CEDI Front-End Rejections: Common Errors and Simple Fixes
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Every month the Common Electronic Data Interchange (CEDI) which electronically processes your DME claims, provides a list of the most common reasons why an electronic claim is rejected. This even before the claim hits the payers’ computers.
These errors are considered "front end rejections" because CEDI filters and rejects them prior to the payer ever seeing them. This is why sometimes you may wonder why when you call the carrier and they tell you they never received the claim. This is why it is so important that you check your CEDI reports.
These reports should identify the specific errors with the claim and will identify why they were rejected at the "front end". Since there are no appeal rights you must fix the problem(s) and then resubmit the claim for payment. Fortunately most of these errors are easily amenable to repair.
Some of these rejections may result in all your claims suddenly being rejected (e.g. PTAN and NPI not matching). If as a seasoned DME provider this should suddenly happen to you or if you are new to DME, you should immediately contact your software vendor. They should be able to successfully resolve this issue for you.
Most errors tend to be supplier keyboard errors including incorrect patient ID problems or incorrect HCPCS codes or modifiers inconsistent with the HCPCS codes.
Here are some common CEDI Front End Rejection Errors and best remedies for resolution.
HCPCS code is incorrect. Correct the HCPCS and resubmit the claim
Your NPI and Electronic Transmitter ID do not match up. Contact your EHR & resubmit
Duplicate HCPCS code on same claim. Check HCPCS, correct and resubmit
Rendering providers NPI is incorrect. Work with your EHR and resubmit
Medicare ID is incorrect. Correct and resubmit the claim
Your NPI and Tax ID are inconsistent. Work with your software vendor
You used the wrong modifier. Check the claim, fix and resubmit
Your NPI and PTAN are not matching up. Work with your software vendor.
Again it is important to remember that all claims receiving a “Front End Rejection” have no appeal rights. That is the reason for the rejection that must be identified, repaired and then the claim can be resubmitted. Once resubmitted watch for future reports to ensure they have been successfully made it through the front door and sent onto the payer. Fortunately identifying and correcting these errors is usually quite simple, resulting in only a minor delay in reimbursement.
If you are unsure of the HCPCS code or correct modifier for a certain Kevin Root product, please do not hesitate to contact our advisory team. KevinRoot Medical is available to help connect you with experienced professionals who can assist with all of your billing compliance needs, while also supporting practices with premium Root orthotics, custom solutions, and advanced lower-extremity biomechanical technologies designed for today’s modern podiatric practice.
