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Thursday, January 28, 2010

Jurisdiction B News: Ordering/Referring Provider Front-End PECOS Warning Edits

 
 
 
 
Attention All CEDI Trading Partners, Suppliers, Billing Services, Clearinghouses and Vendors Reminder: Ordering/Referring Provider Front-End PECOS Warning Edits at the Common Electronic Data Interchange (CEDI) CEDI errors C200, C201 and C202 are warning errors/edits indicating the Ordering/Referring Provider submitted on the claims was not eligible to order/refer for the service billed according to the Medicare Part A and Part B Provider Enrollment, Chain and Ownership System (PECOS). These edits will generate as a warning on the CEDI GENRPT until April 5, 2010. These errors/edits are in place as part of Centers for Medicare & Medicaid Services (CMS) Change Request 6421 and related Medicare Learning Network (MLN) article MM6421 implemented with the October 2009 Release. CMS has completed the systematic loading of approximately 220,000 National Provider Identifiers (NPIs) to the existing PECOS records of providers who are eligible to order/refer. With this update to the PECOS records, CEDI has seen a drop in the number of warning messages being produced on the supplier s GENRPT. Prior to April 5, 2010, CMS will make publicly available on the Internet the names and NPIs of the Medicare physicians and non-physician practitioners who are eligible to order or refer in the Medicare program. CMS will replace this file on a periodic basis. At any given time, only the most current file will be available. When the file is available for download, CMS will post an announcement on the Ordering and Referring Provider page on the Medicare provider/supplier enrollment Web site:  www.cms.hhs.gov/MedicareProviderSupEnroll. CMS will send notification of the availability of the file via the CMS provider and supplier listservs and will announce its availability at the appropriate CMS Provider/Supplier Open Door Forums. Should a supplier receive one of these warning errors/edits on a claim, CEDI recommends the following:Contact the Ordering/Referring Provider to verify their eligibility with PECOS.Contact the Ordering/Referring Provider to verify how their name is listed with their PECOS enrollment and ensure the name submitted on the claim matches the PECOS record. Verify the Type I (individual physician s) NPI and name of the Ordering/Referring Provider is submitted on the claim.  If the Type II (physician s group) NPI and name is submitted, a match will not be found on the PECOS file
Ordering/Referring providers may use the following Web site to obtain information in relation to PECOS and to enroll and/or access the PECOS system to ensure they are listed and authorized to order/refer services for Medicare:
http://www.cms.hhs.gov/MedicareProviderSupEnroll/04_InternetbasedPECOS.asp.   If DME suppliers have questions, please contact your Medicare DME MAC Provider Contact Center:
Jurisdiction A 866-590-6731Jurisdiction B 866-590-6727Jurisdiction C 866-238-9650Jurisdiction D 866-243-7272
 Providers may also contact their Medicare Part A and/or Part B contractor's enrollment team in regards to their enrollment file as reflected in PECOS. 

 
 Registration and playback for the "On Demand" Medicare University 2009 Virtual Convention has been extended by popular demand to March 31, 2010.

National Government Services has extended the availability for registration and playback of the 2009 Medicare University Virtual Convention "On Demand" courses through March 31, 2010.  For the low cost of $150, you have access to over 60 unique on-demand courses, not offered through Medicare University, at a time that is convenient for you.  Plus, you can earn as many as 57 continuing education units!

Visit the Course page on the Medicare University 2009 Virtual Convention Web site to view a list of all the on-demand courses.  After March 31, 2010 there is no turning back, so register today at www.NGSMEDICARECONVENTION.com

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