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Referring Doctor missing.

bmanus

Guru
Messages
126
Location
Concord NC
Best answers
0
Good Morning,

My procedure 88305 has been denied my Noridian Medicare for missing referring doctor information. I was unware that the referring doctor is required. Is this true? If so could some point me to the correct section of the Medicare billing manuel for this information. Is this new for 5010?

Thank you in advance for your help with this matter.
 

Evelyn Kim

Guru
Local Chapter Officer
Messages
201
Location
San Antonio, TX
Best answers
0
According to the Labortory and Pathology manual it is required to document on claim:
"An NPI for an ordering/referring/attending/operating provider was mandatory effective May 23, 2008. Legacy/Provider Transaction Access Number (PTAN) numbers cannot be reported on any claims sent to Medicare on or after May 23, 2008. An NPI is required regardless of whether the provider participates in the Medicare program or not or is a covered entity. It is the responsibility of the claim/bill submitter to obtain the ordering/referring/attending/operating NPI for health care providers. Claims received without an NPI in Item 17b are rejected."

I found this manual on our local Medicare carrier, Trailblazerhelth.com, but each carrier should be able to access similiar information.

Hope this helps.
 
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