Editing for Ordering/Referring Providers Delayed

Due to recent inquiries, the Centers for Medicare & Medicaid Services (CMS) is clarifying its policy regarding expanded ordering/referring provider claim edits. CMS has not yet decided when it will begin to reject claims if an ordering/referring provider does not have a record in the Provider Enrollment, Chain, and Ownership System (PECOS). CMS will give providers ample notice before claim rejections begin. Recent revisions to Change Requests (CRs) #6417 and #6421 require Medicare administrative contractors to delay rejecting claims until receiving further direction from CMS.

Post Date 01/11/11

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