Critical Access Hospital (CAH) Method II Claim Updates
Effective January 1, 2026, Critical Access Hospital (CAH) Method II claims will be denied if the Attending & Rendering providers have not been reassigned to the CAH’s 855A billing PTAN. The Centers for Medicare & Medicaid Services (CMS) Method II requirement went into effect on July 1, 2025; however, CMS has granted a grace period through January 1, 2026, before claims will be denied.
If you are a Critical Access Hospital and have elected to bill under Method II, all Attending and Rendering providers must have reassigned their rights; otherwise, claims will be denied. This includes, but is not limited to, teleradiology and other contracted providers.
If the organization has an active reassignment with the provider, the additional PTAN can be added to the current Reassignment through the provider’s 855I.
If these steps are not handled properly, effective January 2, 2026, the Critical Access Hospital will experience denials with denial code N253, “Service not payable due to billing conflict,” and Reason Codes 31006 and 31007, “Duplicate professional services due to no reassignment record”.
Blue & Co. suggests downloading a Reassignment report from PECOS and reconciling it to your active provider list.
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If your facility needs assistance with creating a streamlined process to reassign your providers to your CAH PTAN, or would like to improve your enrollment processes, contact our experts today.
