Electronic Claim Submission - JA DME
Common Electronic Data Interchange (CEDI) - Electronic Claim Submission
Electronic Data Interchange (EDI) is the computer-to-computer electronic exchange of business documents using standard formats. One method of EDI is the ability for suppliers to transmit Electronic Media Claims (EMC) to Medicare.
The Common Electronic Data Interchange (CEDI) contractor, National Government Services, provides a single electronic front end solution for all DME MAC suppliers. CEDI works closely with DME MAC software vendors, billing services, clearinghouses and trading partners (electronic submitters) on all electronic front -end needs.
The following electronic transactions are handled by CEDI:
- Electronic claims [American National Standards Institute (ANSI) X12N 837 and National Council for Prescription Drug Programs (NCPDP)]
- Delivery of all electronic front-end acknowledgements and reports
- Electronic Remittance Advices (ERA)
- 276/277 Claim Status Request/Response
It is imperative for suppliers to receive and work the front-end acknowledgement reports to ensure all claims are received within the Noridian claims processing system. When these reports are not worked, Noridian never receives the claim into the claims processing system until the claim is corrected and resolved.
Learn what questions the CEDI Help Desk can and cannot answer.
Electronic Claims
A key first step to billing electronically is enrolling in the CEDI (Common Electronic Data Interchange) program, which is managed by the CEDI Contractor.
Benefits of Electronic Claims Submission:
- Faster Payments: Electronic claims can be paid as soon as 14 days after receipt, while paper claims have a minimum payment delay of 28 days.
How to Submit Electronically:
Suppliers can choose from several methods to submit claims electronically to the DME MAC:
- Free Software: PC-ACE is a complimentary billing software that complies with HIPAA standards and offers features for claim submission, archiving, and reporting. For more details, contact CEDI.
- CEDI Claims Portal: This web-based option is ideal for suppliers submitting a small volume of claims.
- Approved Software Vendor, Billing Service, or Clearinghouse: CEDI provides an Approved Entities List on their website for suppliers to review.
DME MAC Contractor Codes (Payer IDs):
- Jurisdiction A: 16013
- Jurisdiction D: 19003
Enrollment in CEDI
To enroll in electronic claims processing and explore other available electronic transactions, please contact the CEDI Contractor.
Change in Submission of CEDI Enrollment Forms
New forms are only required if modifications are needed to your current enrollment.
CEDI has updated two validations within the CEDI enrollment form submission process to verify the DME supplier's information while completing the forms. Previously these validations were done after submission. The validations will not allow submission of enrollment forms with invalid or incomplete information related to the Supplier's Name and the DME Supplier Signature. Below is guidance on preventing and/or resolving these validations.
- The authorized or delegated official's name entered in the DME Supplier Signature field will be verified against PECOS and must match the authorized or delegated official's name. Access PECOS to verify how the authorized or delegated official's name is listed.
Important: The full name is required including punctuation. Please do not use initials or nicknames.
The CEDI enrollment forms will only accept the authorized and/or delegated official of the facility. Clearinghouses, Billing Services and/or other Third Party Entities are NOT ALLOWED to sign enrollment forms and must not submit them on behalf of the supplier.
- The Supplier Name on the enrollment form must match the Legal Business Name as it is in PECOS to be accepted. To verify the Supplier/Provider name please contact the NPEAST at 1-866-520-5193 or NPWEST at 1-866-238-9652 or access PECOS.
Important: Please include punctuation as it appears in PECOS. An exact match is required.
