A provider or supplier that bills Medicare for a service or item must show the name and unique identifier of the ordering/referring provider on the claim if that service or item was the result of an order or referral. The unique identifier must be a National Provider Identifier (NPI). Only Medicare-enrolled physicians and non-physician practitioners as defined in MM6421 are eligible to order/refer services for Medicare beneficiaries. A provider is considered as enrolled in Medicare for the purpose of ordering /referring a service to a beneficiary if they are found on the national PECOS file. All providers should be verifying their enrollment on the CMS on-line enrollment systems known as Internet-based PECOS.
Additional PECOS information is available on the CMS Web site at: http://www.cms.hhs.gov/MedicareProviderSupEnroll/04_InternetbasedPECOS.asp
| Article Title |
Date Posted |
File Type |
Update on Claims Processing for Ordering/Referring Providers
(CMS Message 201002-35)
|
February 26, 2010 |
 |
| PECOS Dear Physician Letter
|
February 08, 2010
Revised February 26, 2010 |
|
Message of Interest to Physicians and Non-Physician Practitioners Regarding NPI and Enrollment Files
(CMS Message 201001-29)
|
February 05, 2010 |
|
UPDATE: Ordering/Referring Provider Front-End PECOS Warning Edits at the Common Electronic Data Interchange (CEDI)
(CEDI Message)
|
January 22, 2010 |
|
Delay in Implementing Phase 2 of CRs 6417 and 6421
(CMS Message 200911-35)
|
November 25, 2009 |
|
| Physicians ODF Follow Up Notice - CR 6421: Editing the Ordering/Referring Provider in DMEPOS Claims
|
November 17, 2009 |
|
Change Request 6421 - Editing the Ordering/Referring Provider in DMEPOS Claims
(CMS Message 200910-47)
|
November 06, 2009 |
|
| PECOS Ordering/Referring Provider Case Sensitive Edits
|
October 30, 2009 |
|
Expansion of the Current Scope of Editing for Ordering/Referring Providers for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers' Claims Processed by Durable Medical Equipment Medicare Administrative Contractors (DME MACs)
(MM6421)
|
April 24, 2009 |
|
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02/26/2010 |
