The Phase 2 ordering and referring denial edits have been implemented. These edits check the specified claims for an approved or validly opted-out physician or non-physician who is an eligible specialty type with a valid individual National Provider Identifier (NPI). If either of these are missing or incorrect, claims will deny. SE1305 (PDF, 127 KB) has more information regarding the full implementation of these edits.

Additional Resource: Ordering & Referring List: Verify eligibility to order or refer Medicare services for Medicare patients.

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