Due to recent inquiries, the Centers for Medicare & Medicaid Services (CMS) has issued a clarification regarding its policy surrounding the implementation of expanded ordering/referring provider claim edits.
In a January 10 update, CMS stated that it “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 [MACs] to delay rejecting claims until receiving further direction from CMS.”
- CR 6417 is available for viewing and download at www.cms.gov/transmittals/downloads/R825OTN.pdf
- CR 6421 is available for viewing and download at www.cms.gov/transmittals/downloads/R823OTN.pdf
