Missing or Invalid Order/Referring Provider Information

CARC/RARC Description
N264 Missing/incomplete/invalid ordering provider name
N265 Missing/incomplete/invalid ordering provider primary identifier
CO-16 Provider liable

 

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

 

Last Updated Apr 17, 2019