NGS is denying claims for PECOS not enrolled (reason code 17729). We have confirmed on data.cms.gov website that the MD is enrolled and NGS rep states their internal file also shows enrolled and Name/NPI matches. After researching all the TB9997 claims, the common denominator is the start date is after 6/3/24, which happens to be the effective date CMS implemented the edit.
All the June claims with a start date of "06/01/24" are processing without an issue. The rep has sent a referral to the claims department at NGS; however, she said to wait 30-45 days before following up. I encourage you to ask your billers if they are seeing the same issue and to call NGS ASAP if they too are seeing the claims in this status. The more providers call, perhaps the faster they will react.
Susan Dailey
Vice President of Reimbursement
559-582-6832 ext. 3010
559-585-8648 (fax)
559-470-7875 (cell)
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