Medicare - Ordering & Referring Provider Not Eligible Denial
- This denial states that referring or ordering provider is not eligible to bill the service as provider is not enrolled in Medicare.
- To check Medicare enrollment of provider, refer PECOS website - https://opedge.com/Pecos
- On the website, enter the provider's first, and last name and state or enter the NPI number then click on the search button.
- If the provider is enrolled in Medicare then it will show a Green correct tick mark stating the Provider is PECOS enrolled or a Red cross mark stating the Provider is NOT PECOS enrolled according to the latest file provided by CMS.
- For the same denial reason from other insurance, you can refer to the same website if it follows Medicare guidelines.
in PECOS provider are showing in green, but we are still receiving denial related to provider not enrolled with medicare
ReplyDeleteIf referring provider is showing in green on PECOS and you have still received denial for referring provider not enrolled with Medicare then you can place a call to Medicare and verify PECOS details. Hopefully, they will ask you to reopen or resubmit the claim.
DeleteThanks for sharing your knowledge....
ReplyDeleteThank you!
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