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:
- Part A Claim Payment Alerts
- Information for Critical Access Hospitals
MLN booklet - CR13900
– Editing for Duplicate Processing for Practitioner Professional Services and Critical Access Hospital (CAH) Professional Services - Office of Inspector General report
– Medicare Part B Overpaid and Beneficiaries Incurred Cost-Share Overcharges of Over $1 Million for the Same Professional Services

