CMS temporarily delays implementation of ordering and referring denial edits

April 24, 2013

Due to technical issues, the Centers for Medicare and Medicaid Services (CMS) has temporarily delayed implementation the ordering and referring denial edits originally planned for May 1. A new implementation date has not yet been announced.

Despite the delay, the California Medical Association (CMA) is urging physicians who refer or order services for Medicare beneficiaries to enroll with Medicare as soon as possible. When the edits are turned on, claims will be denied if the ordering/referring physician does not have an enrollment record.

CMS began notifying ordering/referring physicians of the need to enroll in Medicare in October 2009. Enrollments can be completed via the online Provider Enrollment, Chain, and Ownership System (PECOS) or by completing a paper enrollment application (applicable CMS-855).

Physicians can confirm whether a referring or ordering physician is enrolled by downloading a report of all the eligible physicians and nonphysician practitioners who have current enrollment records from the CMS website. The report is updated weekly.

Contact: Michelle Kelly, (213) 226-0338 or mkelly@cmadocs.org.


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