NO DATE SET FOR EXPANDED ORDERING/REFERRING PROVIDER CLAIM EDITS

It has come to CMS’ attention that there was an editorial oversight in the OIG Compendium of Unimplemented Recommendations (March 2011 Edition). The OIG report states that the CMS will delay the implementation of Phase 2 of Change Request (CR) 6417 and CR until Tue Jul 5, 2011. This is incorrect. CMS has not yet determined when it will begin to apply the ordering/referring provider claim edit to ordering/referring providers that do not have a record in the Provider Enrollment, Chain, and Ownership System (PECOS). As previously stated, CMS will give providers ample notice before the ordering/referring provider claim edit is applied. Recent revisions to CRs #6417 and #6421 require MACs to delay rejecting claims until receiving further direction from CMS. Source: Frontier Focus Newsletter, Division for Medicare Health Plans Operations, CMS Region VIII, Denver CO dated March 21, 2011