Automatically add a referring provider to claims when one is not already present. Optionally filter by CPT codes.
Applies to: Professional (837P), Institutional (837I), Dental (837D)
Note: This rule only adds a referring provider if one is not already present on the claim. It will never overwrite an existing referring provider.
| Field | Required | Description |
|---|---|---|
| Start Date | Yes | When this rule becomes active |
| End Date | No | When this rule expires |
| Payer Number | No | Only apply for a specific payer. Blank = all payers |
| CPT Codes | No | Comma-separated CPT codes. Only add the referring provider if the claim contains one of these codes. Blank = all claims |
| Referring NPI | Yes | The referring provider's NPI |
| Referring Last Name | Yes | Last name (or organization name) |
| Referring First Name | No | First name (leave blank for organizations) |
| Entity Type | Yes | Person or Organization |
| Notes | No | Your reference notes |
Medicare requires a referring provider on physical therapy claims.
| Field | Value |
|---|---|
| Payer Number | 00882 |
| CPT Codes | 97110,97112,97140,97530 |
| Referring NPI | 1234567890 |
| Referring Last Name | JOHNSON |
| Referring First Name | MICHAEL |
| Entity Type | Person |
A payer requires a referring provider on every claim.
| Field | Value |
|---|---|
| Payer Number | 60054 |
| Referring NPI | 9876543210 |
| Referring Last Name | PRIMARY CARE GROUP |
| Entity Type | Organization |