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Part A Noridian Custom Edits (NCE) - STC*A3:23:41

To decrease the provider burden associated with claim-related administrative costs, Noridian is integrating Noridian Custom Edits (NCE) into our EDI gateway for electronic claims processing. NCE enhance claims editing for both providers and payers and integrate with existing claims acknowledgement reporting (277CA) on 837 electronic claim submissions.

NCE allow Noridian to:

  • Help identify problematic or "certain to deny" claims prior to Noridian claims processing
  • Alert providers of errors and potential claim processing issues around medical necessity, non-covered services, missing modifiers, and other clinical editing
  • Deliver timely and clear notifications of how to fix claim errors
  • Save administrative time tied to claim resubmissions
  • Improve transparency of claim editing and claims processing

NCE populate in the STC elements of the 277CA with distinct code sets that can be cross referenced to the NCE table below.

Note: Claims rejected by NCE editing are not sent through the claims processing system. If you are seeking a denial, remittance advice, or do not wish to make any corrections, simply resubmit the claim.

NCE Flag NCE Rule ID NCE Description NCE Expression
01ODID 20687 [Pattern 20687] The other diagnoses codes <1> are invalid due to having an incomplete number of digits and or the diagnosis code is termed. This inpatient edit will set when another diagnosis code has an incomplete number of digits.
VCCCf 21839 [Pattern 21839] Value code 42 and condition code 26 must both be present on the claim This inpatient edit will set when a claim is billed with a Condition Code 26 and not a Value Code 42 -or- An inpatient claim is billed with a Value Code 42 and not a Condition Code 26.
002IAG 27742 [Pattern 27742] The principal diagnosis code <1> is for maternity and is not typical for the patient's age <2> years. This outpatient edit will set when the principal diagnosis code is identified as a maternity age classification and the age of the patient is less than nine or greater than 64.
003ISX 18850 [Pattern 18850] The other diagnosis code <1> is designated for male patients only and this conflicts with the submitted gender of the patient. This edit will set when the diagnosis code describes a condition for a male gender and the patient's gender is female.
003ISX 18849 [Pattern 18849] The other diagnosis code <1> is designated for female patients only and this conflicts with the submitted gender of the patient This outpatient edit will set when the diagnosis code describes a condition for a female gender and the patient's gender is male.
DDRERR N/A This message is returned when invalid/incorrectly formatted data is submitted on the claim. An example of invalid data would be when an invalid Type of Bill (TOB) of 0073 is submitted. Ruleset could not be found for claim with current setup. Check route setup and ensure a default rule set has been configured.
N/A N/A SMARTEDIT SECURITY ID INSTITUTIONAL_DEFAULT IS NOT VALID OR ENTERPRISE DOES NOT EXIST This edit occurs when the Payer ID is not the same throughout the file.
03DDC 4690 [Pattern 4690] The other diagnoses code is a duplicate of the principal diagnosis code. This inpatient edit will set when an other diagnosis code is a duplicate to the principal diagnosis code.
03ODDC 4691 [Pattern 4691] The other diagnoses code is a duplicate of another other diagnosis code on the claim. This inpatient edit will set when an other diagnosis code is a duplicate to another other diagnosis code.