NHIC CR6421-PECOS-Part II
Andrea Couture
Description
Collection
Title:
NHIC CR6421-PECOS-Part II
Creator:
Andrea Couture
Date:
11/2/2009
Text:
Points to remember:
* For DMEPOS suppliers-
o Upon implementation of Phase 2, only accept and fill orders from
eligible Medicare providers. The CMS national file mentioned in item 2
above will greatly assist you.
o If you submit electronic claims, ensure that the ordering/referring
provider name is reported in all uppercase letters. This information is
included in the CEDI Companion Document and some of the DME MACs have made
this information available separately from the Companion Document.
o Do not report a nickname in the ordering/referring provider name.
For example, a reported first name of BOB will result in a non-match to
the first name of ROBERT (editing includes the comparison of the first
initial of the first name), causing the claim to fail the two new edits.
o Do not use commas, periods, or apostrophes within the
ordering/referring provider's name. For example, O'CONNELL should be
reported as OCONNELL.
o Ensure that names are reported correctly. For example, do not
include credentials in a name field in the name segment for the
ordering/referring provider (e.g., do not report a first name as DR JOHN.)
o Use of the Advance Beneficiary Notice of Noncoverage (ABN) is not
appropriate on a rejected claim. An ABN is appropriate only when a
provider/supplier expects Medicare to deny coverage for an item or service
under the Limitation on Liability provisions of Section 1879 of the Social
Security Act.
o Many ordering/referring providers are getting their enrollment
information into PECOS or are updating their enrollment information. It may
take some time for a Medicare enrollment contractor to process these
enrollment applications. Once an application has been approved, the
ordering/referring provider will have an enrollment record in PECOS that
contains the NPI. After the implementation of Phase 2, a DMEPOS claim may
identify an ordering/referring provider who now has a current enrollment
record (i.e., in PECOS with the NPI in the record) but the date of service
that precedes the date the ordering/referring provider's information was
effective in PECOS. Such a claim would pass the two new edits-Medicare is
not comparing the date of service on the claim to the date the
ordering/referring provider was effective in PECOS. The claim would not be
rejected.
* For ordering/referring providers-
o If you are not enrolled in the Medicare program, or if you enrolled
more than 5 years ago and have not submitted any updates or changes to your
enrollment information in 5 years, you do not have an enrollment record in
PECOS. In order to continue to order DMEPOS for Medicare beneficiaries, you
will have to enroll in the Medicare program or revalidate your Medicare
enrollment information. You may do so by (1) using Internet-based PECOS
(which transmits your enrollment application to the Medicare carrier or A/B
MAC via the Internet-be sure to mail the signed and dated Certification
Statement to the carrier or A/B MAC immediately after submitting the
appllication), or (2) by filling out the appropriate paper Medicare provider
enrollment application(s) and mailing it, along with any required additional
paper information, to the local Medicare carrier or A/B MAC, who will enter
your information into PECOS and process your enrollment application.
Information about enrolling in Medicare is found on the CMS web site at
www.cms.hhs.gov/MedicareProviderSupEnroll.
o Make sure you have a current enrollment record in Medicare. You can
do this by calling your designated enrollment contractor or you can go
on-line, using Internet-based PECOS, to view your enrollment record. While
doing so, if you have a PECOS record, ensure that your NPI is in it. If it
is not, update your enrollment record. You can find information about
Internet-based PECOS and a link to Internet-based PECOS at
www.cms.hhs.gov/MedicareProviderSupEnroll. We recommend that all providers
and suppliers read the information and downloadable documents about
Internet-based PECOS that are available on the CMS provider/supplier
enrollment web page: www.cms.hhs.gov/MedicareProviderSupEnroll.
o If you are a dentist or other specialty who is eligible to
order/refer but have not enrolled in Medicare because the services you
provide are not covered by Medicare, you need to enroll in Medicare order to
continue to order or refer in the Medicare program.
o If you are a physician who is employed by the Department of Veterans
Affairs or the Public Health Service but have not enrolled in Medicare
because you would not be paid by Medicare for your services, you need to
enroll in Medicare in order to continue to order or refer in the Medicare
program.
o If you are a resident who has a medical license but have not
enrolled in Medicare because you would not be paid by Medicare for your
services, you need to enroll in Medicare in order to continue to order or
refer in the Medicare program. Residents who do not have medical licenses
are not eligible to enroll in the Medicare program. Should they order or
refer, the teaching physician is to be reported in a claim as the
ordering/referring provider.
Andrea Deshaies-Couture
Business Coordinator
Next Step O & P, Inc.
155 Dow Street #200
Manchester, NH 03101
603.668.3831
603.668.4032 (Fax)
< <URL Redacted>> www.nextstepoandp.com
If you want total security, go to prison. There you're fed, clothed, given
medical care, and so on. The only thing lacking ... is freedom. --5-Star
General and U.S. President Dwight D. Eisenhower (1890-1969)
Notice to Recipient: This e-mail is confidential and meant only for the
intended recipient(s) of the transmission and may be a communication
privileged by law. If you received this e-mail in error, any review, use,
dissemination, distribution or copying of this e-mail is strictly
prohibited. If you are not the intended recipient, please contact the
sender by reply e-mail and please delete this e-mail from your system and
destroy any copies. Thank you for your cooperation.
* For DMEPOS suppliers-
o Upon implementation of Phase 2, only accept and fill orders from
eligible Medicare providers. The CMS national file mentioned in item 2
above will greatly assist you.
o If you submit electronic claims, ensure that the ordering/referring
provider name is reported in all uppercase letters. This information is
included in the CEDI Companion Document and some of the DME MACs have made
this information available separately from the Companion Document.
o Do not report a nickname in the ordering/referring provider name.
For example, a reported first name of BOB will result in a non-match to
the first name of ROBERT (editing includes the comparison of the first
initial of the first name), causing the claim to fail the two new edits.
o Do not use commas, periods, or apostrophes within the
ordering/referring provider's name. For example, O'CONNELL should be
reported as OCONNELL.
o Ensure that names are reported correctly. For example, do not
include credentials in a name field in the name segment for the
ordering/referring provider (e.g., do not report a first name as DR JOHN.)
o Use of the Advance Beneficiary Notice of Noncoverage (ABN) is not
appropriate on a rejected claim. An ABN is appropriate only when a
provider/supplier expects Medicare to deny coverage for an item or service
under the Limitation on Liability provisions of Section 1879 of the Social
Security Act.
o Many ordering/referring providers are getting their enrollment
information into PECOS or are updating their enrollment information. It may
take some time for a Medicare enrollment contractor to process these
enrollment applications. Once an application has been approved, the
ordering/referring provider will have an enrollment record in PECOS that
contains the NPI. After the implementation of Phase 2, a DMEPOS claim may
identify an ordering/referring provider who now has a current enrollment
record (i.e., in PECOS with the NPI in the record) but the date of service
that precedes the date the ordering/referring provider's information was
effective in PECOS. Such a claim would pass the two new edits-Medicare is
not comparing the date of service on the claim to the date the
ordering/referring provider was effective in PECOS. The claim would not be
rejected.
* For ordering/referring providers-
o If you are not enrolled in the Medicare program, or if you enrolled
more than 5 years ago and have not submitted any updates or changes to your
enrollment information in 5 years, you do not have an enrollment record in
PECOS. In order to continue to order DMEPOS for Medicare beneficiaries, you
will have to enroll in the Medicare program or revalidate your Medicare
enrollment information. You may do so by (1) using Internet-based PECOS
(which transmits your enrollment application to the Medicare carrier or A/B
MAC via the Internet-be sure to mail the signed and dated Certification
Statement to the carrier or A/B MAC immediately after submitting the
appllication), or (2) by filling out the appropriate paper Medicare provider
enrollment application(s) and mailing it, along with any required additional
paper information, to the local Medicare carrier or A/B MAC, who will enter
your information into PECOS and process your enrollment application.
Information about enrolling in Medicare is found on the CMS web site at
www.cms.hhs.gov/MedicareProviderSupEnroll.
o Make sure you have a current enrollment record in Medicare. You can
do this by calling your designated enrollment contractor or you can go
on-line, using Internet-based PECOS, to view your enrollment record. While
doing so, if you have a PECOS record, ensure that your NPI is in it. If it
is not, update your enrollment record. You can find information about
Internet-based PECOS and a link to Internet-based PECOS at
www.cms.hhs.gov/MedicareProviderSupEnroll. We recommend that all providers
and suppliers read the information and downloadable documents about
Internet-based PECOS that are available on the CMS provider/supplier
enrollment web page: www.cms.hhs.gov/MedicareProviderSupEnroll.
o If you are a dentist or other specialty who is eligible to
order/refer but have not enrolled in Medicare because the services you
provide are not covered by Medicare, you need to enroll in Medicare order to
continue to order or refer in the Medicare program.
o If you are a physician who is employed by the Department of Veterans
Affairs or the Public Health Service but have not enrolled in Medicare
because you would not be paid by Medicare for your services, you need to
enroll in Medicare in order to continue to order or refer in the Medicare
program.
o If you are a resident who has a medical license but have not
enrolled in Medicare because you would not be paid by Medicare for your
services, you need to enroll in Medicare in order to continue to order or
refer in the Medicare program. Residents who do not have medical licenses
are not eligible to enroll in the Medicare program. Should they order or
refer, the teaching physician is to be reported in a claim as the
ordering/referring provider.
Andrea Deshaies-Couture
Business Coordinator
Next Step O & P, Inc.
155 Dow Street #200
Manchester, NH 03101
603.668.3831
603.668.4032 (Fax)
< <URL Redacted>> www.nextstepoandp.com
If you want total security, go to prison. There you're fed, clothed, given
medical care, and so on. The only thing lacking ... is freedom. --5-Star
General and U.S. President Dwight D. Eisenhower (1890-1969)
Notice to Recipient: This e-mail is confidential and meant only for the
intended recipient(s) of the transmission and may be a communication
privileged by law. If you received this e-mail in error, any review, use,
dissemination, distribution or copying of this e-mail is strictly
prohibited. If you are not the intended recipient, please contact the
sender by reply e-mail and please delete this e-mail from your system and
destroy any copies. Thank you for your cooperation.
Citation
Andrea Couture, “NHIC CR6421-PECOS-Part II,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 7, 2024, https://library.drfop.org/items/show/230925.
