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Providers with Multiple Service Locations Urged to Ensure Claims Data Exactly Match Enrollment Information

The Centers for Medicare & Medicaid Services (CMS) will activate billing claims edits for outpatient providers with multiple service locations in July. Once CMS implements the July 2019 quarterly release, Medicare administrative contractors will be directed to permanently turn on edits and return claims that do not exactly match.

Providers need to ensure that the claims data exactly match their provider enrollment information on the Form CMS-855A submitted by the provider and entered into the Provider Enrollment, Chain and Ownership System.

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

These billing edits were originally postponed in March 2019.

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