03/16/2020

MCR Rejection-Referring Provider not Eligible to Refer Service Billed

Just received a rejection form medicare for cpt codes 73620 rt fy and 76882 rt. reject code was  co-183 ( referring provider not eligible to refer the service billed and N574 our records indicate that the ordering referring provider is of a type /specialty that cannot order or refer. Is there something about the referring provider listed, the patient has diabetes and there is also a diabetes RFC service so i need the patients PCP on the claim for that.

If a referring provider is not eligible to refer patients, the only action that can be taken for future claims is to contact the practice and inform them that they are not listed in PECOS as a valid referring provider. They will need to take the necessary steps with provider enrollment to update the record so it will not affect claims where it is required, such as radiology & routine foot care. Until that it is done, attempt submitting a corrected claim with an alternate NPI number for the same practice, such as using the group NPI of the referring practice instead of the individual NPI of the referring physician. The patient cannot be held responsible for any balance of non-covered services due to an enrollment issue of the patients referring provider.