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This list provides the Smart Edit message descriptions for codes found on the 277CA electronic billing report. Refer to the Smart Edit web page for the general information on Smart Edits. These edits pertain to all Novitas providers and is intended for use by health care electronic billing personnel. If your rejection code does not appear on this list, try using the HIPAA 277CA Reject Code Lookup Tool (JH) (JL). For Novitas EDI contact information, click the 'Contact Us' option in the top menu bar of our website. Quick link to Smart Edit List - Part A. The Smart Edits shown in the chart below cannot be overridden and must be corrected for resubmission due to a data element limitation.
Effective date |
Message displayed |
Detail information |
July 15, 2023 |
Smart Edit The field referring first name cannot contain more than 35 characters. |
Please correct the referring provider first name field, X12 data element loop 2310F NM104. This error must be corrected prior to resubmission. |
July 15, 2023 |
Smart Edit The field Line-3-billingproviderCLIAID cannot contain more than 10 characters |
Please correct the Billing Provider CLIA ID field, X12 data element loop 2300/2400 REF*X4 This error must be corrected prior to resubmission. |
July 15, 2023 |
Smart Edit due to an error the claim could not be inserted |
This message is returned when invalid/incorrectly formatted data is submitted on the claim. An example of invalid data would be when an invalid birthdate of 00010101 is submitted. This error must be corrected prior to resubmission. |
July 15, 2023 |
Smart Edit The field attributeCode_OC cannot contain more than 2 characters occurred twice |
Please correct the Occurrence Code field, X12 data element loop 2300 HI*BH This error must be corrected prior to resubmission. |
Aug 12, 2023 |
Smart Edit IJ000453 unable to get managed connection for javajboss/apollo-datasource |
This is a systematic error. No corrections are needed but claims must be resubmitted. | The Smart Edits shown in the chart below have varying impacts to the claim. Please read the 'Detail information' column carefully.
Effective date |
Flag |
Pattern number |
Message displayed |
Detail information |
July 15, 2023 |
DDR PE_PAY |
N/A |
The payer ID is invalid (refer to 2010BB NM109 loop and segement of your electronic claim file) |
The edit will set when payer ID in 2010BB NM109 LOOP is invalid for Medicare billing. A valid Medicare Payer ID should be reported. Reference: Novitas Solutions Payer ID codes |
July 29, 2023 |
MBC |
4087 |
Per CMS guidelines, payment for procedure code <1> is always bundled into payment for other services not specified and no separate payment is made. |
Informational only This edit will set as an informational message when no payment will be made on the specific service reported. References: Centers for Medicare and Medicaid Services (CMS) National Physician Fee Schedule look up tool- Look up a procedure with bundled status at: Physician Fee Schedule Look-Up Tool Fee Lookup (JH) (JL) |
July 29, 2023 |
MTF |
20657 |
The beginning date of service occurred more than 12 months from the entry date <1>, this exceeds Medicare's timely filing guidelines. |
This edit will set when the timeframe to file a claim has expired. If a denial or reject is needed for other insurance, please resubmit this claim after 24 hours. References: Timely filing requirement Timely filing calculator |
July 29, 2023 |
mUO |
24078 |
Per Medicare CCI Guidelines, procedure code <1> has an unbundle relationship with history procedure code <2> on line ID <4> and claim ID <3>. Review documentation to determine if a modifier is appropriate. |
This edit will set when the services submitted are bundled per Medicare Correct Coding Initiative (CCI). Review the claim and determine if a modifier should be added, resubmit with appropriate modifier, or resubmit after 24 hours. Reference: National Correct Coding Initiative |
September 14, 2023 |
mAT |
93 |
Per Medicare guidelines procedure code <1> requires modifier GP, GO, or GN. |
This edit will assign when a therapy code is billed without a required modifier. Add the appropraite modifier to the procedure code and resubmit. Reference: Therapy Modifiers |
September 14, 2023 |
mC35 |
25834 |
Per Medicare guidelines, procedure code <1> is not covered when billed by a provider with specialty 35, Chiropractor. |
Informational only This edit will assign when a procedure code is billed that is not payable to a chiropractor. CMS References: Billing and Coding: Chiropractic Services Medicare Benefit Policy Manual |
September 14, 2023 |
mMAT |
13350 |
Per Medicare guidelines, modifier AT is required when billing procedure code 98941 for active treatment. Medicare does not pay for maintenance therapy. |
This edit will assign when procedure code 98941 is submitted without modifier AT. Add the modifier and resubmit. CMS References: Billing and Coding: Chiropractic Services Medicare Documentation Job Aid for Chiropractic Doctors |
Not effective yet |
DCP |
Smart Edit |
This line is a possible duplicate of a claim line performed by the same provider on the same day. |
This edit will set when a claim is submitted twice during a 24-hour period and no changes have been detected. Review the claim, if no changes are needed, resubmit claim after 24 hours. |
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