Edit / Error Knowledge Base >

A provider has the following options available for the Edit / Error Knowledge Base:

835 CROSSWALKS: 

• The 835 CROSSWALKS are available in proprietary edit order mapped to HIPAA Codes, or in HIPAA Code order mapped to proprietary edits. You can locate the proprietary edit by searching with the Claim Adjustment Reason Code (CARC) found in the CAS segment of your 835 transaction.
• Click here to use the 835 CROSSWALKS.

277 CROSSWALKS:  

• The 277 CROSSWALKS are available in proprietary edit order mapped to HIPAA Codes, or in HIPAA Code order mapped to proprietary edits. You can locate the proprietary edit by searching with the Claim Status Code found in your 277 transaction.
• Click here to use the 277 CROSSWALKS.

EDIT SEARCH TOOL:

• Once you have located the 5-digit proprietary claim “edit” using either the 835 or the 277 CROSSWALK you can use the EDIT SEARCH TOOL. A series of Edit Ranges will appear. Choose which range your edit is in, and then click on that edit range. The result will be a “page” of information which provides pertinent information regarding the edit.
• Click here to use the EDIT SEARCH TOOL.

Components of an Edit Page (html):

• Edit Number:
  This is the eMedNY Proprietary 5-digit number. This is returned on the 835 or 820 Supplementary file depending on claim type and/or status. An example: 00026

• Edit Message:
  This is the eMedNY Proprietary Message that is associated with the 5-digit edit number. An example: Date of Birth Invalid

• HIPAA Claim Adjustment Reason Code:
  This is the edit Code (CARC) returned on the 835 Remittance Advice transaction in the CAS segment. An example: 16

• (HIPAA Remittance Advice) Remark Code:
  This is an additional code that may be returned on the 835 Remittance Advice transaction in one of the following segments: MOA, MIA, or LQ. An example: MA38

• HIPAA Healthcare Claim Status Code:
  This is the claim status code returned on the 277 Claim Status Response transaction. An example: 158

• (HIPAA) Entity Identifier Code:
  This is the entity identifier code that may be returned on the 277 Claim Status Response transaction. An example: QC

• Potential Causes:
  This gives a brief explanation as to the possible reasons the claim failed this edit.

• Solution:
  This is a more detailed explanation of reasons for edit failure, with advice as to how to resubmit the claim or, if applicable, who to contact.

• 837 Loops and Segments:
  If applicable, an example of the 837 transaction segments is shown depicting the fields necessary to resubmit the claim. (Note: Due to the fact that most pharmacy claims use the NCPDP format and are usually analyzed quickly at the response level, an NCPDP format is not depicted in the Edit / Error Knowledge Base.) An example of an 837 loop/segment:

NOTE : All of the codes above are also depicted in the Crosswalks, depending on your search criteria and which Crosswalk you are using.

Click here to review the format of the inbound claim transactions and/or the format of the 835 Remittance transaction, 835 Supplementary File, or the 277 Claim Status Response transaction by using the NYSDOH Companion Guides. These guides are an excellent tool in determining NYSDOH’s usage of the federally mandated HIPAA transactions, as well as the NCPDP record formats