DME MACs Establish Claims Processing Pre-payment Auto-denial Edit to Search for Oxygen Specialty Codes

Currently, 38 states require licensure and/or certification to provide oxygen and/or oxygen related equipment. CR5929 requires Medicare DMEPOS suppliers who submit claims for oxygen or oxygen related equipment to notify the National Supplier Clearinghouse (NSC) via the supplier enrollment form CMS 855S. If applicable, suppliers must also provide a copy of their state license and/or certification to the NSC. An oxygen specialty code is assigned by the NSC to all suppliers who have indicated on the 855S that they will be providing oxygen and/or oxygen related equipment.

To act in accordance with CR5929, the DME MACs will now edit claims in search of oxygen specialty codes to assure that only those suppliers who have specified oxygen related products on their enrollment form and have furnished the required licensure/certification are receiving Medicare reimbursements for such supplies in applicable states. By establishing a claims processing pre-payment auto-denial edit, claims will be denied in states where Medicare files do not reflect valid licensure/certification for suppliers providing oxygen related products.

This instruction does not require that DMEPOS suppliers who were registered with the NSC prior to April 1, 2008, as providing oxygen and/or oxygen related services or equipment to submit a CMS 855S Change of Information. Any future oxygen and/or oxygen related claims submission by a DMEPOS supplier in a state where a license/certification is required will result in an investigation by the NSC if the DMEPOS supplier does not have the oxygen and/or oxygen equipment specialty code.

For more information, view the Change Request in its entirety, which is located on the CMS website.

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