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Medicare Medicaid Plans
MMP Edits Update Effective February 29, 2016 - Clarification

CMS is continuing enhancements to the Medicare-Medicaid Processing System.  In order to ensure syntactically correct Medicaid encounters are received, CMS has determined a need to revise the list of re-activated Common Edit Module (CEM) edits effective February 29, 2016 to a total of eight (8) edits. The following CEM edits will be re-activated effective February 29, 2016:

Edit Reference

Edit Description

Comprehensive Resolution/Prevention

Professional and DME:  

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

Institutional:
X223.087.2010AA.N301.070 
 

X223.087.2010AA.N302.060 

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.   

 

Professional and DME:  

X222.351.2400.SV101-7.020  

Institutional:  

X223.424.2400.SV202-7.025

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.

Dental Only: X224.086.2010AA.N301.050
X223.086.2010AA.N302.040

 

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.