US · guidance
CMS Pub. 100-04, ch. 17, § 100.4.4
Submission of Claims from Vendors Without a Provider
Primary Identifier for the Ordering Physician
(Rev. 3721, Issued: 02-24-17, Effective: 05-25-17, Implementation: 05-25-17)
The designated A/B MACs (B) shall edit to determine if a UPIN, (or NPI when
effective), of the ordering physician has been entered on the claim. If the UPIN, (or NPI
when effective), has not been entered on the claim, the designated A/B MAC (B) shall
treat the claim as unprocessable.
The contractor shall use the following remittance advice messages and associated codes
when rejecting/denying claims under this policy. This CARC/RARC combination is
compliant with CAQH CORE Business Scenario Two
Group Code: CO
CARC: 206
RARC: N265
MSN: N/A
History
(Rev. 3721, Issued: 02-24-17, Effective: 05-25-17, Implementation: 05-25-17)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
539913b287a4ff03d7056f92fdfe7f18f9ac7f872a70950bf20fd566977dea78
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