Skip to Main Content

Print | Bookmark | Font Size: + |

August 8, 2023

Reminder: OPPS Off-Campus Provider-Based Department Edits

On August 1, 2023, CGS was instructed to permanently activate the edits that validate outpatient off-campus provider department addresses submitted on claims against the service facility addresses reported on the CMS 855A Medicare Enrollment application/PECOS.

If your claim receives one of these return to provider (RTP) edits (reason code 34977, 34978, 34984, 34985, 34986 or 34987):

  • Review the address reported on the claim (DDE claim page 03 / MAP171F).
  • Use myCGS or Direct Data Entry (DDE Inquiry Option 1D) to access a list of service facility addresses on file for your facility’s NPI/PTAN.
  • If the address on the claim is not an EXACT match to the address in the myCGS® or DDE query screen, make the necessary corrections, and F9 or resubmit the claim.
  • If the address on the claim is an EXACT match to the address in the myCGS® or DDE query screen, report the appropriate modifier (ER, PN, PO) on all applicable service lines.
  • Submit an 855A enrollment application in PECOS if you identify:
    • A new practice location that’s not enrolled
    • An existing practice location address that changed (including termination)

For additional information, please reference the resources on the Browse by Facility Type – OPPS/CMHC page on our website.

spacer

26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © CGS Administrators, LLC. All Rights Reserved