PECOS Errors Being Corrected
NAHC has been informed that the issue will be resolved with the July 2014 system release. No provider action is needed
June 20, 2014 10:26 AM
A system integration error with the PECOS and claim processing has been identified. Below is from Palmetto, CGS has a similar message on their web site.
NAHC is increasingly hearing of claims being incorrectly denied due PECOS edits and suspected there was a system problem. According to CGS, a resolution to this issue is scheduled for implementation with the July 2014 system release.
No provider action is required.
SE1305 (PDF, 127 KB) - Full Implementation of Edits on the Ordering/Referring Providers in Medicare Part B, DME, and Part A Home Health Agency (HHA) Claims (Change Requests 6417, 6421, 6696, and 6856) required updates to Medicare systems. However, currently there is a system integration issue with how the provider enrollment files are being loaded to the claim system.
Impact to Provider
Home Health claims are suspended to S MOSUQ with reason code 37236 or 37237 - the NPI and/or physician's last name or first name submitted on the home health claim does not match the physician's information at the Provider Enrollment, Chain, and Ownership System (PECOS).
6/18/14 - CMS and the system maintainer are aware of this issue and are working to resolve it. We are waiting on direction from CMS.