Encounter Data Processing System - Edits and EDR Resubmission

In June 2018, CMS completed an infrastructure transition to maintain and improve the Encounter Data Processing System (EDPS). After the transition, CMS discovered that a small number of edits had incorrectly rejected records, as reflected on your MAO-002 reports. CMS analysis shows that a small number of records (0.8% of records submitted between May 19 and July 30, 2018, which represents .03% of 2018 submissions to date) were affected by these edits. The number of records with dates of service in 2015 and 2016 is approximately 190,000 (.0009% of 2018 submissions to date). In addition, over 90% of these incorrectly rejected records related to edit 98325 – service line (s) duplicated. The edits and the file submission dates affected by the issues, are listed in the table below.

CMS has implemented system patches to rectify these issues and has identified the submitters and files that were affected. CMS is actively contacting impacted submitters, and is providing relevant information, including a list of affected files and records to these submitters in order to ensure that submitters have ample opportunity to resubmit the incorrectly processed records. This would include the incorrectly rejected records identified as duplicates, because these records have not been accepted by the EDPS.

In addition, if an MAO believes that records submitted during the time periods below were incorrectly rejected, CMS recommends that submitters resubmit these records.

Table 1. Edits and EDR Submission Dates Affected during Transition

Edit	EDR Submission Dates Affected
00699 – Void Must Match Original	May 19 through July 30
00780 – Adjustment Must Match Original	May 19 through July 30
00785 – Linked Encounter not in EODS	May 19 through July 30
02110 – Beneficiary HICN Not on File	May 23 through July 13
02240 – Beneficiary Not Enrolled in MAO for DOS	May 19 through July 2
98300 – Exact Inpatient Duplicate Encounter	May 19 through May 26
98325 – Service Line(s) Duplicated	May 19 through May 28

In the event you have questions, please contact CSSC Operations at 1-877-534-2772 (option 2) or by email at csscoperations@palmetogba.com.

Last Updated: 08/20/2018 04:43:00 PM