Referred or Ordered Services Denied

Effective with claims received on or after May 23, 2008, Medicare will not pay for referred or ordered services; unless the name and NPI of the ordering, referring and attending, operating, other, or service facility providers are completed on the claims. Further, in accordance with the NPI final rule; effective May 23, 2008, when reported on a claim, the identifier for such a provider must be an NPI, regardless of whether the provider is a covered entity, or participates in the Medicare program. Therefore, Medicare will not pay for referred or ordered services, or items, unless the name and NPI number of the ordering, referring and attending, operating, other, or service facility provider are on the claim. If, after several unsuccessful attempts to obtain the NPI; CR 5890, requires that the provider or supplier who is furnishing the services or items report their own name and NPI in the claimÕs ordering/referring/attending/operating/other/service facility provider/purchased service provider fields.