HomeLatest NewsFederal NewsCMS Postpones Billing Edit Requiring Exact Matching for OPPS Providers Until April...

CMS Postpones Billing Edit Requiring Exact Matching for OPPS Providers Until April 2020

The Centers for Medicare & Medicaid Services (CMS) has further postponed activating billing edits requiring exact matching for the address on claims data for outpatient prospective payment system providers with multiple service locations. The edits are now scheduled to be fully implemented in April 2020, allowing for additional agency testing and provider updates.

Once the edits are activated, CMS will direct Medicare Administrative Contractors to permanently turn on the edits and return claims that do not exactly match. During testing, CMS found that minor discrepancies, such as writing the word “Road” versus abbreviating it to “Rd.,” would have resulted in returned claims.

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

Providers who need to add a new or correct an existing practice location address must submit a new Form CMS-855A enrollment application in PECOS.​


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