Starting on January 6, 2014, Medicare implemented edits to
verify that ordering/referring providers have current Medicare enrollment and are
of a provider type that is eligible to order or refer for Medicare
beneficiaries. The edit is required when ordering/referring for Part B clinical
laboratory and imaging, DME, and Part A HHA claims.
The billing process now requires a new form (HCFA 02/12) and a valid National Provider Identifier (NPI) to verify current Medicare enrollment. Providers have until April 1, 2014 to start using the new form. Until that time, providers may continue to use form CMS 1500. Claims that are submitted by non-eligible providers or non-eligible provider types will be denied.
If you order or refer items or services for Medicare beneficiaries and you do not have a Medicare enrollment record, you need to submit an enrollment application to Medicare. You can do this using Internet-based PECOS or by completing the paper enrollment application (CMS-855O) found on Medicare’s website.
For Part B providers and suppliers who submit claims to carriers, you may encounter the following payment posting errors:
N264
Missing/incomplete/invalid ordering provider name
N265
Missing/incomplete/invalid ordering provider primary identifier
These N codes are the alert that the referring provider is not a registered CMS provider.
The billing process now requires a new form (HCFA 02/12) and a valid National Provider Identifier (NPI) to verify current Medicare enrollment. Providers have until April 1, 2014 to start using the new form. Until that time, providers may continue to use form CMS 1500. Claims that are submitted by non-eligible providers or non-eligible provider types will be denied.
If you order or refer items or services for Medicare beneficiaries and you do not have a Medicare enrollment record, you need to submit an enrollment application to Medicare. You can do this using Internet-based PECOS or by completing the paper enrollment application (CMS-855O) found on Medicare’s website.
For Part B providers and suppliers who submit claims to carriers, you may encounter the following payment posting errors:
N264
Missing/incomplete/invalid ordering provider name
N265
Missing/incomplete/invalid ordering provider primary identifier
These N codes are the alert that the referring provider is not a registered CMS provider.
Please contact Client Services if you have any questions, or if you're not sure that your practice is set up correctly for the new regulations.
Contributors: Mel Johnson and Christine Parker
