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Reminder: OPPS Provider-Based Edits

Are you having issues with the recently implemented provider-based billing edits impacting OPPS facilities with multiple service locations?

Certain edits were implemented on/after 8/1/2023 to ensure you are billing your provider-based locations correctly. The edits are FISS reason codes 34977, 34978, 34984, 34985, 34986 and 34987. Please note that these edits are now permanently activated in all National Government Services' regions.

The FISS DDE system includes the ability to inquire about your various practice address locations by accessing the Inquiries Submenu then 1D Provider Practice Address Query. Please refer to the NGS FISS DDE Provider Online Guide Chapter IV Inquiries Submenu (01) for more information.

Claims editing for any of these reason codes will RTP for correction when submitted incorrectly by OPPS providers with multiple service locations. To correct the errors, the appropriate modifier must be appended to all lines on the impacted claim and/or the provider enrollment file needs correction.

For more information, please review the following articles:

Posted 12/8/2023