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.html and for Part B at https://www.edissweb.com/web/cgpblue/reports/nce.html.

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