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Last Modified: 5/14/2020 Location: FL, PR, USVI Business: Part B

N265 informational message FAQ

Q: I received remittance advice remark code (RARC) “N265” on my remittance advice; what does it mean? How can I avoid this in the future?
A: If you receive an N265: Missing/incomplete/invalid ordering provider primary identifier RARC, the ordering/referring provider‘s National Provider Identifier (NPI) is not found in the Provider Enrollment, Chain and Ownership System (PECOS) or in First Coast Service Options’ (First Coast’s) internal crosswalk file.
If you received this RARC during Phase 1, it was considered an informational message. If there were no other issues with the claim, it continued to process through to adjudication.
However, if you receive this RARC during Phase 2, the billing provider will not be paid for the items or services that were furnished based upon an order or referral.
To avoid this error -- N265: Missing/incomplete/invalid ordering provider primary identifier -- the billing provider should:
Make sure that the ordering/referring provider’s NPI included in the claim is the NPI of an individual and not of an organization
Ensure the ordering/referring provider has verified his or her enrollment in Internet-based PECOS
Ensure that the ordering/referring provider is classified as the type of specialty eligible to order/refer beneficiary services
Note: Billing providers can verify the eligibility of an ordering/referring provider by visiting the Ordering Referring Report external link page (located on the CMS website) and downloading the current Medicare Ordering and Referring File.
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Source: SE1011, CR 6417
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