV107-2,
SV107-3, or SV107-4 is "1"
and 2300.HI01-1 is "BK" then
2300.HI01-2 must be a valid
ICD-9-CM Diagnosis code on
the date in 2400.DTP03 when
DTP01 = "472", based on the
ICD-9-CM Diagnosis Code list.
If 2400.SV107-1, SV107-2,
SV107-3 & SV107-4 are not
"1" and 2300.HI01-1 is "BK",
2300.HI01-2 must be a valid
ICD-9-CM Principal Diagnosis
code for every date in the DOS
range for this claim based on
the CMS subset of the ICD-9CM Diagnosis Code list.
Last Revision: February 6, 2015
Page 4 of 10
General Description
on the patient’s state code
in the address provided on
the claim.
If Date Time Period Format
Qualifier is RD8, the "From"
date service must be a date
prior to the "To" date of
service provided.
The diagnosis code pointed
to by diagnosis code pointer
1 (SV107‐1, SV107-2,
SV107-3, or SV107-4) is
invalid for the claim line
date of service.
Questions regarding the
effective dates of a
diagnosis code should be
directed to the DME MAC
where the claim would be
processed based on the
patient’s state code in the
address provided on the
claim.
The first diagnosis code's
effective dates fall entirely
outside the claim’s dates of
service.
Questions regarding the
effective dates of a
diagnosis code should be
directed to the DME MAC
where the claim would be
processed based on the
Edit Reference
X222.380.2400.DTP03.060
X222.226.2300.HI01-2.030
X222.226.2300.HI01-2.070
CEDI Top 15 5010A1 Edits
Edits Received on the
277CA
Edit Logic
General Description
Edit Reference
patient’s state code in the
address provided on the
claim.
CSCC A8:
"Acknowledgement /
Rejected for relational field
in error"
CSC 306: Detailed
description of service
2400.SV101-7 must be
present. when 2400.SV101-2 is
present on the table of
procedure codes that require a
description.
Procedure Code sent
requires a
description/additional
information. This
description must be sent in
the SV101-7 field.
X222.351.2400.SV101-7.020
Please contact your
software vendor for more
information on how to place
the description in this field
if needed.
Note: This description field
is different than the NTE
(general narrative) field.
CSCC A7:
"Acknowledgement /
Rejected for relational field
in error"
CSC 453: "Procedure Code
Modifier(s) for Service(s)
Rendered."
2400.SV101-3 must be valid
procedure modifier on the date
in 2400.DTP03 when DTP01 =
"472".
Procedure Modifier must be
valid for the Service Date.
(DTP01 = "472")
X222.351.2400.SV101-3.020
CSCC A7:
"Acknowledgement
/Rejected for Invalid
Information…"
CSC 480: "Other Carrier
2320.SBR09 must not = "MA"
or "MB".
Claim Filing Indicator Code
must not = "MA" or "MB".
Non-Medicare insurances
will need to choose a valid
code for the type of
X222.295.2320.SBR09.020
Last Revision: February 6, 2015
Page 5 of 10
CEDI Top 15 5010A1 Edits
Edits Received on the
277CA
Claim filing indicator is
missing or invalid"
CSCC A8:
“Acknowledgement /
Rejected for relational field
in error”
CSC 496: "Submitter not
approved for electronic
claim submissions on
behalf of this entity."
EIC 85: Billing Provider
Edit Logic
Edit Reference
insurance being included in
the claim file. "MA" and
"MB" are not valid for NonMedicare insurances.
2010AA.NM109 billing provider
must be "associated" to the
submitter (from a trading
partner management
perspective) in 1000A.NM109.
2010BB.REF02 billing provider
must be "associated" to the
submitter (from a trading
partner management
perspective) in 1000A.NM109.
Last Revision: February 6, 2015
General Description
Page 6 of 10
The Billing Provider NPI not
associated with submitter.
The Trading
Partner/Submitter ID is not
authorized to submit claims
for the supplier.
If this error is received, the
supplier must complete and
sign the appropriate form
on the CEDI Web site
(www.ngscedi.com) and
return to CEDI for
processing.
Suppliers who use a third
party (e.g. a clearinghouse
or billing service) must
complete the Supplier
Authorization Form.
Suppliers who submit their
own claims and do not use
a third party biller must
complete the CMS EDI
Enrollment Agreement.
Payer Additional Identifier
billing provider must be
"associated" to the
submitter NPI.
X222.087.2010AA.NM109.050
X222.140.2010BB.REF02.075
CEDI Top 15 5010A1 Edits
Edits Received on the
277CA
CSCC A7:
"Acknowledgement
/Rejected for Invalid
Information…"
CSC 500: "Entity's
Postal/Zip Code"
EIC IL: Subscriber
CSCC A7:
"Acknowledgement
/Rejected for Invalid
Information…"
CSC 507: "HCPCS"
Edit Logic
Edit Reference
2010BA.N403 must be a valid
postal/zip Code
Subscriber Postal Zone or
ZIP Code must be a valid
US Postal Service Zip Code.
X222.125.2010BA.N403.020
When 2400.SV101-1 = "HC",
2400.SV101-2 must be a valid
HCPCS Code on the date in
2400.DTP03 when DTP01 =
"472".
When Product or Service ID
Qualifier = "HC", the
Procedure Code must be a
valid HCPCS Code for the
Service Date. (DTP01 =
"472"). The HCPCS can be
verified with PDAC. If
additional information is
needed concerning the valid
combination, please contact
the Jurisdiction where the
claim will be processed.
The HCSPCS must be valid
for the date of service and
the modifiers attached must
be a valid combination.
Verify that all required
modifiers are sent if
modifiers are required.
The HCPCS can be verified
with PDAC. If additional
information is needed
concerning the valid
combination, please contact
the Jurisdiction where the
claim will be processed.
X222.351.2400.SV101-2.020
When 2400.SV101-1 = "HC",
2400.SV101-2 must be a valid
HCPCS Code on the date in
2400.DTP03 when DTP01 =
"472".
OR
When 2400.SV101-1 = "HC",
2400.SV101-2 must be a valid
HCPCS Code from the DME
subset on the date in
2400.DTP03 when DTP01 =
"472".
Last Revision: February 6, 2015
General Description
Page 7 of 10
X222.351.2400.SV101-2.030
CEDI Top 15 5010A1 Edits
Edits Received on the
277CA
Edit Logic
When 2400.HCP09 = "HC",
2400.HCP10 must be a valid
HCPCS Code on the date in
2400.DTP03 when DTP01 =
"472".
CSCC A7:
"Acknowledgement
/Rejected for Invalid
Information…"
CSC 510: "Future date"
CSC 187: "Date(s) of
service"
When 2400.DTP02 = RD8 and
the second date is a future
date, one of the following proc
options must exist for the
procedure: "IS", "PA", "PE",
"PI", "PK", "PL", "PP", "PS" or
"PX".
If 2400.DTP02 is
D8,2400.DTP03 must not be a
future date.
If 2400.DTP02 is RD8, the first
date listed in 2400.DTP03 must
not be a future date.
Last Revision: February 6, 2015
Page 8 of 10
General Description
Edit Reference
When Product or Service ID
Qualifier = "HC", Procedure
Code must be a valid
HCPCS Code on the Date of
Service when DTP01 =
"472".
The service end/to date is
greater than the date this
claim was received.
Questions regarding proper
billing policy should be
directed to the DME MAC
where the claim would be
processed based on the
patient’s state code in the
address provided on the
claim.
X222.416.2400.HCP10.020
If Date Time Period Format
Qualifier is D8, Service
Date must not be a future
date.
If Date Time Period Format
Qualifier is RD8, the "From"
date of service must not be
a future date.
X222.380.2400.DTP03.040
X222.380.2400.DTP03.080
X222.380.2400.DTP03.050
CEDI Top 15 5010A1 Edits
Edits Received on the
277CA
CSCC A7:
"Acknowledgement
/Rejected for Invalid
Information…"
CSC 535: "Claim
Frequency Code."
CSCC A7:
"Acknowledgement
/Rejected for Invalid
Information…"
CSC 562: "Entity's
National Provider Identifier
(NPI)"
EIC 85: Billing Provider
Last Revision: February 6, 2015
Edit Logic
General Description
Edit Reference
2300.CLM05-3 must be "1".
Claim Frequency Code must
be "1".
X222.157.2300.CLM05-3.020
2010AA.NM109 must be a valid
NPI on the Crosswalk when
evaluated with 1000B.NM109.
Billing Provider Identifier
must be a valid NPI on the
Crosswalk. Verify that the
NPI and DME PTAN are
linked together. To
establish a crosswalk, verify
the supplier's information
listed on the NPPES web
site matches the
information at the NSC.
If you have questions about
these matches please
contact NPPES at 800-4653203 or the NSC at 866238-9652.
Note: PECOS can also affect
your crosswalk. PECOS is
the system used by the
NSC for DME suppliers to
enroll in Medicare.
Suppliers can log in to and
verify that their NPI is listed
correctly. For assistance
with PECOS, call 866-4848049.
X222.087.2010AA.NM109.030
Page 9 of 10
CEDI Top 15 5010A1 Edits
Edits Received on the
277CA
CSCC A8:
"Acknowledgement /
Rejected for relational field
in error"
CSC 562: "Entity's
National Provider Identifier
(NPI)"
CSC 128: "Entity's tax id"
EIC 85: Billing Provider
CSCC A7:
"Acknowledgement
/Rejected for Invalid
Information…"
CSC 698: "Form Type
Identifer."
Last Revision: February 6, 2015
Edit Logic
General Description
Edit Reference
2010AA.NM109 must be valid
according to the NPI algorithm.
Billing Provider Identifier
must be a valid NPI.
X222.087.2010AA.NM109.020
The first position of
2010AA.NM109 must be a "1".
The first position of Billing
Provider NPI must be a "1".
X222.087.2010AA.NM109.040
2010AA.REF must be
associated with the provider
identified in 2010AA.NM109
Billing Provider Tax
Identification Number must
be associated with the
billing provider's NPI.
Verify that the information
you are submitting matches
the information on file with
the NPPES and NSC.
X222.094.2010AA.REF02.050
2440.LQ02 must be a valid
form for the procedure code in
2400.SV102.
Form Identifier must be a
valid form for the procedure
code.
X222.492.2440.LQ02.030
Page 10 of 10