EDISS Takes Rejection Calls; PCC Takes Denial Calls
For All Medicare Submitters
To ensure callers reach the appropriate department, EDISS would like to provide some clarification on the terms "Rejection" and "Denial." EDISS can help with Rejections, but not Denials.
Rejection (EDISS):
The claim file stopped processing before it reached Medicare. The submitter received an error on one of the three EDISS front-end system acknowledgement reports - the TA1, 999, or 277CA report. A remittance advice will NOT be generated.
EDI can help with Rejection questions.
Denial (PCC):
The claim processed through EDI, was received by Medicare for processing, but was either not paid or not paid in full by Medicare. The submitter will receive the Denial information on a Remittance Advice.
The Provider Contact Center (PCC) can help with Denial questions.
Message Sent:
August 3, 2021