No Date Set for Expanded Ordering/Referring Provider Claim Edits
The Centers for Medicare & Medicaid Services (CMS) provided clarification on its policy regarding expanded ordering/referring provider claim edits. CMS reported that the agency 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 promised to give providers ample notice before claim rejections begin. Recent revisions to Change Requests (CRs) #6417 and #6421 require Medicare Administrative Contractors to delay rejecting claims until receiving further direction from CMS.
