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Medicare claim denial process delayed

May 06, 2013

By Craig Palmer, ADA News staff

Washington—Medicare officials announced a temporary delay “due to technical problems” of the scheduled May 1 ordering/referring provider edits reported in the April 15 ADA News print edition and April 8 on

These edits would have checked Medicare Part B claims from laboratories, imaging centers and DMEPOS (durable medical equipment, orthotics and supplies) that have an ordering or referring physician/nonphysician provider and Part A home health agency claims that require an attending physician provider, the Centers for Medicare & Medicaid Services said.

“CMS will advise you of the new implementation date in the near future,” said the e-news notice posted at the CMS Medicare Learning Network website. “In the interim, informational messages will continue to be sent for those claims that would have been denied had the edits been in place,” CMS said.

The Association offers member resources on Medicare enrollment and Medicare opt-out procedures at ADA and will continue to update information on the Medicare ordering and referring denial edits at and in ADA News print editions.

The CMS notice Temporary Delay in Implementing Ordering and Referring Denial Edits also offers tutorials and resources on the Internet-based Provider Enrollment, Chain and Ownership System PECOS.