- About Electronic Data Interchange (EDI)
- EDI Front End Clinical Edits
- 275 Electronic Attachment
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- 837D Edit Spreadsheet
- 835 Electronic Remittance Transaction (ERA)
- 277 Electronic Request For Additional Information (RFI)
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- EDI Software PC Print
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- Quarterly Top Ten Professional EDI Edits
- Quarterly Top Ten Institutional EDI Edits
EDI Front End Clinical Edits
EDI is continuing to implement EDI clinical business edits into the NGS EDI front end.
These edits assist in proactively alerting providers of potential claim issues and provide resources to assist with avoiding and resolving the impact of potential denials and appeals.
The new clinical business edits:
- Apply to Part B claims in Jurisdiction 6 (Illinois, Wisconsin and Minnesota) and Jurisdiction K (Connecticut, New Hampshire, New York, Maine, Massachusetts, Rhode Island, Vermont).
- Apply to all direct submitters and those who transmit claims via a clearinghouse/billing service.
- Can be identified on the 277CA transaction by the presence of the 2200D and/or 2220D STC12 data element on the 277CA transaction.
The information for the edit is returned on the 277 Claim Acknowledgement (277CA) transaction that you currently receive. After reviewing an NGS EDI clinical edit, you can make any needed updates and resubmit the claim.
If you choose not to change the claim you can resubmit the claim in its original format, (*you must not make ANY changes to the claim). The claim will pass through to MCS for processing.
EDI is also implementing EDI clinical informational messages into the NGS EDI front end.
These are information only messages, they do not reject the claim. These messages will provide helpful information to providers on claims or ADRs that need their attention.
| Line Number | 277CA STC Codes | Smart Edits Message | Smart Edits Description |
|---|---|---|---|
| 1. | A3:23:41 | NGSEDIT MAMMOGRAPHY CODES OF 77063, 77065, 77066, 77067 AND G0279 REQUIRE A CERTIFICATION NUMBER. | When billing HCPCS 77063, 77065, 77066, 77067 or G0279 a mammography certification number is required. |
| 2. | A3:23:41 | NGSEDIT DME MAC Procedure code billed should be submitted to the DME MAC. | DME procedure codes should be submitted to the DME MAC. |
| 3. | A3:23:41 | NGSEDIT The Procedure code billed is a facility service code. The service must be billed on an Institutional claim. | Facility procedure codes must be billed on an Institutional claim. |
| 4. | A3:23:41 | NGSEDIT Procedure code 82306 required diagnosis code is missing. | When billing HCPCS 82306 a payable diagnosis code is required. |
| 5. | A3:23:41 | NGSEDIT Procedure code 93970 or 93971 required diagnosis code is missing. | When billing HCPCS 93970 or 93971 a payable diagnosis code is required. |
| 6. | A1:20:41 | NGSMESSAGE ADR NGS is waiting on a response to an ADR for one or more of your claims. Please see your ADR letter(s) for details. ADR status is available on the NGS Connex Portal (www.ngsmedicare.com). | Informational message only: Please review your ADR letters (s), NGS is waiting on a response for one or more of them. |
Revised 4/15/2025
Helpful Resources
EDI Front End Rejection Code Lookup Tool
Reset My EDI Password
Contact the EDI Help Desk
877-273-4334
Available by phone or email Monday–Friday*
8:00 a.m.–5:00 p.m. ET
8:00 a.m.–4:00 p.m. CT
* Closed for training on the 2nd and 4th Friday of the month.
12:00 p.m.–4:00 p.m. ET
11:00 a.m.–3:00 p.m. CT
Form(s) you'll need:
Helpful Resources
EDI Front End Rejection Code Lookup Tool
Reset My EDI Password
Contact the EDI Help Desk
888-379-9132
Available by phone or email Monday–Friday*
8:00 a.m.–5:00 p.m. ET
8:00 a.m.–4:00 p.m. CT
* Closed for training on the 2nd and 4th Friday of the month.
12:00 p.m.–4:00 p.m. ET
11:00 a.m.–3:00 p.m. CT
Form(s) you'll need: