Thursday, November 7, 2013

Phase 2 Medicare Ordering & Referral Denial Edits

If you haven't heard, or not aware... Medicare put this out yesterday, These denial edits will affect both Part A and Part B -- L : ) MLN Connects - Provider eNews - Medicare Learning Network Wednesday, November 6, 2013 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; and Claims from Part A Home Health Agencies (HHAs). For more information: MLN Matters® Article #SE1305, “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)” For More information... click this link

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