CMS Second Delay of Phase 2 for PECOS Edits

The Centers for Medicare & Medicaid Services (CMS) will delay until January 3, 2011 the implementation of Phase 2 which results in non-payment if the billed service requires an ordering/referring provider and the ordering/referring provider is not on the claim. 

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 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.

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