MACs to Fully Activate Edits for Practice Location Address Requirements on August 1

Fiscal Intermediary Shared System (FISS) edits were created to allow Medicare systems to validate all outpatient off-campus provider department addresses submitted on the claims against the service facility addresses found in the Provider Enrollment, Chain and Ownership System (PECOS) provider files as reported on the 855A Medicare Enrollment application.

Permanent activation of the edits will begin on August 1, 2023. Part A Medicare Administrative Contractors (MACs), including Noridian, will activate Reason Codes 34977, 34978, 34984, 34985, 34986, and 34987 and set them up to Return-to-Provider (RTP) claims that do not meet the requirements for services rendered in the provider-based off-campus, outpatient department of a hospital, or in the provider-based, off-campus dedicated emergency department.

For additional information on the requirements, see Noridian’s Provider-Based Facilities page. CMS has updated MLN SE19007, which also gives additional information on the billing requirements.


Last Updated Jul 17 , 2023