CMS PECOS Edits By May 1st

CMS MLN Matters article stated that CMS will instruct contractors to turn on Phase 2 of the denial edits on the following claims to check for a valid individual National Provider Identifier (NPI) and to deny the claim when this information is missing.  The MLN Matter states this will be effective May 1^st 2013. 

These denials apply to Medicare Part B claims including Durable Medical Equipment, Orthotics, and Supplies (DMEPOS) that have an ordering or referring physician/non-physician provider.  The also apply to Medicare Part A Home Health Agency claims that require an attending physician provider.

For more information please utilize the following link.

http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/MedicareOrderingandReferring.html