Medicare NPI exclusion edits

Correction: Edit should read as follows:
EDIT HU 0024C:INVALID CLAIM SRV FAC ID QUAL - IN LOOP 2310D(PROF) WHEN NM108 IS SENT IT MUST BE EQUAL TO XX

Update: RelayHealth has also implemented the following NPI edit for all Medicare Part A payors.
EDIT HU 0024C:INVALID CLAIM SRV FAC ID QUAL - IN LOOP 2310D(PROF) NM108 MUST BE EQUAL TO XX

RelayHealth will be implementing payor NPI changes on May 22, 2008 in preparation for the CMS requirements that will take effect on May 23, 2008. As part of this change, RelayHealth will be implementing the following NPI edits for all Medicare Part A and Part B payors.
The following edits apply to Medicare Part A payors:
EDIT HU 0022C:INVALID CLAIM REND PRV ID QUAL - IN LOOP 2310C(INST), NM108 MUST BE EQUAL TO XX
EDIT HU 0026C:INVALID CLAIM ATTEND PHY ID QUAL - IN LOOP 2310A(INST), NM108 MUST BE EQUAL TO XX
EDIT HU 0027C:INVALID CLAIM OPERATE PHY ID QUAL - IN LOOP 2310B(INST), NM108 MUST BE EQUAL TO XX
EDIT HU 0028D:INVALID SRV LINE REND PRV ID QUAL - IN LOOP 2420C(INST), NM108 MUST BE EQUAL TO XX
EDIT HU 0034D:INVALID SRV LINE ATTND PHY ID QUAL - IN LOOP 2420A(INST), NM108 MUST BE EQUAL TO XX
EDIT HU 0035D:INVALID SRV LINE OPER PHY ID QUAL - IN LOOP 2420B(INST), NM108 MUST BE EQUAL TO XX

The following edits apply to Medicare Part B payors:
EDIT HU 0021C:INVALID CLAIM REF PROV ID QUAL - IN LOOP 2310A(PROF), NM108 MUST BE EQUAL TO XX
EDIT HU 0023C:INVALID CLAIM PUR SRV ID QUAL - IN LOOP 2310C(PROF), NM108 MUST BE EQUAL TO XX
EDIT HU 0025C:INVALID CLAIM SUP PROV ID QUAL - IN LOOP 2310E(PROF), NM108 MUST BE EQUAL TO XX
EDIT HU 0029D:INVALID SRV LINE PUR SRV ID QUAL - IN LOOP 2420B(PROF), NM108 MUST BE EQUAL TO XX
EDIT HU 0031D:INVALID SRV LINE SUP PROV ID QUAL - IN LOOP 2420D(PROF), NM108 MUST BE EQUAL TO XX
EDIT HU 0032D:INVALID ORDERING PROVIDER ID QUAL - IN LOOP 2420E(PROF), NM108 MUST BE EQUAL TO XX
EDIT HU 0033D:INVALID SRV LINE REF PROV ID QUAL - IN LOOP 2420F(PROF), NM108 MUST BE EQUAL TO XX
EDIT HU 0036D:INVALID PURCHASE SERVICE ID - FOR PROFESSIONAL CLAIMS, PS101 MUST BE 10 NUMERIC AND POSITION 1 MUST BE 1 OR 2 AND MUST PASS NPI CHECK DIGIT ROUTINE

Action Required: Please be aware of the Medicare Part A and Part B new edit requirements effective May 22, 2008.

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