PECOS-Edits

CMS Announces Delay in Home Health PECOS Edits

CMS Issues Temporary Delay in the Rollout of PECOS Edits.

Due to technical issues, implementation of the Phase 2 ordering and referring denial edits is being delayed. These home health edits would have checked the following claims for an approved or validly opted-out physician or non-physician who is an eligible specialty type with a valid individual National Provider Identifier (NPI). If either of these were missing or incorrect, claims would deny.

  • Medicare Part B claims from laboratories, imaging centers and Durable Medical Equipment, Orthotics, and Supplies (DMEPOS) that have an ordering or referring physician/non-physician provider; and
  • Part A Home Health Agency (HHA) claims that require an attending physician provider.

CMS will advise you of the new implementation date in the near future. In the interim, informational messages will continue to be sent for those claims that would have been denied had the edits been in place.

As HEALTHCAREfirst gets additional information, we will post it to our blog.

Free PECOS Validation Tool here.

April 25, 2013

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