My claim was denied with remittance messages 183 and N574. I submitted the name and NPI of the ordering/referring provider. What is wrong?

Answer:
The most common reasons for this denial are:

The provider does not have a have a current PECOS enrollment record. CMS maintains the Medicare Ordering and Referring File as a list of providers who are enrolled in PECOS and who are eligible to order or refer for services. Verify the provider's enrollment status with the provider and/or on the Medicare Ordering and Referring File. 

The NPI entered is for a group practice or organization, rather than an individual physician or non-physician practitioner.

Resources:

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

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