MMP Edits Update

CMS has determined a need to re-activate four (4) Common Edit Module (CEM) edits that are currently deactivated for 837 Medicaid Encounters, effective February 29, 2016. The following CEM Edits outlined in the Medicare Encounter Data Companion Guides - Table 11 will be re-activated to ensure syntactically correct Medicaid encounters are received:

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Comprehensive Resolution/Prevention

X222.091.2010AA.N301.070 X222.091.2010AA.N302.060
X223.087.2010AA.N301.070

CSCC A7: "Acknowledgement /Rejected for Invalid Information…"
CSC 503: "Entity's Street Address"
EIC: 85 Billing Provider

A Post Office Box address cannot be used for the Billing Provider on Professional, DME or Institutional encounters.

X222.351.2400.SV101-7.020

CSCC A8: "Acknowledgement / Rejected for relational field in error"
CSC 306 "Detailed description of service"
2400.SV101-7 must be present when 2400.SV101-2 is present on the table of procedure codes that require a description.

A more descriptive meaning of the procedure code must be present when using a not otherwise classified or generic HCPCS procedure code.

Last Updated: 01/21/2016 04:46:00 PM