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  • Processing Claims and Evaluating Claims Processing
  • Post author
    Lacy Gaskins

Processing Claims and Evaluating Claims Processing

The Centers for Medicare & Medicaid Services (CMS) requests Medicare Administrative Contractors (MACs) process claims and evaluate claims processing according to edits that auto-deny claims based on certain Healthcare Common Procedure Coding System (HCPCS) codes depending on DMEPOS supplier status. Medicare Modernization Act of 2003 sets standards for DMEPOS suppliers receiving Medicare Part B payments. The Provider Enrollment Chain and Ownership System (PECOS) system provides input on these standards.

 Full Transmittal: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R1797OTN.pdf

Subject: Guidance on Implementing System Edits for Certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)

Number: 1797

Title: 9904

Release Date: Feb. 10, 2017

Effective Date: July 1, 2017

Implementation Date: July 3, 2017

Special Notes: N/A

  • Post author
    Lacy Gaskins

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