CMS Ordering/Referring Phase 2 Denial Edits Effective May 1, 2013
Beginning May 1, 2013, the Centers for Medicare & Medicaid Services (CMS) will begin denying claims that do not contain a valid National Provider identified (NPI). This denial edit will affect:
- Medicare Part B claims including Durable Medical Equipment, Orthotics, and Supplies (DMEPOS) that have an ordering or referring physician/non-physician provider; and
- Part A Home Health Agency (HHA) claims that require an attending physician provider.
Currently in Phase 1, for claims that fail to meet the requirements, CMS is issuing a warning. However in Phase 2 these claims will be denied beginning May 1, 2013.
On your remittance advice, look for the following indicators:
- N264: Missing/incomplete/invalid ordering physician provider name
- N265: Missing/incomplete/invalid ordering physician primary identifier
For a list of all Medicare physicians/non physician practitioners who are eligible to order and refer and who have current enrollment records in Medicare (PECOS), visit the CMS Ordering & Referring Information webpage.