PECOS Edits for Ordering/Referring Physicians is Delayed


CMS has announced that Phase 2 of the PECOS edits for ordering/referring physicians is now delayed and a new effective date has not been announced. Claims where there is no PECOS record for the referring/ordering physician were set to be denied on May 1, 2013.

This means that your current Medicare claims will not be subject to edits that will ensure that the referring /ordering physician has an active profile in the Provider Enrollment Chain Ownership System (PECOS).  Medicare will continue to process claims normally and will still provide you with notification if an ordering/referring physician doesn’t have a PECOS record.

The complete Medicare announcement may be viewed here.

Questions regarding this issue may be directed to Joe McTernan or Devon Bernard.