Can CMS clarify the logic for EDPS error 01405 - Sanctioned Providers?


Answer:

This edit will be posted on Institutional encounters when the header “from” date of service is within the billing provider or rendering provider’s (header only) sanction effective date and the sanction termination date received from Provider Enrollment, Chain, and Ownership System (PECOS). This edit will be posted on Professional encounters when the header “from” date of service is within the billing provider or rendering provider’s (header and line) sanction effective date and the sanction termination date received from PECOS.

Source: User Group Q&A Documentation from April 27, 2017


Last Updated: 04/27/2017