Author Topic: referring provider & secondary claims  (Read 1986 times)


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referring provider & secondary claims
« on: February 08, 2010, 01:23:20 PM »

I have some claims that were rejected due to " referring provider" needed for a procedure. What if the doctor says that is is only him and there was no referring provider, can you use the patients primary care physician or previous physician? Or should I just find out what the procedure is that needs this and send the claim without it?

Also I have sent various claims to Medicare and when i get the eob it says that the cliam information has been forwarded to the pts secondary insurance. Do i need to submit the claim to them as well, or will they follow through with the claim based off of the eob?


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Re: referring provider & secondary claims
« Reply #1 on: February 08, 2010, 03:59:57 PM »
those are medicare cross-over claims, and you don't do anything but follow up to make sure they paid, if it goes over 30 days


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Re: referring provider & secondary claims
« Reply #2 on: February 08, 2010, 08:08:31 PM »
I have claims where the referring provider is required, and my provider is the referring provider.  For example, my doc is a DO (doctor of osteopathy) board certified in osteopathic and emergency medicine.  He worked in ER's for over 20 yrs.  He gets a patient with chest pain and does an EKG in the office.  The EKG requires the referring dr, which is him.  I put in his name/NPI and that is accepted.  Not sure what services you are billing for, but you can't put in the name of a physician to get the claim thru.  It must be the physician who ordered the services, even if it is the billing provider.

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Re: referring provider & secondary claims
« Reply #3 on: February 09, 2010, 01:08:29 PM »
just a thought to make sure if you have an authorization number that you put it in the correct box.  I had a couple claims returned needing referral doc because the authorization number populated both the authorization number box and the referral box, once I deleted the authroization number from the referral box the claim cleared fine.  This particular claim didn't need a referral, just an authorization.


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Re: referring provider & secondary claims
« Reply #4 on: March 03, 2010, 05:56:29 AM »
My understanding for the denials "referring provider" with any procedure code is required as either the physician who referred for the service or the physician who rendered the service with the NPI details.