Last Modified: 5/14/2020
Location: FL, PR, USVI
Business: Part B
Q: Where do I indicate referring or ordering provider’s information on my claim?
A: Indicate the referring or ordering provider’s information in the section titled Name of referring provider or other source (Item 17 & 17b of the CMS-1500 paper claim form or the 2310A Referring Provider Loop, segments NM101 using qualifier DN or DK, NM103-NM105 [Name], NM108 using [XX] qualifier, and NM109 [NPI] of the 837P electronic claim) as indicated below.
• Report the name of the referring or ordering practitioner of a service in Item 17 (837P 2310A loop, segment NM1) and the appropriate qualifier to the left of the dotted line on the CMS-1500 (02/12) claim form: DN (referring provider) or DK (ordering provider)
• No information should appear in Item 17a (837P 2310A loop, segment REF02). Item 17a was formerly used to report the Unique Physician Identification Number (UPIN), which is no longer used -- leave this item blank. Information appearing in this item or loop will cause your claims to be returned as unprocessable and rejected electronically.
• Report the National Provider Identifier (NPI) of the referring/ordering provider in Item 17b or the 837P 2310A Referring Provider Loop, segments NM101 using qualifier DN (referring provider) or DK (ordering provider), NM103-NM105 [Name], NM108 using [XX] qualifier and NM109 [NPI].
• Note: When a service is referred or ordered by another practitioner, a valid NPI is required and must be reported. Your claims will be returned as unprocessable if the NPI is required and is missing, invalid or submitted in the wrong item (e.g., a valid NPI submitted in Item 17a).
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