Change in 837 4010 EMC Pre-Pass Editing

Home Provider Part B Medicare Areas EDI/HIPAA

The electronic media claims (EMC) system reviews every claim for a number of pre-pass edits to ensure that claim data is valid. If a claim contains missing or incorrect information, one of two things will happen because of a pre-pass edit.

1. If an informational edit is in effect, the claim, batch, or file will process normally. The informational edit identifies the error and alerts the submitter in order to correct future claims.



2. If a delete edit is in effect, the claim, batch, or file will not process normally; it deletes from the claims processing system and alerts the submitter to the error.

If an incorrect carrier number (1000B/NM109) is submitted after October 2, 2006, the file will be rejected and the error will be displayed on the Batch Detail Control Listing (BDCL) report as edit M360. This informational edit will serve as a reminder to Medicare Part B Trading Partners to send the correct carrier number. Below are the WPS Medicare Part B carrier numbers:

Illinois 00952
Michigan 00953
Minnesota 00954
Wisconsin 00951

The edits will temporarily be set as informational and effective October 2, 2006 delete. It is important that you receive and review your prepass reports.

A complete list of current 4010A1 pre-pass edits, as well as a detailed description, is available in the WPS Bulletin Board in the EDI file library in the HIPAA directory (file name: 4010_401.doc) or on the WPS web site:
http://www.wpsic.com/edi/pdf/hipaa_mcs837.pdf .

If you need additional information you may also contact the WPS EDI Hotline for IL, MI & WI: 877-567-7261, or for MN: 952-885-2811, 952-885-2881 or 952-885-2882.

Page Last Updated: Tuesday, 26-Feb-2008 14:16:27 CST