Answer:
The most common reasons for this denial are:

The provider does not have a have a current PECOS enrollment record. CMS maintains the Medicare Ordering and Referring File as a list of providers who are enrolled in PECOS and who are eligible to order or refer for services. Verify the provider's enrollment status with the provider and/or on the Medicare Ordering and Referring File. 

The NPI entered is for a group practice or organization, rather than an individual physician or non-physician practitioner.

Resources:

Contact Palmetto GBA JJ Part B Medicare

Provider Contact Center: 877-567-7271

Email JJ Part B

Contact a specific JJ Part B department


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