Missing or Invalid Order/Referring Provider Information - JE Part B

Common Reasons for Message

• Item 17 on CMS-1500 Claim Form or electronic equivalent was left blank
• Either DN, DK, or DQ qualifier was not included or was incorrect
  • DN - Referring Provider
  • DK - Ordering Provider
  • DQ - Supervising Provider
• Provider's name included a middle name, middle initial, or credentials
• Provider is not enrolled as an ordering/referring provider in Medicare

Next Step

• If claim was deemed unprocessable, submit a new, corrected claim
• Verify information in Item 17 or electronic equivalent
• Ensure provider's name was entered as it is found in Order and Referring file
• Submit an Appeal request
  • Submit documentation with Redetermination request. View Medical Documentation Requirements webpage.