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eClaims - Common Rejections - Missing/Invalid Referring Provider NPI?

Missing Referring Provider NPI
Rejection messages include, but are not limited to:

  • CLAIM LEVEL REFERRING PROVIDER NPI IS MISSING
  • CLAIM LEVEL - REFERRING PROVIDER PRIMARY ID# QUALIFIER IS MISSING OR INVALID (Bad Data: XX )
  • CLAIM LEVEL REFERRING PROVIDER NPI IS MISSING OR INVALID
  • ACKNOWLEDGEMENT/REJECTED FOR MISSING INFORMATION^Entity's National Provider Identifier (NPI)^Referring Provider

This rejection is stating that the NPI for the referring provider is missing/invalid. The NPI for the referral can be accessed via the Referrers reference under the 'Provider IDs' tab. After the NPI has been entered the claim can be rebuilt and resent.

If the referring provider's NPI number is uncertain, refer to nppes.cms.hhs.gov/NPPES/, the national NPI Registry, to look up the National Provider ID of the referring provider.

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