No Date Set for Ordering/Referring Provider Claim Edits

Posted 6-8-11

The Centers for Medicare & Medicaid Services (CMS) has not yet determined when it will begin to apply the expanded edit for ordering/referring provider claims. These edits are applicable to ordering/referring providers that do not have a record in the Provider Enrollment, Chain and Ownership System (PECOS). As previously stated, CMS will give providers ample notice before the ordering/referring provider claim edit is applied.

For information on the requirements for billing for ordering/referred services, review the Medicare Learning Network’s 'Medicare Enrollment Guidelines for Ordering/Referring Providers' fact sheet (PDF, 3.06 MB).