Article Detail - JA DME
Deceased Physicians’ UPINs on DMERC Claims
Original Effective Date: 03/15/2002
Revision Effective Date: 11/01/2013
Effective April 1, 2002, the Common Working File (CWF) will reject DMERC claims using deceased physicians' Unique Physician Identification Numbers (UPINs) whose dates of service exceed the physician's date of death. Assigned claims will be denied based on medical necessity if submitted with invalid or deceased ordering or referring physician's UPINs or claims whose dates of service exceed the physician's date of death. Unassigned claims will be developed. Maintenance, service, and repair codes will be excluded from this editing.
The UPIN deceased physician list will be matched against the American Medical Association's deceased physician database and the Social Security Administration's Death File. Physicians who have died in the past 15 months will not be part of the deceased physician list.
The following new messages will be printed on the supplier's Medicare Remittance Notice (MRN) for claims denied due to deceased UPIN:
- Reason code 52 - The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed.
- Remark code M33 - Claim lacks the UPIN of the ordering/referring or performing physician or practitioner, or the UPIN is invalid.
Claims denied based on a deceased UPIN will require a new order and/or Certificate of Medical Necessity (CMN) from the current treating physician.
