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September 30, 2025

Claim Edits for CAH Professional Services

Critical Access Hospitals (CAHs) bill for facility and professional outpatient services only when physicians or practitioners reassign their billing rights to the CAH.

To prevent claim denial reason codes 31006 and 31007 (indicating that providers don’t have a reassignment on file in PECOS):

  • CAHs must submit the reassignment application through PECOS or the paper Form CMS-855I.
  • Starting in January 2026, CAH claims for professional services will deny if a reassignment isn’t in PECOS.

References:

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