May 8, 2015
CMS "Ordering Referring Report"
CMS instructed contractors to turn on Phase 2 denial edits
on January 6, 2014. These edits check the following claims for a valid individual National Provider Identifier (NPI) and deny the claim when this information is invalid:
- Claims from clinical laboratories for ordered tests;
- Claims from imaging centers for ordered imaging procedures;
- Claims from suppliers of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) for ordered DMEPOS; and
- Claims from Part A Home Health Agencies (HHAs)
CMS had made available to the public, via the Downloads section of the "Ordering Referring Report" page
on the Medicare provider/supplier enrollment website.
This file contains the NPIs and the names of physicians and non-physician practitioners who have current enrollment records in PECOS and are a type/specialty that is eligible to order and refer:
- Doctor of Medicine or Osteopathy;
- Dental Medicine
- Dental Surgery;
- Podiatric Medicine;
- Optometry;
- Physician Assistant
- Certified Clinical Nurse Specialist;
- Nurse Practitioner
- Clinical Psychologist
- Certified Nurse Midwife; and
- Clinical Social Worker
Providers who are eligible to order and refer and do not have an enrollment record need to complete the CMS 855O application form. This application is used for the sole purpose of enrolling to order and refer items and/or services to Medicare beneficiaries. Internet-based PECOS is the fastest and most efficient way to submit your enrollment application. You may enroll online
. Print, sign and date the two-page Certification Statement. Then mail the Certification Statement and all supporting paper documentation to CGS within seven days of electronic submission. CGS will also accept the CMS 885O
paper application at the following mailing address:
CGS
J15 Part B Provider Enrollment
P.O. Box 20017
Nashville, TN 37202

