LEEDer Group Inc.
8508 North West 66th St.
Miami, Florida 33166 USA

Phone: 305.436.5030
Fax: 305.436.0086
E-mail Address: info {at] LEEDerGroup [dot] com

2013-11 Ordering and Referring Denial Edits Full Implementation on January 6, 2014





Palmetto GBA Home / Jurisdiction 11 Part B / CMS e-News / Special Updates / Ordering and Referring Denial Edits…

Jurisdiction 11 Part B

Ordering and Referring Denial Edits Will Be Implemented on January 6, 2014

CMS will instruct contractors to turn on Phase 2 denial edits on January 6, 2014. These edits will check the following claims for a valid individual National Provider Identifier (NPI) and deny the claim when this information is invalid:
Claims from clinical laboratories for ordered tests
Claims from imaging centers for ordered imaging procedures
Claims from suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) for ordered DMEPOS
Claims from Part A Home Health Agencies (HHAs)

For more information:
MLN MattersĀ® Article #SE1305 (PDF, 122 KB), ‘Full Implementation of Edits on the Ordering/Referring Providers in Medicare Part B, DME, and Part A Home Health Agency (HHA) Claims (Change Requests 6417, 6421, 6696, and 6856)’

last updated on 11/07/2013