CO172 Provider specialty code not valid for this type of service

Noridian Administrative Services (NAS), the Jurisdiction D DME MAC, showed an increase in CO172 (provider specialty code not valid for this type of service) denials in April on oxygen claims. This was due to CMS Change Request #5563, dated 6/29/07, which directs the contractor to add the CMS specialty code B1 to all suppliers who are registered with the National Supplier Clearinghouse as oxygen providers.

According to the NSC, these files had been updated for those providers who are on file as a supplier of oxygen and/or oxygen-related equipment. But according to Noridian, those files were not showing as updated.

When a provider contacted the DME MAC, Noridian referred the provider to the NSC, and the NSC referred the provider back to the DME MAC.

NAS has, however, worked with the NSC and its systems staff to load the oxygen specialty codes into the claims processing system. For those suppliers who are certified to bill oxygen as listed in the NSC files, this will prevent the incorrect CO172 denials that providers started receiving April 7, 2008.

During the week of April 14, NAS reprocessed (adjusted) all oxygen claims that had denied with the CO172 message since April 7, 2008. Adjusted claims (those with ICNs ending in 0001) that remain denied with a CO172 message indicate that the NSC file does not reflect that the supplier is certified to bill oxygen. For more information on the required oxygen certification and how to update your NSC file, see the article titled “Oxygen Certification Requirement Implemented” posted to the NAS website on 4/11/08 in the “What’s New” section.

NAS has stated that all claims that were denied in error for suppliers who are certified to bill oxygen were reprocessed and suppliers will not need to resubmit these claims.

If you are a provider who received this denial code and want to check your status with the NSC to verify you are registered properly, call 866/238-9652. You can find the licensure/certification requirements on the NSC website at www.palmettogba.com/nsc. Select the Licensure Information link in the “Tools and Top Links” section. Then select the “Licensure Information” link and scroll down to find the link for the DMEPOS State License Directory. Thirty-eight states require licenses and/or certifications to provide oxygen and/or oxygen-related equipment. The NSC assigns an oxygen specialty code to all DMEPOS suppliers that have indicated they will be providing oxygen and/or oxygen-related equipment on the Form CMS-855S enrollment application.

Sarah Hanna is a reimbursement consultant and vice president of ECS Billing & Consulting, Tiffin, Ohio, and specializes in proper billing protocols, Medicare coverage guidelines and billing office procedures. She can be contacted at 419/448-5332 or [email protected].

Based on analysis of 1,959,196 claims adjudicated by the Medicare DME MACS and processed for RemitDATA customers in April 2008. Source: RemitDATTA, 866/885-2974, www.remitdata.com