Posts Tagged ordering/referring provider


Due to PECOS Backlog, CMS Announces Delay of January 3, 2011 Automated Edits & Claims Denial

Oneonta Gorge, Logjam

NOTE: The date has been changed to July 5, 2011 delayed indefinitely.


The following statement was released by CMS on November 26, 2010:

The Centers for Medicare & Medicaid Services (CMS) previously announced that, beginning January 3, 2011, if certain Part B billed items and services require an ordering/referring provider and the ordering/referring provider is not in the claim, is not of a profession that is permitted to order/refer, or does not have an enrollment record in the Medicare Provider Enrollment, Chain and Ownership System (PECOS), the claim will not be paid.  The automated edits will not be turned on effective January 3, 2011. We are working diligently to resolve enrollment backlogs and other system issues and will provide ample advanced notice to the provider and beneficiary communities before we begin any automatic nonpayment actions.

Previous posts on enrolling physicians in PECOS  are here and here.

Image by Squash713 via Flickr

Posted in: Medicare & Reimbursement, PECOS

Leave a Comment (2) →