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Ordering/Referring Provider Case Sensitive Edits

National Government Services, one of the largest Medicare contractors in the country, released the following information to avoid unnecessary claim rejections.  They will reject claims when lower case characters are submitted in the ordering/referring provider field.  See their notice below for details:

Ordering/Referring Provider Case Sensitive Edits

CEDI has front end edits in place to validate the data submitted conforms to HIPAA and Medicare requirements.  As part of these edits, the Common Electronic Data Interchange (CEDI) utilizes external code sources to validate the data on inbound transactions.  The Provider Enrollment, Chain and Ownership System (PECOS) file used to verify eligibility for ordering/referring providers is one of the external data code sources utilized by CEDI. 

The information from PECOS is provided to CEDI using only upper case characters.  The alpha character data on the claim for the ordering/referring provider must be in upper case in order to validate the name against the PECOS file.

CEDI will reject inbound transactions submitted with lower case characters where the external code source used to perform the edits is only provided in upper case.  If a lower case character is submitted in the ordering/referring provider field, the claim will be rejected. 

CEDI strongly encourages submitting all alpha characters in upper case to avoid this type of issue. 

For more information and questions, please contact the CEDI Help Desk at [email protected] or at 866-311-9184.

Thank you,
National Government Services, Inc.
Corporate Communications