Possible Rejection Messages

• Referring Provider first name cannot contain numeric characters
• Referring Provider First Name is required.
• Referring Provider ID is required.
• Referring Provider NPI is required and must be valid for this payer.
• Referring Provider Entity Type Qualifier must be 1.

When filing 5010 claims always make sure the Referral type is always set to Person. This is because in 4010, you can report a referring provider using the name of the organization in which he or she works —Acme Hospital or the name of the provider - such as Janet Svenson. In 5010, the referring provider needs to be a person and not an entity or facility.

To setup Referring Provider Info

1) Select Clients from the View menu, or click the Clients icon on the Therapy or View Listbar
2) Select a Client
3) Select the Insurance tab
4) Select the Insurance policy
5) Click on the HCFA/837 Details button and enter the information under Referring Physician Information section

In order to avoid the above errors, make sure:

• Avoid any suffix or prefix in the Referring Provider name ex. Dr. Janet Svenson
• For Paper HCFA Claims: Enter the referring provider name in the textbox as you want it to appear on the claim form
• For Electronic 837 Claims: Always enter the Referring provider name in this format: LastName FirstName MI
• For example, if the providers first name is John and last name is Smith, enter "Smith John". If MI is needed, enter "Smith John A"