Medicare to begin screening claims for eligible referring/ordering doc

Why This Topic Matters

Practices that bill Medicare need to verify provider identifiers and enrollment records so claims are not flagged or denied when a referring or ordering provider is missing or not recognized in Medicare’s files.

Article Sections

1. CMS phases in screening for referring and ordering providers

   Introduces the new Medicare claims-processing approach and describes the overall move from warning messages to denials. It explains the policy’s timing and the role of provider enrollment data.

2. Phase I and Phase II claims edits

   Summarizes the two rollout phases and how claims will be handled at each stage. The section focuses on the transition from a remittance warning to automatic denial.

3. How carriers check provider eligibility

   Describes the Medicare databases used to validate referring and ordering providers and the sequence of checks performed by carriers. It also notes the types of claim situations affected by the edits.

4. What practices should do now

   Outlines general workflow steps practices may consider for reviewing enrollment records and provider identifiers. It emphasizes internal verification and onboarding processes.

5. Official resources

   Lists CMS reference materials and online resources cited in the article. These sources support further review of the policy update.

6. Eligible providers

   Provides a summary list of provider categories recognized under the referenced Medicare policy. The section is included as a source-based overview of provider types.