Activation of Systematic Validation Edits for OPPS Providers with Multiple Service Locations

August 5, 2019

In MLN Matters SE19007 “Activation of Systematic Validation Edits for OPPS Providers with Multiple Service Locations” notifies providers that Medicare is now requiring the exact match of all addresses for practice locations that are listed on provider claim submissions to Medicare. Medicare began auditing in July 2018 for purposes of reinforcing Chapter 1, Section 170 of the Medicare Claims Processing Manual “Payments on the MPFS for Providers with Multiple Service Locations.” The exact address match will be in full and effect once the July 2019 quarterly release is implemented.

Claims that do not have an exact address match will be returned to the provider. Providers can make corrections to their service facility address for a claim submitted in the DDE MAP 171F screen for DDE submitters.

It is recommended that providers review their Medicare enrollment record and billing practices to ensure compliance with the exact address match requirement. Medicare recommends that all providers update their billing records to match Medicare enrollment records. Providers should verify and submit changes through the CMS-855A or CMS-855B application through the Provider Enrollment, Chain, and Ownership System (PECOS) as soon as possible. Changes and updates to an address or the addition of a new location typically take Medicare 30–60 days to process.

If you have questions or need legal assistance with updating your Medicare enrollment information, please contact Amanda Waesch at 330-253-9185, alwaesch@bmdllc.com.

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