Clearinghouse Rejection: Referring Provider (2310A) is required to be a person

Clearinghouse Rejection: Referring Provider (2310A) is required to be a person

 CE - Referring Provider (2310A) is required to be a person (NM102 = '1') 

  • Referring Provider Library: If the full name of a Referring Provider is entered in the Last Name field, it is recognized as an institution instead of a person

      • This puts a 2 in place of the usual, 1 in the 2310A Loop NM1 segment.

    • Example:

      • James Flores MD is entered in the Last Name field of the Referring Provider Library.

    • Result in the ANSI Claim: 2310A NM1*DN*2*JAMES FLORES MD

    • Flores is entered in the Last Name, James is entered as the First Name.

      • Result in the ANSI Claim: 2310A NM1*DN*1*FLORES*JAMES


 

  • If an Institution needs to be the referring:

    • Enter part of the entity's name in the Last Name and part in the First Name field.

    • Example: The Clinic Health Center is the name of the Institution.

    • Enter Health Center as the Last Name.

      • Enter The Clinic as the First Name.

        • Result: 2310A NM1*DN*1*HEALTH CENTER*THE CLINIC


    • Related Articles

    • Clearinghouse Rejection Articles

      If the Subscriber State (AB) is a Canadian province then Subscriber Zip Code (AB T8L0S2) must be six characters Referring Provider (23010A) is required to be a person 2300 NTE02 has a character limit of 80 characters Service Line 1 COB Claim ...
    • Add or Modify Referring Providers/PCP

      Add or Modify Referring Providers/PCP One Library is kept for both the Referring Provider and PCP. System Settings for Referring Provider Access System Settings: Admin > System Settings > Charges > REFPROVIDER Auto-populate the Referring Provider on ...
    • Rejections Examples

      Rejection: Invalid Subscriber ID Format for ___ Resolution: From the Patient Dashboard, verify Eligibility, view the Eligibility Report, view the Patient's Scanned Insurance Card, and/or call the Patient. Correct the Policy Number. On the Encounter ...
    • Billing/Rendering and Referring Providers Import Tool

      Billing/Rendering and Referring Providers Import Tool Providers can be imported into the Referring Provider Library and the Billing/Rendering Provider Library. Use the Modify Import Profiles button to create a Profile. Use the Import button to Import ...
    • Billing/Rendering/Referring Provider FAQs

      Provider Numbers Where do I add the Provider's Medicaid number? Provider's Medicaid Number Billing/Rendering Provider: The Medicaid number is added on the Billing/Rendering Provider screen in the Licensure/Credentialing panel. (Libraries > ...