January 2021 EDI Front End Quarterly Release: New and Modified Edits
Part A Edit Changes:
| Edit Reference Number | Change | Reason for change | Trading Partner Impact/Results |
|---|---|---|---|
| X223. 433.2400.DTP03.040 | Revised 277C Edit | Change the edit to not reject the file when the date submitted is a future date when the bill type submitted is 0322. | When bill type is 0322, 2400 DTP:472 (service line date) allow the value to be a future date, all other Bill types reject if future date is sent |
Additional CR
Please be advised that while the Centers for Medicare & Medicaid Services mandated quarterly release for January 2021 will be installed the weekend of 1/3/2021, the code set updates included with this release will not be effective in the EDI Front-End processing system until Wednesday, 1/6/2021. EDI claims sent prior to 1/6/2021 that include any of the new or updated codes will reject in the EDI front-end.
| Title & Description | Purpose | Trading Partner Impact |
|---|---|---|
| CR 11881; (CAQH CORE CR) Subject: Implement Operating Rules - Phase III ERA EFT: CORE 360 Uniform Use of CARC and RARC Rule - Update from CAQH CORE MLN Matters® Number: MM11881 |
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 10/1/2020. The codes and associated messages are updated in the updated versions of MREP and PC Print software. | Trading Partners should review the MLN Matters article for this CR so 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 PC Print code set update, which will be available for download from our website under the Claims & Appeals tab > EDI Solutions > EDI Software: PC Print > Download PC Print |
Posted 12/8/2020