Top Provider Questions – EDI
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- My DDE password needs to be reset who do I contact?
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If you need to have your password reset only, please contact the CGS Security Administration Team at 1-615-660-5444. Please have the following information ready before calling.
- User ID
- First and last name of the user to which that ID is assigned
- Error message
Published: 03.23.22
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- When filling out the J15 DDE PPTN Application/Reactivation form do I need to include any User ID I currently use or had been issued previously?
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Yes, submitting these IDs on the form will assist CGS in determining whether a new user ID would need to be assigned.
Published: 03.23.22
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- How do I file my notice of election electronically?
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NOEs can be submitted electronically beginning January 2, 2018. For additional information, refer to the CMS 837I NOE Companion Guide on the CMS website.
Published: 03.23.22
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- Will I be able to get Electronic Remittances Advice (ERA) for checks that were issued prior to my setup?
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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.
Published: 03.23.22
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- 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-
The service facility location (2310E Claim level) loop requires a 9 digit zip code.
Published: 03.23.22
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- I am receiving the following Claim Status Code and EIC Code on my 277CA. What do these codes entail and who do I contact for assistance?
496 – Submitter not approved for electronic claims submissions on behalf of this entity
85 – Billing provider-
You are not setup to bill 5010 electronically when you receive this message. You must contact the EDI Help Desk prior to moving to production.
Published: 03.23.22
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- My claim is rejecting with a 306 message on my 277CA.
306 – Detailed description of service-
If the procedure is a non-specific code you must submit a description of the procedure code in SV202-7. 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.
Published: 03.23.22
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- I sent in a 5010 claim file and I have not received my 277CA.
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Your file may have rejected on the 999 Functional Acknowledgment. If your file rejected on the 999 report you will not receive a 277CA. You will need to look at 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. The errors will need to be corrected and the file resubmitted.
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 ASC X12N v005010 – Understanding the 999 Implementation Acknowledgement job aid on our website.
Published: 03.23.22
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- I received a payer acknowledgement/Acceptance report from my clearinghouse. Does this mean you accepted my claims?
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CGS returns back to the submitter (in this case the clearinghouse) a 999, and if the 999 was accepted a 277CA report will be returned. 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.
Published: 03.23.22
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- Once I submit a 5010 837 claim file how long should it take to get a 999 and /or 277CA?
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This process can take from one hour up to 48 hours.
Published: 03.23.22
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- How often is the PC-ACE Pro32 software upgraded?
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The software is upgraded quarterly. Please visit our website for the latest version. Please note you may only upgrade one version before the current version.
Published: 03.23.22
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- I am missing an Electronic Remittance Advise (ERA). How do I order a duplicate?
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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. A paper copy can be obtained through myCGS or the IVR.
Published: 03.23.22
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- 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 which is element SBR03/2000B must also be empty.
Published: 03.23.22
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- How long are Electronic Remittance Notices (ERN)/Electronic Remittance Advices (ERA) available in my mailbox?
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Your Electronic Remittance Notices (ERN)/Electronic Remittance Advices (ERA) posted to your mailbox are only available for 14 days. Be sure to download them immediately so reruns and restores are not necessary at the end of the month.
Published: 03.23.22
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- Do I have to recertify my DDE user ID?
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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 Form at the bottom. Notification for DDE recertification is sent out via listserv.
Published: 03.23.22
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- Why is CGS moving to accepting only the Online EDI Application and EDI Enrollment Agreement From?
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To ensure the CGS EDI department receives accurate and legible information with form submittals, EDI forms will transition to a paperless environment. All EDI enrollment forms including EDI Enrollment Agreement and the EDI application form will be required to be completed and submitted online beginning May 1, 2020.
Published: 03.23.22
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- Why did CGS return my Online EDI Application for the Provider Authorization Form?
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It is important that you complete and fill out the Provider Authorization Form after clicking on 'SUBMIT' when doing the online application. The Provider Authorization Form is linked with the actual application it was generated from when the 'SUBMIT APPLICATION' button was depressed. Once you go to the link it has provided you must printout the Provider Authorization Form only, input the TAX ID number, and have it signed by an authorized official from the provider. You may not use the same Provider Authorization form for any other applications completed. It will not link to the current one it was generated from. Applications are returned if the Provider Authorization form is not receiced within seven days.
Published: 03.23.22
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- I received my application back with errors on my Provider Authorization Form. Can I correct and refax it or will I have to complete an entirely new application and authorization form?
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Once an application has been processed, if there are any corrections needed, you will have to fill out another EDI Online Application and Provider Authorization Form. We no longer accept corrections. Please refer to the online instructions to ensure you have completed your application thoroughly before submitting.
Published: 03.23.22
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- How do I verify DDE/PPTN enrollment?
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- Step 1:
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Complete the J15 DDE PPTN Application/Reactivation form.
- Step 2:
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Fax in the completed application. The Fax numbers are located on the bottom of the form.
- Step 3:
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J15 EDI will complete the DDE PPTN enrollment process within 20 business days.
- Step 4:
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A confirmation e-mail will be sent to the EDI contact on the application
- Step 5:
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If you do not receive a confirmation email, please reach out to the Help Desk at:
Ohio/Kentucky Part B – 1.866.276.9558 (option 2)
Ohio/Kentucky Part A – 1.866.590.6703 (option 2)
Home Health/Hospice – 1.877.299.4500 (option 2)
Published: 03.23.22
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- I need help understanding the 277CA rejection that I received.
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The 277CA Edit Lookup Tool allows Trading Partners, billing services, providers, and clearinghouses to view easy-to-understand descriptions associated with the edit code(s) returned on the 277CA – Claim Acknowledgment for 5010A1 claims. The tool allows you to enter the edit codes and will return possible explanations for the cause of the edit.
Step 1: Access the 277CA Edit Lookup Tool
Step 2: Enter the edit information located in the STC segment or reported on your acknowledgment file into the 5010A1 277CA Edit Lookup Tool
Step 3: Click Submit
Example: STC*A7:562:85**U*1983˜
A7 = CSCC (Claim Status Category Code)
562 = CSC (Claim Status Codes)
85 = EIC (Entity Identifier Code)The results will be returned below the search fields and will display all possibilities for the cause of the edit.
For additional instructions, please refer to 277CA EDI Edit User Guide
Published: 03.23.22
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