Observation Stays No Longer Subject to Concurrent Review

Medicaid/CHIP—Providers submitting claims for services that require an order or referral must include the NPI of the ordering/referring provider on the claim

Friday, August 25, 2017

Federal regulation 42 CFR §455.440 compels state Medicaid agencies to require all claims for items and services which are ordered, referred, or prescribed contain the NPI of the provider who ordered, referred or prescribed the items or services.

For institutional outpatient claims, ordering provider NPIs are submitted on the CMS-1450 claim form in field 76 or in loop 2310A on electronic claims.

For professional claims, ordering/referring provider NPIs are submitted on the CMS-1500 claim form in field 17b, or in loop 2310A with modifier DN on electronic claims.

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