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December 3, 2010

Important Update on PECOS & Ordering/Referring

At this time CMS has not turned on the automated edits that would deny claims for services that were ordered or referred by a physician or other eligible professional simply for lack of an approved file in PECOS. CMS is working diligently to resolve backlog and other systems issues and will provide ample advance notice to the provider and beneficiary communities before CMS begins any such automatic denials. While there are some rumors that the edits will be turned on in January, we want to reiterate that CMS has not announced any date (January 3 or otherwise) as to when ordering/referring edits will be turned on.

Physicians or other eligible professionals not currently enrolled in PECOS should take the initiative to enroll sooner rather than later. There are three ways to verify that you have an enrollment record in PECOS:

If you are not yet in PECOS, the best way to submit your application is through internet-based PECOS. For more information, visit http://questions.cms.gov/External Website

Note: If you have problems accessing any hyperlink in this message, please copy and paste the URL into your Internet browser.

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