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Reminder: PECOS Warning Edit Change
Attention All CEDI Trading Partners, Billing Services, Clearinghouses, and Vendors
Effective January 1, 2012, the DME MACs began 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 are being 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.
January 29, 2012, CEDI will no longer 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.
New MLN Matters Article
Important Reminder for Providers and Suppliers Who Provide Services and Items Ordered or Referred by Other Providers and Suppliers
MLN Matters Number: SE1201
Related Changed Request (CR) #: N/A
Related CR Release Date: N/A
Effective Date: N/A
Related CR Transmittal #: N/A
Implementation Date: N/A
To view this MLN Matters article, you may click on the link below or paste the following into your Internet browser:
http://www.cms.gov/MLNMattersArticles/Downloads/SE1201.pdf 
Post Date 01/30/12
Adobe Acrobat Download
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