Phase 2 of Ordering and Referring Requirement

CMS will soon begin denying Part B, DME, and Part A HHA claims that fail the Ordering/Referring Provider edits. These edits ensure that physicians and others who are eligible to order and refer items or services have established their Medicare enrollment records and are of a specialty that is eligible to order and refer. CMS will provide 60 day advanced notice prior to turning on the Ordering/Referring edits. CMS does not have a date at this time. CMS shall authorize A/B MACs to begin editing Medicare claims with Phase 2 Ordering/Referring edits. This means that the Billing Provider will not be paid for the items or services that were furnished based on the order or referral from a provider who does not have a Medicare enrollment record. Below are the denial edits for Part B providers and suppliers who submit claims to carriers:    254D      Referring/Ordering Provider Not Allowed To Refer    255D       Referring/Ordering Provider Mismatch    289D       Referring/Ordering Provider NPI Required CARC code 16 and/or the RARC code N264 and N265 shall be used for denied or adjusted claims.