New EDI edits for Medicare Advantage claims

Last modified: September 13, 2021

EDI claim edits now notify you of missing or mismatched information
As of Aug. 28, 2021, the new payer-level edits for Electronic Data Interchange (EDI) 837 claim submissions provide alerts of specific information that may be missing or doesn’t match data contained in our systems.

How you’ll be notified of claim issues
Claims that are rejected for these edits will appear on your claims rejection report, also known as a 277CA report. We are no longer mailing letters about claim submissions that need attention. Instead, your clearinghouse will be responsible for notifying you of any issues.

What you need to do
Please help ensure you are receiving these messages from your clearinghouse. Claims that are rejected should be corrected and resubmitted electronically to be accepted into our processing system for adjudication. 

Get more details

PCA-1-21-03238-M&R-News_09022021