Temporary Delay in Implementing Ordering and Referring Denial Edits for Medicare

Important Announcement on April 25, 2013: Temporary Delay in Implementing Ordering and Referring Denial Edits – Due to technical issues, the implementation of the Phase 2 denial edits is being delayed. These edits would have checked certain claims for an approved or validly opted-out physician or non-physician who is an eligible specialty type with a valid individual National Provider Identifier (NPI). CMS will advise of the new implementation date in the near future. In the interim, informational messages will continue to be sent for those claims that would have been denied had the edits been in place. Language regarding beneficiary liability has also been updated in this version of the article. Claims from billing providers and suppliers that are denied because they failed the ordering/referring edit shall not expose a Medicare beneficiary to liability. Therefore, an Advance Beneficiary Notice is not appropriate in this situation.