REMINDER: Ordering/Referring Provider Front-End PECOS Warning Edits at the CEDI
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Reminder:  Ordering/Referring Provider Front-End PECOS Warning Edits at the Common Electronic Data Interchange

Common Electronic Data Interchange (CEDI) errors C200, C201 and C202 are warning errors/edits indicating the Ordering/Referring Provider submitted on the claims was not eligible to order/refer for the service billed according to the Medicare Part A and Part B Provider Enrollment, Chain and Ownership System (PECOS).  These edits will generate as a warning on the CEDI GENRPT until April 5, 2010.  These errors/edits are in place as part of Centers for Medicare & Medicaid Services (CMS) Change Request 6421 and related Medicare Learning Network (MLN) article MM6421 implemented with the October 2009 Release.

CMS has completed the systematic loading of approximately 220,000 National Provider Identifiers (NPIs) to the existing PECOS records of providers who are eligible to order/refer.  With this update to the PECOS records, CEDI has seen a drop in the number of warning messages being produced on the supplier's GENRPT.

Prior to April 5, 2010, CMS will make publicly available on the Internet the names and NPIs of the Medicare physicians and nonphysician practitioners who are eligible to order or refer in the Medicare program.  CMS will replace this file on a periodic basis.  At any given time, only the most current file will be available.  When the file is available for download, CMS will post an announcement on the "Ordering and Referring Provider” page on the Medicare provider/supplier enrollment Web site www.cms.hhs.gov/MedicareProviderSupEnroll.  CMS will send notification of the availability of the file via the CMS provider and supplier Listservs and will announce its availability at the appropriate CMS Provider/Supplier Open Door Forums.

Should a supplier receive one of these warning errors/edits on a claim, CEDI recommends the following:

  • Contact the Ordering/Referring Provider to verify their eligibility with PECOS.
  • Contact the Ordering/Referring Provider to verify how their name is listed with their PECOS enrollment and ensure the name submitted on the claim matches the PECOS record.
  • Verify the Type I (individual physician's) NPI and name of the Ordering/Referring Provider is submitted on the claim. If the Type II (physician's group) NPI and name is submitted, a match will not be found on the PECOS file.

Ordering/Referring providers may use the following Web site to obtain information in relation to PECOS and to enroll and/or access the PECOS system to ensure they are listed and authorized to order/refer services for Medicare http://www.cignagovernmentservices.com/medicare_dynamic/leaveCIGNA.asp?link=http://www.cms.hhs.gov/MedicareProviderSupEnroll/04_InternetbasedPECOS.asp.

If DME suppliers have questions, they should contact their Medicare DME MAC Provider Contact Center:

Jurisdiction A 866-590-6731

Jurisdiction B 866-590-6727

Jurisdiction C 866-238-9650

Jurisdiction D 866-243-7272

Providers may also contact their Medicare Part A and/or Part B contractor's enrollment team in regards to their enrollment file as reflected in PECOS.

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