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Home Health & Hospice Week

Industry Note:

Wrong NPI Type, Specialty Trigger Edits

Published on Tue May 03, 2011

Don't be too quick to blame PECOS for all the informational messages you receive about claims lacking valid physician NPIs. Background: Last year CMS caused a panic among home care providers by setting deadlines for so-called PECOS edits to begin on claims (see Eli's HCW, Vol. XIX, No. 37, p. 290). In the first stage, which was implemented, the edits pay claims but send providers an informational message if the claim's referring/ordering physician doesn't have a valid National Provider Identifier number and/or isn't enrolled in the online Provider Enrollment, Chain and Ownership System (PECOS). The second stage, which will return claims without valid NPIs or PECOS enrollment, got yanked at the last minute due to physicians failing to enroll. Failure to enroll in PECOS is the numberone reason for the informational messages being issued, with 79 percent of claims with such messages being due to PECOS, CMS confirms in a [...]
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