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DDE User Guide Update 10 Dec 2024

For Medicare Part A Submitters

To better serve our provider community, the Direct Data Entry (DDE) User Guide has been updated. Updated items include:

  • New resource links to the Noridian website condition code pages added to Chapter Five - Claims Corrections, page 119

Access this guide within the "Educational Resources" section of the Jurisdiction E and Jurisdiction F DDE webpages. If you have questions about DDE, please contact the Part A Provider Contact Center.

Message Sent:
December 10, 2024
January 5, 2021
December 17, 2020

EDI Rejection Look Up Tool 10 Dec 2024

For All Submitters

On 2/09/2024 providers will have access to the EDI Rejection Lookup Tool that will replace the Rejection Spreadsheets.

The EDI Reject Lookup Tools will allow submitters to access rejection information received on their TA1, 999 or 277CA reports. The tool provides the user with detailed information as to what the rejection is related to.

To use the Edit Lookup Tool, enter in either part of the rejection code or a keyword.

Message Sent:
December 10, 2024
February 6, 2024

Importance of Verifying EDISS Connect Registration 10 Dec 2024

For All Submitters

EDISS Connect is the enhanced online registration and testing tool found at https://connect.edissweb.com/. If the information contained within EDISS Connect is not up to date, it can lead to issues submitting and receiving data in the future. To eliminate any issues that may occur with EDISS Connect profiles, please verify the following:

  • Transactions
    • Providers are limited to selecting two vendors for their 837 transactions and only one for all other transactions
    • Non-Medicare lines of business must indicate the same Vendor Submitter ID for all lines of businesses on their 835 Remittance Advice in EDISS Connect
  • Vendor associations
  • Submitter ID
  • NPI values
  • Basic demographic information
    • Email address
    • Address
    • Phone number
    • Fax number

Message Sent:
December 10, 2024
January 9, 2024
May 3, 2022

Coming Soon! EDI Enrollment Recertification 31 Oct 2024

For All Providers and Vendors

Starting in November, EDI Support Services is implementing a required annual recertification of all provider/vendor EDI Enrollment(s). This recertification is for all billing NPIs/vendor accounts currently registered in the EDISS Connect registration website. It is important that this is completed timely, to ensure that EDI functionality is not impacted.

Note: Providers that have multiple NPIs tied to their EDISS Connect account will be receiving multiple notifications.

How it will work

Providers/vendors will be receiving an email notification when they are due to recertify. This will go to the email address that is on file in EDISS Connect. There will be instructions in the email on how to complete the recertification.

What you can do to prepare

Ensure that your contact information on file in your EDISS Connect account is up to date.

  • Visit https://connect.edissweb.com
  • Log into your account
    • If it has been more than 90 days since you last logged in, you will need to use the 90 days since last login? link to create a new user.
  • Once in the account, select Edit Profile to review and make updates to your contact information

Watch for updates to additional educational resources at https://www.edissweb.com.

Message Sent:
October 31, 2024
October 25, 2024
October 21, 2024

Testing for Medicare Providers 05 Oct 2024

For New Medicare Direct Submitters

Medicare testing process information is available at https://www.edissweb.com/web/cgpblue/registration.

After adding a direct Medicare 837 transaction in EDISS Connect, allow 10 business days for EDI Support Services (EDISS) to complete testing setup. When setup is complete, submit a Medicare 837 Test file and review the TA1, 999, and 277CA Acknowledgement Reports.

Once a provider has received a clean 277CA Acknowledgement Report, EDI Support Services (EDISS) will ensure the 837 transaction is approved in EDISS Connect. For help, please contact EDISS.

Message Sent:
December 10, 2024
July 5, 2022

Noridian Custom Edits (NCE) Disabled 8/24/2024 01 Oct 2024

For All Medicare Submitters

The Noridian Custom Edits (NCE) that appear on the 277CA reporting were disabled starting on 8/25/2024. The edits will no longer be applied to claims processed on or after that day. For past reference, the list of Part A and B edits will be available on https://www.edissweb.com/ until 10/31/2024.

Message Sent:
October 1, 2024
September 6, 2024

Requirements for Electronic Remittance Advice (ERA) Inquiries 01 Oct 2024

For All Submitters

EDI Support Service (EDISS) will be implementing a change effective 11/1/2024 regarding what information is required when calling or emailing for electronic remittance advice assistance. As a reminder, EDISS retains all electronic data for 30 days.

If the request is made by phone:

  • Unique Submitter ID used to retrieve and/or download the file
  • Billing NPI
  • The check example that is missing

Note: If there are more than 5 missing ERAs, it is recommended that you send an email for the request.

If the request is made by email:

  • Unique Submitter ID used to retrieve and/or download the file
  • Billing NPI
  • Check number, check date, check amount - this must be sent via a secure email

Note: For JE providers utilizing a vendor, EDISS must receive the request from the Vendor.

To prevent delays in receiving assistance, please ensure you have this information ready when making the request or you may be asked to call back once you have obtained the required information.

Message Sent:
October 1, 2024

Updated Requirements for Claim Submission Inquiries 01 Oct 2024

For All Submitters

To provide the most efficient customer service possible for our Submitter community, EDISS implemented a change to what information is required when calling or emailing for claim submission assistance. Effective 11/1/2024, EDISS requires additional elements from the inbound file for questions regarding claim submissions.

  • Date of Submission - must be within the last 30 days
  • ISA13 (Interchange Control Number) - this is typically nine digits in length
  • Unique Submitter ID used to send the file

Providing this information ensures that EDISS reviews the correct file. To prevent delays in receiving assistance, please ensure you have this information ready when calling as those who do not have this may be asked to call back once they have obtained the required elements.

Message Sent:
October 1, 2024

Connect Registration Guides Update 06 Sep 2024

For All Submitters

There have been recent improvements made to the EDISS Connect registration guides. The new and improved guides can be viewed on https://www.edissweb.com by selecting a state and navigating to the Registration page.

Message Sent:
September 6, 2024

Navigating the IVR 06 Sep 2024

For All Medicare Submitters

EDISS provides the following overview of the Noridian Interactive Voice Response (IVR) system prompts to help our Submitter community become more familiar with what to expect when calling. For more information, visit https://med.noridianmedicare.com/.

Menu Prompt Department Assistance Provided Additional Prompts
General or press 1 Part A and B Contact Center Patient eligibility, claim status (use for assistance with denials), check and remit information and general questions Enter the following information:
  • NPI
  • PTAN
  • Last 5 of the Tax ID (TIN/S)
Select which menu option best fits your need.
EDI or press 2 EDI EDI registration, Gateway and Connect password assistance, claim rejection assistance Is the call related to the Noridian Medicare Portal registration or password assistance?
Verbal Response
  • Say Yes - Caller will be transferred to User Security department
  • Say No - Caller will be asked if his/her inquiry is general or password related
    • Say General for general EDI questions
    • Say Passwords for EDI passwords
Note: Vendors who do not have a specific NPI or PTAN available, say Agent to speak with a representative.
Enrollment or press 3 Provider Enrollment Medicare enrollment assistance Is caller calling to obtain EDI Trading Partner or Submitter ID?
Verbal Response
  • Say Yes - Caller will be transferred to EDI department
  • Say No - Caller will be asked if his/her inquiry is regarding mailing addresses, application fees, or application status information
    • Say Yes - Caller will be directed to website for additional information based on his/her selection
    • Say No - Caller must provide the Provider Authentication Elements to reach a representative
Reopening or press 4 Phone Reopenings Medicare Part B Phone Reopenings Enter the following information:
  • NPI
  • PTAN
  • Last 5 of the TIN/SSN
  • ICN for the claim needing to be adjusted
Security or press 5 User Security Direct Data Entry (DDE) and Noridian Medicare Portal (NMP) registration and password assistance Are you calling for EDISS connect or EDISS gateway assistance?
Verbal Response
  • Say Yes - Caller will be transferred to EDI department
  • Say No - Caller will continue to User Security

Message Sent:
September 6, 2024
August 3, 2021

EDISS Password Criteria Reminder 06 Aug 2024

For All Submitters

Passwords for all EDISS systems, including, but not limited to, EDISS Connect, SSPR, and the EDISS Gateway must adhere to the following criteria:

  • At least eight (8) characters, maximum of sixteen (16)
  • At least one upper-case letter
  • At least one lower-case letter
  • At least one number
  • At least one special character ($, #, *, -, or _ ). Do not use '&' or '+'
  • The use of dictionary names or words as passwords is prohibited
  • The same password cannot be reused for six (6) generations
  • Maximum Sequential Repeat: 2 (e.g LL or GG or 00 is the max of repeats of a character allowed)
  • Maximum Characters from Previous Password: 4

Message Sent:
August 6, 2024
September 8, 2022

ERA vs SPR 06 Aug 2024

For All Medicare Submitters

Did you know that when you register for electronic remittance advice (ERA), you will receive both the ERA and a standard paper remittance (SPR) for 45 days for Part B and 30 days for Part A?

Note: JE Part B providers will have the overlap occur when they change vendors.

It is common for EDI to receive calls regarding still receiving SPRs in the mail after a provider has registered. This overlap allows time for providers to ensure any software used, is working as it should before the SPR mailing stops.

Per CMS direction in Change Request (CR) 10151, Noridian cannot revert remittance back to the SPR once a provider has registered to receive ERA.

Message Sent:
August 6, 2024

Multiple Billing NPIs for a Single Medicare PTAN 06 Aug 2024

For Medicare Part B Submitters

Due to CMS regulations in the Medicare Part B system, when multiple billing NPIs are linked to one PTAN, the electronic remittance advice (ERA) for all NPIs associated with that PTAN will deliver to only one trading partner. This could potentially result in one ERA containing multiple billing NPIs. Each NPI within the ERA will be contained in its own transaction set (ST-SE).

  • JF Medicare providers - All ERAs created for the Medicare PTAN will deliver to the trading partner indicated in the Connect registration website for the lowest numeric Submitter ID.
  • JE Medicare providers - The remit will deliver to whichever NPI last updated their 835 transactions in Connect.

For this reason, it is important for Submitters to log into their EDISS Connect accounts to ensure all NPIs linked to one PTAN indicate the same trading partner for delivery for their remits.

Message Sent:
August 6, 2024
September 6, 2023

EDISS Apologizes for Recent Connectivity Issues 02 Jul 2024

For All Submitters

Many of you have noticed connectivity issues and/or report delays over the past several weeks, for which EDI extends sincere apologies. In spite of our preparation and advance testing, unforeseen issues did occur during several recent system updates. We understand these issues have been disruptive to your business, and have been diligently working to find and correct their sources. Please know that we continue to actively work to improve connections for all of our Trading Partners. We appreciate your patience and understanding during this process to improve our system stability.

Message Sent:
July 2, 2024
February 1, 2022

PC-ACE Quarterly Update 02 Jul 2024

For All PC-ACE Users

An updated version of the HIPAA-compliant PC-ACE software is now available for download from the EDISS website at https://www.edissweb.com.

An update to PC-ACE is available every quarter (i.e., January, April, July and October). Updating quarterly is important to ensure edits, codes and other information is current within the PC-ACE program. The update installation may either be run from the website or saved to your local computer or network.

ATTENTION: If saving the update to your local computer or network, DO NOT save the update file in the current WINPCACE folder on the drive where PC-ACE is installed. Doing so will cause loss of data to any information you have saved within PC-ACE.

Message Sent:
July 2, 2024
January 9, 2024
October 4, 2023
September 6, 2023
April 7, 2023
February 7, 2023
September 8, 2022
April 5, 2022

PC-Print Quarterly Update Available 02 Jul 2024

For Medicare Part A Submitters

An updated version of PC-Print is currently available for download at https://www.edissweb.com/cgp/software/pcprint.html. For further assistance with software updates, please contact EDISS.

Message Sent:
July 2, 2024
January 9, 2024
October 4, 2023
April 7, 2023
February 7, 2023
August 4, 2022
April 5, 2022

Acknowledgement Report and Remittance Advice Reminders 06 Jun 2024

For All Submitters

EDI Support Service (EDISS) retains acknowledgement report and remittance advice data for 30 days. If a provider who is registered with a vendor in EDISS Connect needs an acknowledgement report/remittance advice reposted during this 30-day timeframe, they should first check with their vendor. If the vendor needs it reposted to their vendor mailbox, either the vendor or provider may request the repost by calling or emailing EDISS.

Note: If the acknowledgement report/remittance advice content contains more than one provider's information, EDISS will require the repost request come from the vendor.

The following options are available for obtaining remittance advice information:

Iowa Medicaid Providers - The Iowa Medicaid Web Portal can be used for downloading remittances, response transactions, and acknowledgement reports indicating the status of the submitted transaction. User documentation for all acknowledgement reports is available at www.edissweb.com.

Medicare - Providers registered for Electronic Remittance Advice (ERA) can download the remittance advice from a Billing Service/Clearinghouse or directly through a Network Service Vendor, as established through Registration and Connectivity set up.

Per CMS direction in Change Request (CR) 10151, Noridian cannot revert remittance back to the Standard Paper Remittance Advice (SPR) once a provider has registered to receive ERA.

Part A providers that remove ERA will have the option of viewing their Remittance Advice information in the Noridian Medicare Portal (NMP) as single-line Remittance Advice only. For more information on NMP registration and functionality, please visit www.noridianmedicare.com. The claim-level remittance information is available using the Direct Data Entry (DDE) system. The only way to obtain the full remittance advice again would be to add the 835 transaction back into the EDISS Connect account.

Part B providers that remove ERA will only be able to view their full Remittance Advice in the NMP. To view a Remittance Advice in NMP, providers will need to register for the NMP full remittance advice access. For more information on NMP registration and functionality, please visit www.noridianmedicare.com.

Message Sent:
June 6, 2024
December 8, 2023
January 3, 2023

Check the EDISS Website for System Status 04 Jun 2024

For All Submitters

The EDI Support Services (EDISS) website is the resource for Current System Status, Production Alerts, and other EDI information. In the event of Report or Remittance Advice delivery delays, EDISS Gateway issues, website unavailability, and all other EDI system related issues, submitters can reference the Current System Status.

To find the Current System Status, visit https://www.edissweb.com, select a state, and the Current System Status will be located in the top right corner of the site.

Message Sent:
June 4, 2024
March 7, 2023
December 8, 2023
December 6, 2022

Registration and Acceptance for 837D Claims 04 Jun 2024

For All Submitters

EDISS Connect Medicare submitters can now begin enrolling for Dental 837D transactions within their Connect account. Submitters can enroll and complete the testing process at this time only, live production claims processing will begin at a later date. For additional information on the testing process visit www.edissweb.com, select your state and the Registration tab.

To assist providers with their testing process, there is a Dental Companion Guide and an 837D Edit spreadsheet available at www.edissweb.com.

Message Sent:
June 4, 2024

EFT vs. ERA 07 May 2024

For All Medicare Submitters

EDI Support Services (EDISS) often gets questions regarding EFT updates and wants to provide clarification on EFT, ERAs, and who can assist with related questions.

EFT (Electronic Funds Transfer) - The process whereby the provider's Medicare payment is transferred to the provider's bank and automatically deposited into their bank account. For assistance with your EFT, contact Provider Enrollment.

ERA (Electronic Remittance Advice) - The ERA is the electronic version of the SPR (Standard Paper Remittance), which serves as a notice of payment and adjustments sent to providers, billers, and suppliers. It explains the reimbursement decisions of Medicare. For assistance with your ERA, contact EDISS.

Message Sent:
May 7, 2024

Selecting Direct vs. a Vendor in Connect 07 May 2024

For All Submitters

EDISS has come across Provider Connect accounts where both 'I will' and a Vendor are selected for an 837 Claim Submission transaction, but the provider has not tested the direct request. See below for clarification on these options to ensure correct electronic transaction registration.

  • I will and/or: Providers should check only if submitting/receiving transactions directly
  • Add Vendor: Providers should select if using a vendor for transactions
    • Select Add Vendor
    • Type the vendor name or Submitter ID
    • Highlight the vendor and click add

Message Sent:
May 7, 2024

You Asked We Listened - Changes to EDISS Connect Registration 07 May 2024

For All Submitters

There have been some improvements made to EDISS Connect registration. Some of the biggest updates are as follows:

  • The contact listed on the Providers EDISS Connect account will receive a Production alert email for every transaction that is moved into production.
    • For a Provider it's important that the contact is up to date on the account profile page to ensure delivery of the production emails
    • It is important to pay attention to the information in each email, so you know which transaction is ready
    • Typically for the 837I/837P, you will want to wait the overnight cycle before submitting claims to avoid any rejections
    • These emails will include the Provider Trading Partner ID
    • It will alleviate calling and/or emailing in for status of your account (which was stopped back in 2019)
    • It provides you with the confirmation request that you can pass onto your Vendor/Clearinghouse to begin submitting on your behalf
  • Lines of Business no longer in service were removed.
  • Our Contact page on the main login and the contact tab within the Connect account now has the states listed for each jurisdiction.

This provides you with the correct number to call, to avoid any confusion or redialing

Message Sent:
May 7, 2024

How do EDISS Connect transactions affect NMP access? 02 Apr 2024

For All Medicare Submitters

Although you are required to register in Connect prior to NMP enrollment, how is NMP access affected when you make changes to your EDISS Connect transactions? It is actually the transactions in Connect that affect the access to information in NMP. When making changes in EDISS Connect, be sure to leave at least 1 transaction in production to keep uninterrupted NMP access. This can be any of the 3 transactions available in Connect, 837, 835 or 276.

Message Sent:
April 2, 2024

How do I get a Submitter ID? 02 Apr 2024

For All Medicare Submitters

The assigning of a Submitter ID is completed after the registration for EDISS Connect is complete. There are two Types of Submitter IDs that are assigned at different times.

Vendors: Vendor Submitter IDs are assigned 5-7 business days after they register in EDISS Connect.

Providers: Providers have a two-part registration for EDISS Connect. The following steps will occur:

  • Initial registration
  • Receive validation email (3-5 business days)
  • Log back in and complete registration by adding transactions and method they plan to use to complete each transaction
  • Submitter ID is assigned and transactions are granted production status (5-7 business days)

Message Sent:
April 2, 2024

Special Character Usage 02 Apr 2024

For All Submitters

Special Characters used both in file data and appearing as delimiters in EDISS response reports will cause file processing failure. Other Special Characters used in file names will also cause issues.

The following Special Characters within the data cause report files to not generate. If you are missing report files, please review the data for these most commonly submitted Special Characters.

CHARACTER NAME
~ Tilde
` Backtick
  Extra spaces at the end of elements
"" Two double quotes *

* Two double quote characters in a row. (For example, "Text" is acceptable, but ""Text is invalid.)

NOTE: An apostrophe ( ' ) must NOT be used in CLM01.

Submitters must NOT use the following Special Characters in naming their EDI files:

CHARACTER NAME
* Asterisk
^ Carat
: Colon
~ Tilde
` Backtick
' Apostrophe

Submitters can use the following valid Special Characters in file names:

CHARACTER NAME
- Dash
_ Underscore
. Period
| Pipe

NOTE: Do NOT exceed 40 characters in file names.

Message Sent:
April 2, 2024
April 5, 2022

NMP Submissions 05 Mar 2024

For All Submitters

In an effort to simplify the NMP submission process, below is a list of items to check when submitting:

  • Be sure to select the I will and/or option for the 837 transaction selected in production and in Connect.
  • Files sent should be in an ANSI X12 format and contain a file extension of .txt, .edi or .dat
  • Files being uploaded should not be more than 10 MB.

Message Sent:
March 5, 2024

Updating Transactions with EDISS 05 Mar 2024

For All Submitters

In an effort to simplify the process of updating your transactions with EDI, we have created a basic list of the steps needed. Whether you are changing vendors or switching to direct, this list has you covered.

Option 1: Change to a new vendor

  1. Provider will log into their EDISS Connect account at https://connect.edissweb.com/
    Note: If it has been more than 90 days since your last login, select the 90 days since last login? option to regain access to your account.
  2. Select Manage Transactions.
  3. For the 837 transaction, select Add Vendor.
    Note: Only two submission methods can be listed in the EDISS Connect account. If you already have two listed, one will need to be removed to add the new vendor.
  4. Search for the new Vendor by name or Trading Partner ID and Add the correct option once located.
  5. Allow 7-10 business days for the transaction to be moved into production.
    Note: You will not receive a notification when the new vendor has been moved to a production status. We encourage you to log into your account frequently to confirm the status of the transaction.

Option 2: Change to direct

  1. Provider will log into their EDISS Connect account at https://connect.edissweb.com/
    Note: If it has been more than 90 days since your last login, select the 90 days since last login? option to regain access to your account.
  2. Select Manage Transactions.
  3. For the 837 transaction, select the I will and/or check box.
    Note: Only two submission methods can be listed in the EDISS Connect account. If you already have two listed, one will need to be removed to add the I will and/or check box.
  4. Direct claim submission does require testing.
  5. Once a test file is submitted, please allow 72 hours for review of the file.
  6. If the test file is clean, the 837 I will and/or will be moved to a production status in your Connect account.
    Note: You will not receive a notification when the direct transaction has been moved to a production status. We encourage you to log into your account frequently to confirm the status of the transaction.
  7. Methods of submitting direct transactions:
    • Network Service Vendor (NSV)
    • Noridian Medicare Portal (NMP) Claim Submission (Medicare only)
    • Iowa Web Portal (Iowa Medicaid only)

Message Sent:
March 5, 2024

When to Call Rather than Email EDISS 05 Mar 2024

For All Submitters

EDISS cannot address Gateway or Connect access issues over email. Requests or questions around access or needing a Submitter ID must come through a phone call.

Medicare Lines of Business

Jurisdiction E (JE) Part A and B: 855-609-9960

Jurisdiction F (JF) Part A and B: 877-908-8431

All Other Lines of Business

800-967-7902

Message Sent:
March 5, 2024

Determining Which NPI to Use for EDISS Connect Registration 06 Feb 2024

For All Submitters

Providers should only register for transactions in EDISS Connect using their Billing NPI. Rendering or Individual NPIs will be removed from EDISS Connect.

Note: Medicare providers that are unsure of how their NPI(s) are registered, can verify them by referencing their provider enrollment approval letter or the PECOS registration system. The Enrollment on Demand Tutorial titled Where Can I Find My PTAN? located on http://med.noridianmedicare.com contains instructions on how to view the enrollment record within PECOS.

Message Sent:
February 6, 2024

EDISS Takes Rejection Calls; PCC Takes Denial Calls 06 Feb 2024

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:
February 6, 2024

ISA13 Requirement for Claim Submission Calls 07 Nov 2023

For All Submitters

To provide the most efficient customer service possible for our Submitter community, EDISS implemented a change to what information is required when calling for claim submission assistance. Effective 8/1/2020, EDISS requires the ISA13 (Interchange Control Number) element from the inbound file for questions regarding claim submissions. This is specifically required for Submitters who send more than 500 inbound files per day or in cases where the inbound file is not able to be located.

Providing this information ensures that EDISS reviews the correct file. Callers who do not have this may be asked to call back once they have obtained the ISA13 element.

Message Sent:
November 7, 2023

PC-ACE Link Correction 07 Nov 2023

For All PC-ACE Users

Due to reported issues with the Install PC-ACE link on the EDISS website at https://www.edissweb.com, EDISS has posted the corrected link. No issues were reported for the Update PC-ACE link.

We apologize for the inconvenience.

For further assistance with software updates, please contact EDISS.

Message Sent:
November 7, 2023

Part A/B Noridian Custom Edits (NCE) 04 Oct 2023

For All Medicare Submitters

NCE codes populate in the STC elements of the 277CA with distinct code sets that can be cross-referenced to the NCE Spreadsheet. To assist submitters' NCE review, Noridian has established edit spreadsheets for Part A at https://www.edissweb.com/web/cgpblue/reports/nce-pa and for Part B at https://www.edissweb.com/web/cgpblue/reports/nce.

NCE Informational edits set on claims but do not cause them to reject. Claims that hit Informational edits will process through to the payer. These can be distinguished from NCE that do cause the claim to reject by the STC codes. Informational edits will appear in the STC segment as A2:20:PR, while the Rejecting edits will appear in the STC segment as A3:23:41.

Informational NCE example:

STC*A2:20:PR**WQ*********SMARTEDIT PATTERN 8446 INFORMATIONAL. DIAGNOSIS CODE T8453XD COULD INVOLVE THIRD PARTY LIABILITY AND OR SUBROGATION OF BENEFITS.

Rejecting NCE example:

STC*A3:23:41**U*********SMARTEDIT PATTERN 45 PER MEDICARE GUIDELINES TEAM SURGERY IS NOT PERMITTED FOR PROCEDURE CODE 99214.

Message Sent:
October 4, 2023

Public Contact Information 04 Oct 2023

For All Vendors

Public Contact Information has been added to the Vendors Account Profile in EDISS Connect. This update allows a Vendor to list both public contact information for the 5010 Approved Vendor List as well as contact information for EDI. Please ensure the Profile information is accurate and publishable for the public view. If no information is listed for the Public Contact Information, it will continue to default to the current registration information. This list can be found on the EDISS website at https://www.edissweb.com/web/cgpblue/vendors.

Message Sent:
October 4, 2023

Have You Recently Received a New PTAN From Medicare? 06 Sep 2023

For All Medicare Part B Submitters

If your NPI is currently set up for electronic claim submission in Connect, receiving a new PTAN may cause a delay in processing claims associated with the new PTAN. To avoid this delay, contact EDI Support Services before submitting your first batch of claims. Provide the Customer Service Representative with the NPI and new PTAN. Please allow 7-10 business days for completion.

Message Sent:
September 6, 2023

Maintenance Downtime 11 Jul 2023

For All Submitters

EDISS has scheduled routine maintenance on Sundays during the hours of 6:00 AM until 12:00 noon Central time. Systems will be unavailable during these hours. Occasionally, maintenance can run longer than expected. When that occurs, EDISS will post a notification on the EDISS website in the upper right corner.

Message Sent:
July 11, 2023

Rejection vs. Denial 11 Jul 2023

For All Medicare Submitters

To ensure callers reach the department best able to assist with their issue, EDISS would like to clarify the terms Rejection and Denial.

REJECTION means the claim file stopped processing before it reached Medicare. This results in an error on one of the three acknowledgement reports generated by our front-end system the TA1, 999, and 277CA reports. A remittance advice will NOT be generated. EDISS can assist with Rejection related questions.

DENIAL means the claim processed through EDI, was received by Medicare for processing, but was either not paid or not paid in full by Medicare. This information is communicated to the provider on a remittance advice. The Provider Contact Center can assist with Denial related questions.

Message Sent:
July 11, 2023

Using the Gateway SSPR for Password Resets 11 Jul 2023

For All Submitters

EDI Support Services (EDISS) requires all submitters to use the Gateway Self-Service Password Reset (SSPR) website to gain access to their account when their password has been forgotten or has expired.

The "Forgot password?" option uses the security questions and answers that were created during registration. EDISS recommends Gateway users store their security questions and answers in a safe and secure location where they can be accessed for future use.

To access the Gateway SSPR,

For help using this feature,

Message Sent:
July 11, 2023

Edit Reference Documents are Available 06 Jun 2023

For Medicare Submitters

Reference documents for both Institutional and Professional edits are available on the EDISS Website.

Go to EDISSweb.com, click on your state, and under Quick Links on the right-hand side, select the LOB and transaction. Information including descriptions for 837P (Professional), 837I (Institutional), and 277/276 Claim Status Request transactions is available.

Message Sent:
June 6, 2023

Smart Edits Reference Documents 06 Jun 2023

For Medicare Submitters

Smart Edit translation help is available on the EDISS Website. Spreadsheets for Institutional and Professional Smart Edits (also known as Custom Edits) can be found in the same manner as the 837 and 277/276 documents.

Go to EDISSweb.com, click on your state, and under Quick Links on the right-hand side, select either Part A or Part B Custom Edits.

Message Sent:
June 6, 2023

Connect - User Set-up Assistance 02 May 2023

Vendors need to call the EDISS Call Center for assistance with adding new users, or if they're experiencing issues accessing their vendor account. When a vendor needs to add a new user to their existing vendor account, a form will be faxed to the vendor. After the form is returned, an email will be sent to the vendor with additional information.

The "90 Days Since Last Login" link is only for providers to re-gain access to their Connect account.

Message Sent:
May 2, 2023

Forgot Your Gateway Password? 02 May 2023

For All Submitters

EDI Support Services (EDISS) offers a tool called Gateway Password Management to assist submitters who need to re-set their Gateway password. This tool can be found in the shaded lower section of each web page at https://www.edissweb.com/. It requires the answers to your Security Questions, which were set up during registration.

Message Sent:
May 2, 2023

Please be Careful! 02 May 2023

For All Submitters

If you need to email EDISS for help with an error or a re-post, please be sure to verify NPI and/or Trading Partner ID (TPID) numbers that are being sent. We often receive information containing typos, which causes delays in resolution due to additional research. The email address, as well as additional contact information, can be located at https://www.edissweb.com/.

Message Sent:
May 2, 2023

New EDISS Call Center Survey Available 07 Apr 2023

For Medicare Submitters

Noridian is devoted to providing solutions that put people first. Effective March 27, 2023, providers will have the option to participate in a short survey after interacting with Noridian's interactive voice recognition (IVR) system or customer service representatives. Noridian encourages providers to participate in the survey and looks forward to hearing your thoughts.

Also available is the Enrollment Experience Survey. If you have registered with EDI in the past three months, we encourage you to take a short survey (click on the link below) to share your thoughts with us. Thank you!

https://med.noridianmedicare.com/web/medicare/edi-letter-survey

Message Sent:
April 7, 2023
March 7, 2023
August 4, 2022

Electronic Remittance Advice (ERA) Viewing Options 07 Mar 2023

For All Submitters

There are several free software viewing options available for providers that receive Electronic Remittance Advice (ERA) recipients!

To download, navigate to EDISS Website. Click on your state, navigate to the Software/Connectivity tab, click through to the applicable software page, and follow the information on the individual software page.

  • PC-ACE - A claims and remittance software for all Lines of Business offered by EDISS.
    • Note: Before the installation password can be given out, a Software Licensing Agreement (SLA) must be accepted in your EDISS Connect account.
  • PC Print - Free software developed by The Centers for Medicare & Medicaid Services (CMS) for viewing Medicare Part A remittance.
  • Medicare Remit Easy Print (MREP) - Free software developed by The Centers for Medicare & Medicaid Services (CMS) for viewing Medicare Part B remittance.

Message Sent:
March 7, 2023
February 1, 2022

Informational Noridian Custom Edits (NCE) FYI 07 Feb 2023

For Medicare Submitters

Noridian Custom Edits (NCE), referred to as Smart Edit on the 277CA, were created to assist providers in submitting error-free claims by pre-screening for common errors prior to processing. Informational NCEs went live on 3/27/2022. All NCEs populate in the STC elements of the 277CA, but the informational NCEs have a distinct code set that begin with A2:20:PR. Both types can be cross-referenced to the NCE Spreadsheets:

NCEs can:

  • Help identify problematic and/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.

Provide information or reminders on claim submissions.

Message Sent:
February 7, 2023

Medicare Remit Easy Print 07 Feb 2023

For All Medicare Part B Submitters

For the most current version of Medicare Remit Easy Print (MREP), visit https://www.cms.gov/Research-Statistics-Data-and-Systems/CMS-Information-Technology/AccesstoDataApplication/MedicareRemitEasyPrint. This link will bring you to the cms.gov downloads webpage. For further assistance with software updates, please contact EDISS or visit the Software/Connectivity tab of the EDISS website.

Message Sent:
February 7, 2023

Sunday Maintenance Reminder 06 Dec 2022

For All Submitters

EDI Support Services (EDISS) performs scheduled maintenance in Test and Production systems every Sunday from 6:00 AM to 12:00 PM (CT). Systems will be down at this time each week. EDISS selected this timeframe for its low activity level to minimize impact on Trading Partners.

Please avoid claim submissions during the maintenance windows. EDISS apologizes for any inconvenience.

Message Sent:
December 6, 2022
March 1, 2022

EDISS Connect Registration FYI 04 Aug 2022

For Medicare Submitters

Responses to our Registration Survey link have indicated there may be some confusion regarding when registration is appropriate. Here's a quick reference:

IF:

  • You are a third-party billing service
  • You are a rendering provider
  • You are NOT a Medicare Part A/B provider
  • Your Medicare jurisdiction is something other than JE or JF

THEN:

No individual registration is needed

Message Sent:
August 4, 2022

Making a Change in EDISS Connect? 04 Aug 2022

For All Submitters

If you will be changing your Connect account in the near future, EDISS would like to provide a few helpful tips.

  • Transaction changes can be completed in Connect by selecting Manage Transactions and then clicking directly on the NPI. The transactions requirements are as follows:
    • Electronic Remittance Advice (835) and Claim Status Request (276) transactions may have only ONE receipt method selected.
    • Claim Submission (837) transactions can have up to TWO submission methods selected.
  • Registration processing takes 7-10 business days from the date the change is made, provided no testing is required. Once a transaction is set up, Connect will reflect that is is Completed/Approved.
    • For 837 transactions, wait until the day after the approval date to send claims.
  • Edit Profile allows you to edit your company information. Make sure to select Save when done.

Message Sent:
August 4, 2022

Rather Send an Email than Call? 05 Jul 2022

For All Submitters

When using the support email option, support@edissweb.com, include the following information within the email inquiry.

  • Your name
  • Business name and location
  • NPI
  • Business phone number and extension
  • Complete description of your issue

To ensure response delivery to your inbox, please add these addresses to your address book or safe list.

Do not e-mail requests to EDISS for issues such as the status of a claim or remittance or questions about claim processing and denials. EDISS does not handle such inquiries.

Note: Gateway and Connect access questions cannot be done via email, please call the appropriate phone number for assistance.

Message Sent:
July 5, 2022

What is a Trading Partner ID? 05 Jul 2022

For All Medicare Submitters

EDI Support Services (EDISS) assigns a Trading Partner ID, also known as a Submitter ID, when an entity registers for an electronic transaction in EDISS Connect. The Trading Partner ID is used to submit electronic transactions and to register for the Noridian Medicare Portal (NMP).

To obtain and locate the Trading Partner ID for NMP registration, the Provider will need to complete the following steps:

  • Register for access to EDISS Connect, if not already registered.
    • Note: If an EDISS Connect account exists but no one currently has access, contact EDISS for assistance in obtaining the Provider Submitter ID.
  • Register within EDISS Connect for an electronic transaction, if not already registered.
    • Log into EDISS Connect and look for the blue header within the account.
    • Locate the field titled 'SubmitterId' within the blue header.
    • Use the 'SubmitterId' listed when registering for the Noridian Medicare Portal.

Note: The EDISS Connect Registration is a separate registration from the Noridian Medicare Portal Registration. EDISS Connect will only supply the Provider Submitter ID.

Message Sent:
July 5, 2022

Informational NCE Began March 27, 2022 03 May 2022

For All Medicare Submitters

Informational Noridian Custom Edits (NCE) went live for Part A and for Part B on March 27, 2022.

NCE populate in the STC elements of the 277CA with distinct code sets that can be cross-referenced to the NCE Spreadsheet. To assist submitters' NCE review, Noridian established edit spreadsheets for Part A at https://www.edissweb.com/cgpblue/reports/nce-pa and for Part B at https://www.edissweb.com/cgpblue/reports/nce.

Informational edits set on claims but do not cause them to reject. Claims that hit informational edits will process through to the payer. These can be distinguished from NCE that do cause the claim to reject by the STC codes. Informational Edits will appear in the STC segment as A2:20:PR, while the rejecting edits will appear in the STC segment as A3:23:41

Informational NCE example:

STC*A2:20:PR**WQ*********SMARTEDIT PATTERN 8446 INFORMATIONAL. DIAGNOSIS CODE T8453XD COULD INVOLVE THIRD PARTY LIABILITY AND OR SUBROGATION OF BENEFITS.~

Rejecting NCE example:

STC*A3:23:41**U*********SMARTEDIT PATTERN 45 PER MEDICARE GUIDELINES TEAM SURGERY IS NOT PERMITTED FOR PROCEDURE CODE 99214.~

Message Sent:
May 3, 2022

New EDISS Enrollment Experience Survey 03 May 2022

For Medicare Submitters

EDISS has worked with CMS for ways to improve Medicare submitters' EDI enrollment experience. If you have registered with EDI in the past three months, we encourage you to take a short survey (click on the link below) to share your thoughts with us. Thank you!

https://med.noridianmedicare.com/web/medicare/edi-letter-survey

Message Sent:
May 3, 2022
April 5, 2022

Understanding EDISS Reports 03 May 2022

For All Trading Partners

EDI Support Services (EDISS) is committed to helping Trading Partners read and understand the reports generated by our front-end collection system. The following are some tips to ensure Trading Partners maximize the benefit of the information found on these reports.

The reports are created in a specific order:

  • Interchange Acknowledgement (TA1): Will not generate if no errors are detected
  • Functional Acknowledgement (999)
  • Claims Acknowledgement (277CA)

Reports assist Trading Partners track their claims through the electronic collection process, and to the appropriate payment floor. For instructions on downloading reports, refer to the Reports page at https://www.edissweb.com/.

EDISS requires the ISA13 (Interchange Control Number) element from the inbound file for questions regarding claim submissions. This will specifically be required for Submitters who send more than 500 inbound files per day or in cases where the inbound file is not able to be located. Providing this information ensures that EDISS reviews the correct file. Callers who do not have this may be asked to call back once they have obtained the ISA13 element.

Message Sent:
May 3, 2022

Contacting EDISS 01 Mar 2022

For All Submitters

Submitters may contact EDISS over the phone or through email. Please be sure to use the correct Line of Business phone number and follow our email guidelines (below).

Note: Please call the appropriate phone number for assistance with Gateway and Connect access questions. Email cannot be used for these questions at this time.

Phone:

Medicare Lines of Business
Jurisdiction E (JE) Part A and B: 855-609-9960
Jurisdiction F (JF) Part A and B: 877-908-8431

Monday - Friday 8:00 A.M. - 7:00 P.M. (CT)
See Training Closure Schedule

All Other Lines of Business
800-967-7902

Monday - Friday 8:00 A.M. - 5:00 P.M. (CT)
See Training Closure Schedule

Email:

Non-critical questions or issues
support@edissweb.com

Concerns or praise to EDISS management
edimgmt@edissweb.com

Include

  • Your name
  • Business name and location
  • NPI
  • Business phone number and extension
  • Complete description of your issue

To ensure delivery to your inbox, please add these addresses to your address book or safe list.

Do not e-mail requests to EDISS for the status of a claim or remittance or for questions about claim processing and denials. EDISS does not handle such inquiries.

Message Sent:
March 1, 2022
July 6, 2021

EDISS Medicare Remittance Advice Reminder 01 Mar 2022

For All Medicare Submitters

Based on CMS direction involving suppression of Standard Paper Remittance Advice (SPR), as outlined in Change Request (CR) 10151, EDISS wants to ensure providers are aware of the following:

  • If you are currently registered with EDI to receive the Electronic Remittance Advice (ERA) and decide to remove the option from EDISS Connect, Noridian cannot revert your remittance back to the SPR.

Once the electronic option is removed from EDISS Connect, only the following options will be available for obtaining the remittance advice information:

Medicare Part A Providers

Part A providers can view their full Remittance Advice information in the Noridian Medicare Portal (NMP) for 30 days after publication. The claim-level remittance information is available using the Direct Data Entry (DDE) system. To obtain the full Remittance Advice electronically, add the 835 transaction back into the EDISS Connect account.

Medicare Part B Providers

Part B providers will be able to view their full Remittance Advice in the NMP. To view a Remittance Advice in NMP, providers will need to register for the NMP full remittance advice access.

For more information on NMP registration and functionality, please visit https://med.noridianmedicare.com

Message Sent:
March 1, 2022

Connect - What is it? Why do you need it? How do you use it? 01 Feb 2022

For All Submitters

EDISS Connect is a user-friendly online registration tool that allows providers to update basic facility information, manage billing NPIs, update lines of business, add or change vendor associations, and select electronic transactions online. The use of Connect is required for all providers.

Setting up your Connect account is easy. The following are some helpful steps to complete the registration process:

  • Make sure you have a billing NPI setup in your applicable payer system.
  • Go to https://connect.edissweb.com to access Connect.
  • If you get a message stating "Your NPI is registered for another provider," you already have a Connect profile. Speak to an EDISS representative to assist with logging into Connect.
  • After registering in Connect, add transactions for the line of business (LOB) and state in which services will be rendered.
  • Complete transaction changes by selecting Manage Transactions.
  • Transaction requirements:
    • Electronic Payment Advices (835) and Claim Status Requests (276) transactions: Select only one receipt method (including the "I Will/And Or" box for direct submitters)
    • Electronic Claims Submission (837): Select up to two submission methods (including the "I Will/And Or" box for direct submitters)
    • Registration processing timeframe is 7-10 business days. Once a transaction is set up, Connect will reflect "Completed/Approved."
  • To edit your Provider information, go to Account Home
    • Edit Profile - This will allow you to edit your company information. Make sure to select Save.
    • Security Settings - This is where your Connect password can be changed.
      • Note: Connect has a security feature that will require a submitter to login at least once every 60 days or the password will deactivate and need to be reset. At 90 days of inactivity, the user will be removed.
    • Software Settings - This is where you select your software. If you select PC-ACE, complete the Software Licensing Agreement (SLA).
      • Note: The SLA must be completed in order to get PC-ACE assistance from EDISS.

Message Sent:
February 1, 2022