Update: Expansion of the Current Scope of Editing for Ordering/Referring Providers for claims processed by Medicare Carriers and Part B Medicare Administrative Contractors (MACs)

This Medlearn Matters article was revised on January 12, 2011, to clarify that CMS has not yet decided when it will begin to reject claims if an ordering/referring provider does not have a PECOS record. CMS will give providers ample notice before claim rejections begin. Recent revisions to CR 6417 require MACs to delay rejecting claims until receiving further direction from CMS.