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Medicare denial reason 183

I

ivonneatanacio

Guru
Messages
170
Location
Mechanicsville, VA
We have recently started to receive denial on 76942 along with many x-rays codes billed and the reason for denial is 183 the referring provider is not eligible to refer the services billed.

Since when does a Medicare patient require referral for any services?


Need help!!!
 
denials for xrays from m/c

We are having the exact same issues with xrays being denied ...but there is no rhyme or reason and it is not on all of them. We need help too!
 
I have found with most Medicare FIs that you do need a physician in field 17 for most ancillary services. This field was tweeked ever so slightly to include a qualifier to indicate, referring provider, or ordering provider, or supervising provider. Go to NUCC.org to download the most recent revision to the 1500 mnual to learn what the qualifiers are. Also on the CMS website in the MCM this has been added to the instructions for the 1500.
If you leave this field blank or with no qualifier then Mcare is likely to reject with the denial reason you have indicated.
 
I have these denials and it is because the referring provider on the claim is either a chiropractor or a non-par physician. I believe most radiological exams require to have a referring md on the claim. Check your referring md.

Melissa, CPC :)
 
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