Wiki Referring provider

[Four Corners]

Im confused on this one....MCR is denying a claim, due to lack of information. It states missing/incomplete/invalid referring provider. Patient was not referred by a provider, she was referred by a friend. So im not sure what to do?

Thanks in advance!

 

[Cyndi113]

Call the Medicare call center and let them know your problem. They can direct you.

 

[dclark7]

If there are any diagnostic tests on the claim (ECG, x-ray, etc) you need a "referring" (it's actually the provider who ordered the test) provider in box 17 with the NPI in box 17b.