CHA News

Deadline Approaching to Ensure Exact Matching on Claims Data for OPPS Providers with Multiple Locations

For CFOs, Reimbursement Staff

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CHA reminds outpatient prospective payment system providers with multiple locations that the Centers for Medicare & Medicaid Services (CMS) will activate billing claims edits in July to check whether the address on a provider’s claim exactly matches the address entered into the Provider Enrollment, Chain and Ownership System (PECOS), as previously reported in CHA News.

Once CMS activates the claims edits, Medicare administrative contractors will be directed to permanently turn on edits and return claims that do not exactly match.

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 PECOS.

Claims that do not have an exact match will be returned. During testing, CMS found that minor discrepancies, such as spelling out the word “Road” versus abbreviating it to “Rd.,” would have resulted in returned claims. 

On June 25, Noridian will hold a webinar on the new address requirements. Registration is required. Noridian will hold an additional webinar on July 9. Details will be posted to their site when available.  

These billing edits, previously outlined in CHA News, were originally postponed in March 2019.