Ordering and Referring Denial Edits Will Be Implemented on January 6, 2014

CMS will instruct contractors to turn on Phase 2 denial edits on  January 6, 2014. These edits will check the  following claims for a valid individual National Provider Identifier (NPI) 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)

For more information:

  • MLN Matters® Article #SE1305 (PDF, 122 KB), ‘Full Implementation of Edits on the Ordering/Referring Providers in Medicare Part B, DME, and Part A Home Health Agency (HHA) Claims (Change Requests 6417, 6421, 6696, and 6856)’

Source: Palmetto GBA

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