The Centers for Medicare and Medicaid Services (CMS) recently announced that ordering and referring denial edits will begin to be applied to the processing of claims on Jan. 6, 2014.
These edits will check the following claims for a valid National Provider Identifier (NPI), meaning the NPI indicating the referring physician on the claim is that of a PECOS-enrolled provider, and deny the claim when this information is invalid:
• Claims from clinical laboratories for ordered tests
• Claims from imaging centers for ordered imaging procedures
• Claims from suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) for ordered DMEPOS
• Claims from Part A Home Health Agencies (HHAs)
If you are not already enrolled in PECOS, CMS suggested that you start the enrollment process now so that you are enrolled by Jan. 6 when the edits will begin.
