Electronic Health Records

Policy & Regulation News

Ordering, referring denial edits will begin Jan. 6, 2014

By Nicole Freeman

The Centers for Medicare and Medicaid Services (CMS) has announced a January 6, 2014 starting date for the second phase of denial edits.

Here is the full message from CMS:

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; and

• Claims from Part A Home Health Agencies (HHAs).


For more information:


MLN Matters® Article #SE1305, “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)”





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