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October 11, 2012

Ordering/Referring Provider Name and NPI

As stated in Policy Memo No. 1, the name of the ordering provider, when applicable, (including NPI or specific performing provider number, except when exempt by law) must appear on every claim. The ordering/referring provider's name and NPI should appear in Box 17/17b of a paper claim or within the 2310A loop electronically.

A front end edit will reject electronic claims if loop 2310 A is not populated. Paper claims will be rejected when 17/17B are not populated.
NOTE: Any claim with a radiology procedure (7XXXX), laboratory service (8XXXX), diagnostic (9XXXX) or HCPC (excluding Ambulance), will require an ordering/referring provider name and NPI.

This information was originally published in the Blue Shield Report S-1-11 dated January 24, 2011; and subsequently in the Blue Shield Report S-9-11 dated September 26, 2011.