CHA News

CMS Delays Billing Edit Requiring Exact Matching for OPPS Providers With Multiple Service Locations Until October

For CFOs, Reimbursement Staff

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The Centers for Medicare & Medicaid Services (CMS) has postponed the activation of billing edits requiring exact matching for the address on claims data for outpatient prospective payment system providers with multiple service locations. The edits will now be implemented in October 2019.  

CHA reminds providers that once the edits are activated, CMS will direct Medicare administrative contractors to permanently turn on the edits and return claims that do not exactly match. During testing, CMS found that minor discrepancies, such as writing the word “road” versus abbreviating it to “Rd.,” would have resulted in returned claims.  

CHA strongly advises providers to ensure that the claims data exactly match their provider enrollment information on the submitted Form CMS-855A and entered into the Provider Enrollment, Chain and Ownership System (PECOS).

Providers who need to add a new or correct an existing practice location address must submit a new Form CMS-855A enrollment application in PECOS.

Noridian Healthcare Solutions will hold a webinar July 9 about the new address requirements.