Countdown to Home Health PECOS Edits: Are You Ready?

Don’t Be Denied!

Back in March, we first reported that CMS was preparing to turn on edits that will deny home health claims where the Physician is not PECOS-enrolled or qualified to be opted out.

The Medicare Administrative Contractors (MACs) have been sending providers Ordering/Referring Warning Messages to notify you in advance which of your current claims would fail this edit if they were live today. The warning messages and remark codes have been appearing on your remittance advice as follows:

Warning Messages for Part B providers:

  • N264 – Missing/incomplete/invalid ordering provider name
  • N265 – Missing/incomplete/invalid ordering provider primary identifier

Warning Messages for Part A and Home Health and Hospice providers who order and refer:

  • N272 – Missing/incomplete/invalid other payer attending provider identifier

HEALTHCAREfirst and the MACs are recommending that providers go back through recent remittance advices to verify if any of your claims included these warnings. HEALTHCAREfirst providers can also run reports in the system to verify which physicians are currently listed as being PECOS enrolled.

For full details on the edits that are going into effect on May 1st, click here for the March 1st PECOS blog.