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Reminder: PECOS Warning Edit Change
Effective January 1, 2012 the DME MACs will begin to return the warning messages if the ordering or referring provider on the claim is not eligible to order or refer DME supplies as determined from PECOS. These messages will be returned on the Electronic Remittance Advice (ERA) or Standard Paper Remit (SPR) with the following Remittance Advice Remark Code (RARC) and will apply to both 4010A1 and 5010A1 formatted claims:
- N544 - Alert: Although this was paid, you have billed with a referring/ordering provider that does not match our system record. Unless, corrected, this will not be paid in the future.
Through January 29, 2012 CEDI will continue to return the PECOS warning edits for 4010A1 claims on the GenResponse Report.
CMS and the DME MACs will communicate when the edits will become denials when that date is determined.
If you have any questions regarding the CEDI PECOS warning edits, please send an e-mail to ngs.cedihelpdesk@wellpoint.com or call 866-311-9184.
Post Date 01/06/12
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