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PECOS Warning Edit Change
Effective January 1, 2012 the durable medical equipment Medicare administrative contractors (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 Provider Enrollment Chain & Ownership System (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 the Common Electronic Data Interchange (CEDI) will continue to return the PECOS warning edits for 4010A1 claims on the GenResponse Report.
The Centers for Medicare & Medicaid Services (CMS) and the DME MACs will communicate when the edits will become denials when that date is determined.
Post Date 12/21/11
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