AMA License
Warning: You are using IE 7 or below. You may also be using compatibility mode. Our site was not designed to run in IE 7 or below but you can still continue to use it. To disable compatibility mode - View our Instructions.
  • eServices
  • Event Portal
  • Listservs
  • Contact Us
palmetto gba palmetto gba
  • JM Part B Hub
  • Topics
    • Basics for Medicare
    • Browse by Specialty
    • Browse by Topic
    • CERT
    • CMS News
    • EDI
    • eServices Portal
    • E/M Help Center
    • Fee Schedules
    • Learning & Education
    • Medical Policies
    • Medical Review
    • Medicare Beneficiary Identifier (MBI)
    • Publications
    • Resources
    • Take Our Satisfaction Survey and See the Results

    • View All Topics
  • Forms / Tools
    • formspMedicare Forms
    • 277CA Edit Lookup ToolrlaunchACE Smart Edit Look-Up ToolrlaunchAcronym/Terminology IndexADR Response CalculatorrlaunchAppeals CalculatorrlaunchBasics for MedicarerlaunchCharge Denial Rate CalculatorrlaunchCMS 1500 Claim Form (02/12)rlaunchDenial ResolutionEDI Enrollment Instructions Guide ModulerlaunchEDI Online EnrollmentrlaunchEDI System StatusrlaunchEnrollment Application FinderrlaunchEnrollment Application Status LookuprlauncheServices PortalrlaunchFormsFrequently Asked QuestionsGlobal Surgery CalculatorrlaunchIncident To Self-Service ToolrlaunchInteractive ABNrlaunchInteractive Remittance AdvicerlaunchIVR Conversion ToolrlaunchMedicare Advantage Plan DirectoryMedicare Physician Fee Schedule ToolrlaunchModifier LookupMSP CalculatorrlaunchMSP LookuprlaunchNational Correct Coding Initiative (NCCI) ToolrlaunchOnline ERN (ERA) / Report Restore FormrlaunchOverpayment Interest CalculatorrlaunchPhone Numbers, Emails and AddressesProvider Address Job AidReason/Remark Code LookuprlaunchRedetermination Status ToolrlaunchWhat would you like to do?rlaunch
  • Education / Events
    • Learning & Education
  • search Search close Close
You are searching through our JM Part B search collection

Quick Search

Please Note: There is no Medicare information on our corporate website. Please select a specific contract in the 'Search Within' box for Medicare related information.

  1. palmettogba.com
  2. JM Part B
  3. Browse by Topic
  4. Frequently Asked Questions
  5. Ordering and Referring
plogo

© 2021 Palmetto GBA, LLC

We frequently update our articles to reflect the latest changes and updates to Medicare, and strongly recommend you visit this article at link below to confirm you have the latest version.

Published Date:03/01/2021

Printed Date: 9/22/2015

URL: http://palmgba.com/marlowe/redesign6/article.html

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

share share share
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.

Jump to:

help Was this article helpful?

We value your opinion and want to provide the highest-quality and most relevant Medicare knowledge possible. Please let us know if this article was helpful.

That's great!

We’re glad we could help you today and appreciate your feedback. When you rate our articles as most helpful, we know that we are on the right track for providing you with important news and information.

They can't all be winners right?

We're sorry this article didn't help you today. We'll use your feedback to review this article to try to revise or expand it. Contact us with more feedback or a question on this topic.

  • Try these similar articles:
  • Our Search Engine has found:

Last Updated: 03/01/2021

share share share

Contact Palmetto GBA JM Part B Medicare

Email Part B

Contact a specific JM Part B department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

Other Palmetto GBA Sites

Palmetto GBA Home

DMEPOS Competitive Bidding Program

Jurisdiction J Part A MAC

Jurisdiction J Part B MAC

Jurisdiction M Part A MAC

Jurisdiction M Part B MAC

Jurisdiction M Home Health and Hospice MAC

MolDX

National Supplier Clearinghouse MAC

PDAC

RRB Specialty MAC Providers

RRB Specialty MAC Beneficiaries

Anonymous

 

Click to Chat Now

Contact Us

(X)

© 2021 Palmetto GBA, LLC.

Get Adobe Reader

Get ByteScout Free Microsoft Excel Viewer

Privacy Policy

Site Help

Site Map

Site Help

Minimum Requirements

Legal Disclaimer

cms

 


Page Not Found. Our New Website: https://www.palmettogba.com

We've recently uppgraded our website and it looks you're trying to access an old link. Please select an option below.

Attempt to load this page on new site

Go to Home page

Go to Contact Us page

This link may not exist on our new site. Please review the information below from our old site. It was current up until 03/01/2021. Please note: It is possible we have removed this information, so please review the new website by clicking on the link above.

View a related article: