System Identification

40.27 - System Identification (Rev. 160, Issued: 10-26-12, Effective: 01-28-13, Implementation: 01-28-13) The Medicare contractor must ensure that its system can automatically identify claims that include services furnished by providers or practitioners who have opted out of Medicare. It must not make payment to any opt-out physician/practitioner for items or services furnished on or after the effective date of the physician’s or practitioner’s opt out affidavit unless there are emergency or urgent care situations involved. In an emergency or urgent care situation, payment can be made for services furnished to a Medicare beneficiary if the beneficiary has no contract with the opt-out physician/practitioner. See the following section for related instructions.