My claim was denied with remittance messages N264 and N575. I submitted the name and NPI of the ordering/referring provider. What is wrong?

Answer:
The most common reasons for this denial are:
  • The name and NPI combination submitted does not match our provider records. Confirm the correct name and NPI with the provider and/or on the CMS Medicare Ordering and Referring File
  • The provider's name was spelled incorrectly. Confirm the correct spelling with the provider and/or on the CMS Medicare Ordering and Referring File. Do enter "Dr." before the name or credentials after the name.
  • The provider's name was entered in the wrong order. Confirm the correct name with the provider and/or on the CMS Medicare Ordering and Referring File. Confirm you are entering the name in the correct order. On electronic claims, the first and last name are entered in the following ASC 837 v5010 Loop, Segment, Element fields:
    • Referring Provider Last Name: Loop 2310A or 2420F, NM1/DN, 03
    • Referring Provider First Name: Loop 2310A or 2420F, NM1/DN, 04
    • Ordering Provider Last Name: Loop 2420E, NM1/DK, 03
    • Ordering Provider First Name: Loop 2420E, NM1/DK, 04
  • The provider's last name is hyphenated and only one part of the last name was entered. The ordering/referring provider edits compare the first four letters of the last name. If, for example, the provider's last name is Allen-Jones, and a claim is submitted with the last name Jones, the claim will fail the edit and be denied.

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