April 2025 EDI Front End Quarterly Release

Please be advised that while the Centers for Medicare & Medicaid Services mandated release for April 2025 will be installed the weekend of 4/6/2025, the code set updates included with this release will not be effective in the EDI Front-End processing system until Wednesday, 4/9/2025. EDI claims sent prior to 4/9/2025 that include any of the new or updated codes will reject in the EDI front-end.

Title & Description	Purpose	Trading Partner Impact
CR13891 (CAQH CORE CR) SUBJECT: Implement Operating Rules - Phase III ERA EFT: CORE 360 Uniform Use of CARC and RARC Rule - Update from CAQH CORE 2/1/2025 Change Request	This CR instructs the contractors and SSMs to update systems based on the CORE 360 Uniform Use of CARC and RARC Rule publication. These system updates are based on the CORE Code Combination List to be published on or about 2/1/2025. The codes and associated messages are updated in the updated versions of MREP codes.ini and PC Print code set update.	Trading Partners should review the MedLearn Matters article for this CR so that they are aware of the Business Scenario combinations and RARC/CARC updates to the PC PRINT and MREP software. There is a new MREP Codes.ini file, which will be available for download from the CMS website. There is a new version of PC Print code set update (April 2025), which may be downloaded from our website under Resources > EDI Solutions > EDI Software: PC Print > Download PC Print

Title & Description

Purpose

Trading Partner Impact

CR13891 (CAQH CORE CR)

SUBJECT: Implement Operating Rules - Phase III
ERA EFT: CORE 360 Uniform Use of CARC and RARC Rule - Update from CAQH CORE 2/1/2025

Change Request

This CR instructs the contractors and SSMs to update systems based on the CORE 360 Uniform Use of CARC and RARC Rule publication. These system updates are based on the CORE Code Combination List to be published on or about 2/1/2025. The codes and associated messages are updated in the updated versions of MREP codes.ini and PC Print code set update.

Trading Partners should review the MedLearn Matters article for this CR so that they are aware of the Business Scenario combinations and RARC/CARC updates to the PC PRINT and MREP software.

There is a new MREP Codes.ini file, which will be available for download from the CMS website.

There is a new version of PC Print code set update (April 2025), which may be downloaded from our website under Resources > EDI Solutions > EDI Software: PC Print > Download PC Print

Posted 3/10/2025

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