Novitas Smart Edit list - Part B

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.

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.