Celerian Group Company EDI Connection Basics
Celerian Group Company EDI team in an effort to ensure minimum downtime/interruption of services promotes effective immediately provision of the business information.
How Many Lines Can Be Billed On An Electronic Claim? Part A and HHH: The Service Line Loop is located in the 2400 loop. Only 449 iterations of the 2400 loop are allowed. CMS policy limit is 449. Part A Edit Spreadsheet: X223.423.2400.LX01.030. Part B: The Service Line Loop is located in the 2400 loop. Only 49 lines on a Part B claim is allowed. Part B Edit Spreadsheet: Ref: X222.350.2400.LX01.030
Aceptable Documentation for Waiver
Small Provider Claims – Copy of actual payroll summary report, a letter from a Certified Public Accountant (CPA) documenting the number of employees on the CPA’s letter head with the CPA’s signature or Tax forms, i.e. Form 941 Employer’s Quarterly Federal Tax Return or Schedule C Tax form.
Roster Billing – Copy of flyer or list of locations where inoculations were given, including publications.
Dental Claims – Copy of Dental License
All documentation must include, PTAN, NPI and Tax ID number.
Illegible forms have been increasing. This typically occurs from refaxing documents many times or bleeding of the inked letters from copies made over and over. ALL information on the form must be legible. This includes CGS print, script, phone numbers, provider information, trading partner information, disclaimer and agreement information. If any of this information is illegible, your entire form and paperwork along with it will be returned. Please make sure all EDI applications are signed and clearly indicated with 837/835 request. (New setups will also require an EDI Enrollment form) EDI forms may be found by accessing https://www.cgsmedicare.com.
- In the Medicare tab, select the line of business for your segment and choose the EDI icon to the left. Choose only one Line of Business per Application.
- The PTAN, name and address for the Provider must match what is listed in our system before the setup can be completed.
- Multiple PTANS will require 1 application per GROUP PTAN.
- Enrollment forms are only needed if your provider has never been setup to file electronic claims.
- Make sure to always use the most recent forms from the CGS Medicare website.
- Any forms requiring a signature should be signed by a fully authorized official from the office. The signature binds you to the agreement and changes requested.