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TABLE 11 – 837P PROFESSIONAL PERMANENTLY DEACTIVATED CEM EDITS (CONTINUED) EDIT REFERENCE EDIT DESCRIPTION EDIT NOTES X222.091.2010AA.N302.060 X222.094.2010AA.REF02.050 X222.138.2010BB.REF.010 X222.140.2010BB.REF02.075 X222.157.2300.CLM05-3.020 X222.196.2300.REF.010 X222.262.2310B.NM109.030 CSCC A7: "Acknowledgement /Rejected for Invalid Information…" CSC 503: "Entity's Street Address" EIC 85: “Billing Provider” 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 732: "Information submitted inconsistent with billing guidelines." CSC 560: "Entity's Additional/Secondary Identifier." EIC PR: "Payer" 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” CSCC A7: "Acknowledgement /Rejected for Invalid Information…" CSC 535: "Claim Frequency Code" CSCC A7: "Acknowledgement /Rejected for Invalid Information…" CSC 732: "Information submitted inconsistent with billing guidelines." CSC 464: “Payer Assigned Claim Control Number.” CSCC A7: "Acknowledgement /Rejected for Invalid Information…" CSC 562: “Entity’s National Provider Identifier (NPI)” EIC 82: “Rendering Provider” 2010AA.N302 must not contain the following exact phrases (not case sensitive): "Post Office Box", "P.O. Box", "PO Box", "P O Box", "Lock Box", "Lock Bin". 2010AA.REF must be associated with the provider identified in 2010AA.NM109 Non-VA claims: 2010BB.REF with REF01 = "2U", "EI", "FY" or "NF" must not be present. VA claims: 2010BB.REF with REF01 = "EI", "FY" or "NF" must not be present. 2010BB.REF02 billing provider must be "associated" to the submitter (from a trading partner management perspective) in 1000A.NM109. 2300.CLM05-3 must be "1". 2300.REF with REF01 = "F8" must not be present. 2310B.NM109 must be a valid NPI on the Crosswalk when evaluated with 1000B.NM109. 837 Professional Companion Guide Version 12.0/November 2012 28
TABLE 11 – 837P PROFESSIONAL PERMANENTLY DEACTIVATED CEM EDITS (CONTINUED) EDIT REFERENCE EDIT DESCRIPTION EDIT NOTES X222.351.2400.SV101-7.020 X222.430.2420A.NM109.030 CSCC A8: "Acknowledgement / Rejected for relational field in error" CSC 306: “Detailed description of service” CSCC A7: "Acknowledgement /Rejected for Invalid Information…" CSC 562: "Entity's National Provider Identifier (NPI)" EIC 82 "Rendering Provider" 2400.SV101-7 must be present when 2400.SV101-2 is present on the table of procedure codes that require a description. 2420A.NM109 must be a valid NPI on the Crosswalk when evaluated with 1000B.NM109. 8.0 Duplicate Logic In order to ensure encounters submitted are not duplicates of encounters previously submitted, header and detail level duplicate checking will be performed. If the header and/or detail level duplicate checking determines the file is a duplicate, the file will reject as a duplicate, and an error report will be returned to the submitter. 8.1 Header Level When a file (ISA – IEA) is received, the system assigns a hash total to the file based on the entire ISA/IEA interchange. The EDS uses hash totals to ensure the accuracy of processed data. The hash total is a total of several fields or data in a file, including fields not normally used in calculations, such as the account number. At various stages in processing, the hash total is recalculated and compared with the original. If a file comes in later in a different submission, or a different submission of the same file, and gets the same hash total, it will reject as a duplicate. In addition to the hash total, the system also references the values collectively populated in ISA13, GS06, ST02, and BHT03. If two (2) files are submitted with the exact same values populated as a previously submitted and accepted file, the file will be considered a duplicate and the error message CSCC - A8 = Acknowledgement / Rejected for relational field in error, CSC -746 = Duplicate Submission will be provided on the 277CA. 8.2 Detail Level Once an encounter passes through the institutional or professional processing and pricing system, it is stored in an internal repository, the Encounter Operational Data Store (EODS). If a new encounter is submitted that matches specific values to another stored encounter, the encounter will reject as a duplicate encounter. The encounter will be returned to the submitter with an error message identifying it as a duplicate encounter. Currently, the following values are the minimum set of items used for matching an encounter in the EODS: 837 Professional Companion Guide Version 12.0/November 2012 29
Page 1 and 2: ___________________________________
Page 3 and 4: Table of Contents 1.0 Introduction
Page 5 and 6: 1.0 Introduction 1.1 Scope The CMS
Page 7 and 8: The effective date of the spreadshe
Page 9 and 10: specifically for encounter data pur
Page 11 and 12: TABLE 2 - GS/GE FUNCTIONAL GROUP EL
Page 13 and 14: TABLE 4 - 837 PROFESSIONAL HEALTH C
Page 21 and 22: specific error. If a fatal error oc
Page 23 and 24: The MAO-002 report is a fixed lengt
Page 25 and 26: Table 9 below provides the producti
Page 27: TABLE 10 - EDFES NOTIFICATIONS (CON
Page 31 and 32: 9.1 Standard Professional Encounter
Page 33 and 34: 9.2 Capitated Professional Encounte
Page 35 and 36: 9.3 Chart Review Professional Encou
Page 37 and 38: 9.4 Chart Review Professional Encou
Page 39 and 40: 9.5 Complete Replacement Profession
Page 41 and 42: 9. 6 Deletion Professional Encounte
Page 43 and 44: 9. 7 Atypical Provider Professional
Page 45 and 46: 9.8 Paper Generated Professional En
Page 47 and 48: 9.9 True Coordination of Benefits P
Page 49 and 50: 9.10 Bundled Professional Encounter
Page 51 and 52: 10.0 Encounter Data Professional Pr
Page 53 and 54: 10.1 EDPPPS Edits Enhancements Impl
Page 55 and 56: TABLE 14 - EDPPPS EDITS PREVENTION
Page 57 and 58: TABLE 15 - EDPS EDITS PREVENTION AN
Page 59 and 60: TABLE 15 - EDPS EDITS PREVENTION AN
Page 61 and 62: TABLE 17 - EDS ACRONYMS (CONTINUED)
Page 63: REVISION HISTORY VERSION DATE DESCR

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