By Craig Palmer, ADA News staff
These edits will check the following claims for a valid individual National Provider Identifier and deny the claim when this information is invalid, CMS said in a notice posted at the CMS Medicare Learning Network website:
Phase 1 edits notified providers if the ordering or certifying practitioner was not enrolled or properly opted out of Medicare but did not deny payment. In Phase 2, if the ordering/referring provider does not pass the edits, the claim will be denied. This means that the Medicare billing provider will not be paid for the items or services that were furnished based on the order or referral, CMS said.