If you are a member of the CPR+ ListServ, you are probably following the "Ordering/Referring Provider Case Sensitive Edits..." posts. If not, you may be interested to know that there has been a lot of activity on the Listserv this week regarding new edits that NGSCEDI has put into place.

The below email from NGSCEDI was originally posted the end of September regarding new edits being implemented to comply with the Medicare changes announced with MedLearn Matters CR6421:

"This article is based on change request (CR) 6421, which requires Medicare implementation of system edits to assure that DMEPOS suppliers bill for items or services only when those items or services are ordered or referred by physician and non-physician practitioners who are eligible to order/refer such services. Physician and non-physician practitioners must be enrolled in the Medicare Provider Enrollment, Chain and Ownership System (PECOS) and of the type/specialty eligible to order/refer services for Medicare beneficiaries. Be sure billing staff are aware of these changes that will impact DMEPOS claims received and processed on or after October 5, 2009."

Right now, only warnings are returned, but rejections will begin to occur January 1, 2010.

What needs to be done in CPR+ right now? NOTHING!!!

CPR+ is going to make sure that the physician names are in all caps in the outbound 837P and 837I electronic claim files. This means that if the physician name is entered in proper case, it will be sent in all caps. If the physician name is entered in all caps, it will be sent in all caps.

This change will be made across the board for ALL Payors in v8.2c and v8.3a.

If you are sending all caps and still receiving the warning; you need to contact the Ordering/Referring Provider submitted on the claim and have them verify their eligibility with the Provider Enrollment, Chain and Ownership System (PECOS). The issue is not with the Supplier (Billing Provider); it is with the Ordering/Referring Provider.

Ordering/Referring Providers may use the following website to obtain information in relation to PECOS and to enroll and/or access PECOS to ensure they are listed and authorized to Order/Refer services for Medicare: Click Here.

Common Electronic Data Interchange (CEDI) Front-end Editing for Ordering/Referring Providers

In compliance with the Centers for Medicare and Medicaid Services (CMS) Change Request, CR6421, and as supplement to the information provided within the MLN Matters article - Expansion of the Current Scope of Editing for Ordering/Referring Providers, MM6421, previously communicated, the following are new edits that will appear on the CEDI GenResponse Report (GENRPT) should one of the situations described be encountered.

These edits/errors will set as a WARNING message until January 1, 2010, after which time, if the edit is received, the claim will be rejected.

If one of the errors is received, and there are no other errors on the claim(s) that would result in a rejection, the claim(s) will appear in the CLAIMS WITH WARNINGS section of the CEDI GENRPT and the assigned Claims Control Number/ Internal Control Number (CCN/ICN) will appear in the ICN field beneath the claim information in this section and will not be found within the CLAIMS WITHOUT ERRORS section.

If one of the below errors is received and there are other error(s) on the claim(s) that resulted in the claim(s) being rejected, these warning errors will appear listed with the other claim error(s) in the CLAIMS WITH ERRORS section of the CEDI GENRPT and a CCN/ICN will not be assigned.

After January 1, 2010 these edits will no longer be WARNINGS and will result in claim rejection and be returned in the CLAIMS WITH ERRORS section.
Although these errors are only being returned as a WARNING and will not be rejecting claims at this time, it is imperative that these warnings be followed up on by Providers and/or Trading Partners and action taken to ensure the Providers/Suppliers being used to Order/Refer services are on file with Medicare Provider Enrollment, Chain and Ownership System (PECOS) as authorized to do so.

Edit/Error Code C200 shall set at the 2310A (Referring Provider), if present, and the submitted NPI (NM1-09) and name (NM1-03/04) are not found on the CMS supplied file of Providers/Suppliers who are authorized to Order/Refer services for Medicare.

-Error Description: REFERRING PROVIDER NOT AUTHORIZED

Edit/Error Code C201 shall set at the 2310F (Referring Provider), if present, and the submitted NPI (NM1-09) and name (NM1-03/04) are not found on the CMS supplied file of Providers/Suppliers who are authorized to Order/Refer services for Medicare.

-Error Description: REFERRING PROVIDER NOT AUTHORIZED

Edit/Error Code C202 shall set at the 2420E (Ordering Provider), if present, and the submitted NPI (NM1-09) and name (NM1-03/04) are not found on the CMS supplied file of Providers/Suppliers who are authorized to Order/Refer services for Medicare.

-Error Description: ORDERING PROVIDER NOT AUTHORIZED

For more information, or to view the full MLN article click here.

For more information about the edits, please send an email to the CEDI Help Desk.

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It’s important that 2009 CPR+ User Conference registrants who have yet to reserve a room contact the Tamaya Resort immediately at 505-867-1234. We have been informed that our block of rooms is completely filled, but some rooms may become available as other reservations at the resort are cancelled.

As an alternative, the Holiday Inn Express (119 Bell Lane, Bernalillo, NM) located near the Tamaya Resort has rooms available. Call 877-410-6681 for reservations. In addition, there are other hotels in the area that can be located using any travel website.

Don’t let the room situation stop you from attending.
This is a FREE event for our Customers!!!

If you already made plans to attend the conference and made your room reservation, thank you and we look forward to seeing you there.

For those who haven’t made plans yet, this is definitely the year to attend. We’re making tremendous strides to apply the finishing touches to CPR+ version 8.3a, and there’s a lot to show and learn. Here’s a few of the important topics we’ll be discussing:

• Line Item Based Financials
• One-Click Billing
• The new Enterprise SpRx List Manager
• Calculating Patient Responsibility
• And much more.

Not sure what these topics are all about? Come to the conference and find out. We posted our class synopses online, listing all of the classes planned for this year.

In addition, we’ll have 15 exhibitors attending the conference to answer any questions you may have about their products or services. It’s like getting two shows for FREE.

There's no time left to hesitate! Register for the conference and make your hotel arrangements as soon as possible.

We look forward to seeing you there.

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Way back in 2008, Jeff Johnston wrote an article in the Weekly Infusion Issue #12 about CPR+ Customer HomeCare Solutions, Inc. in Chicago, Illinois. This CPR+ customer was able to effectively manage the impact of a heparin recall using reports from CPR+. One of these reports was the Lot Number Log Report.

To run this report, from the Main Menu, select Reports (4) > Pharmacy Reports (2) > Lot Number Log / Report (3). Enter the dispensing date range for the drug, and optionally, the lot number you want to find. Without a lot number, all drugs dispensed in the date range will be printed – that can be a LOT of pages. With a lot number, only drugs dispensed with a matching lot will be printed.

Lot Number Tracking is a critical element of patient safety, and is available on an item-by-item basis in CPR+. Contact Kim Carlsen to schedule some time with a trainer to discuss setting up lot tracking for your inventory.

Click here to view a pdf of this report.

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