CMS Delays Phase 2 for Claim Edits & Provides PECOS Help Line

In early October, 2009 The Centers for Medicare & Medicaid Services (CMS) began Phase I to implement an expanded claim process to verify that the ordering/referring provider on a claim is eligible to order/refer and is enrolled in Medicare.  Phase 1 provides a warning edit. Phase 2 results in unpaid claims. 

In both phases, they determine if the ordering/referring provider on the claim matches the providers in the national PECOS file: CEDI will verify the National Provider Identifier (NPI) of the ordering/referring provider reported on the claim against the national PECOS file.

Phase 2 has been delayed until April 5, 2010. 

Phase 2 – CEDI and VMS will still receive a national file from PECOS and will determine if the ordering/referring provider is required for the billed service. If the billed service requires an ordering/referring provider and the ordering/referring provider is not on the claim, the claim will not be paid. If the ordering/referring provider is on the claim, CEDI will verify that the ordering/referring provider is on the national PECOS file. If the ordering/referring provider is not on the national PECOS file, the claim will not be paid.

For more information regarding Phase 1 and 2 go to: http://www.cms.hhs.gov/Transmittals/Downloads/R480OTN.pdf

CMS Established Help Line for PECOS

The Centers for Medicare & Medicaid Services (CMS) has established an External User Services (EUS) Help Desk to assist physicians, non-physician practitioners and organizations if they encounter an application navigation or access problem with Internet-based Provider Enrollment, Chain and Ownership System (PECOS).

Contact Information for Provider and Suppliers Using the Internet-based Provider Enrollment, Chain and Ownership System (PECOS) to report an application navigation or access problem with Internet-based PECOS, contact the EUS Help Desk at 1-866-484-8049 or send an e-mail to the EUS Help Desk to EUSSupport@cgi.com.