PECOS ordering/referring edits begin Jan. 6, 2014

Why This Topic Matters

Organizations that submit or process Medicare claims need to understand when new edits take effect and which provider credentials may trigger denials. The article helps readers identify where operational checks and enrollment review may be needed to reduce claim disruption.

Article Sections

1. Medicare contractor edit changes beginning January 6, 2014

   Overview of the announced implementation date and the categories of claims affected by the new edits. The section frames the operational impact for providers and suppliers involved in ordered services.

2. CMS background on ordering and referring enrollment requirements

   Brief history of earlier CMS credentialing and enrollment steps related to ordering and referring providers. The section also mentions supporting enrollment resources and prior policy developments.

3. Compliance considerations for providers and billing teams

   Commentary on the practical implications for physician participation status and claim processing workflows. The section highlights the need for internal review and coordination with referring sources.