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Cal Path Facts

Medicare Requirement for NPI of Referring Physicians
 
Medicare through its PECOS enrollment records will begin denying claims from providers where the referring physician /practitioner name and NPI are not in their database. Starting Jan. 4, 2010, CMS will begin rejecting claims that include the names and NPI numbers of physicians and non-physician practitioners that aren't listed in the system. Last month, the agency began sending providers "informational messages"-not denials-to alert them of such claims.
 
 
The bulletin states that CMS is taking the following actions to reduce the number of informational messages prior to Jan. 4:
 
 
    CMS will systematically add to the PECOS enrollment records the NPIs of all physicians and non-physician practitioners whose PECOS records do not contain their NPIs. This action will result in the addition of many more physicians and non-physician practitioners to the PECOS list.
 
 
    CMS will make publicly available on the Internet a national file of Medicare physicians and non-physician practitioners who are eligible to order/refer. The file will contain the NPI and the legal name (from the Medicare PECOS enrollment record). This will allow DMEPOS suppliers to determine if the ordering/referring provider has a current Medicare enrollment record and is eligible to order or refer.
 
 
    An MLN Matters article (MM6421) about CR 6421 is available on the CMS Web site (Search for MM6421 at http://www.cms.hhs.gov/MLNMattersArticles/2009MMAN/list.asp#TopOfPage). To supplement that article, CMS will be preparing a Special Edition Medicare Learning Network (MLN) Matters article.
 
 
    CMS's Medicare contractors have also initiated a revalidation effort (via CR 6574, Transmittal 557), which is designed to update the Medicare enrollment record for 2,500 physicians and non-physician practitioners (50 practitioners per state). We expect that this revalidation effort will be complete or nearing completion by Jan. 4.
 

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