Notice ID: HHS-CMS-SBSS-2022-000001S-CEDI
“The purpose of the CEDI front-end system is to provide a single front-end solution for the submission and retrieval of electronic transactions, and promote both standardization and greater efficiencies in inbound and outbound EDI exchange for the CMS Medicare Durable Medical Equipment (DME) fee-for-service (FFS) claims processing environment. The CEDI System processes an estimated volume of 77-80 million FFS DME claims per year.”
“The CEDI front-end system supports external Trading Partner (TP) submitted X12 837 claims and 276 Claim Status Inquiry transactions. The CEDI system performs all front-end edits on these transactions, assigns the Claim Control Number (CCN) to claims accepted by the CEDI, and creates the flat files for delivery to the appropriate DME MAC. All X12 837 claims accepted by the CEDI are delivered to the appropriate DME MAC based on the beneficiary state code – 276 files are delivered based on the contractor code in the header record of the file. CEDI authenticates and validates that the TP electronic submitter is eligible to submit electronic transactions to the CEDI system. The CEDI system then performs edits on incoming Medicare FFS DME electronic transactions, translates the transaction into a flat file and forwards the output data from transactions that pass edits to the core of the ViPs Medicare System (VMS) claims processing environment. CEDI also receives the X12N 835 Electronic Remittance Advice (ERA) and 277 Claims Status Response transactions from the DME MACs, translates that data into the X12 format and delivers them to the appropriate Trading Partner’s CEDI mailbox. The National Council for Prescription Drug Programs (NCPDP) transactions currently passes through an exchange with VMS for both inbound and outbound transactions.”
“The CEDI System contractor provides all of the necessary hardware, software, labor, and supplies necessary to be responsible for receiving, sending, translating, routing, editing and retaining all DME MAC electronic transactions, as well as trading partner management.”
