Effective for dates of service on or after January 1, 2009 for allowed ASC claims, if modifier = TC, contractors must ensure that either:
• ordering physician name and NPI or
• referring physician name and NPI are present on electronic or paper claims.
If this information is missing, contractors shall return as unprocessable and use Claim Adjustment Reason Code 16 - Claim/service lacks information which is needed for adjudication. Also use the appropriate remittance advice remark codes:
N264 - Missing/incomplete/invalid ordering provider name
N265 - Missing/incomplete/invalid ordering provider primary identifier
N285 - Missing/incomplete/invalid referring provider name
N286 - Missing/incomplete/invalid referring provider primary identifier
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