Update: 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 and 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 National Provider Identifiers (NPIs) to the existing records in PECOS that did not contain an NPI. 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 non-physician practitioners who are eligible to order or refer in the Medicare program. CEDI will provide notification when this has been completed.

Should a supplier receive one of these warning errors/edits on a claim, CEDI recommends they contact the Ordering/Referring Provider submitted on the claim and have them verify their eligibility with PECOS. The supplier should also verify with the Ordering/Referring Provider how their name is listed with their PECOS enrollment and ensure the name submitted on the claim matches the PECOS record.

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.cms.hhs.gov/MedicareProviderSupEnroll/04_InternetbasedPECOS.asp. 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.

If DME suppliers have questions, please contact your 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

Post Date 01/19/10