https://www.youtube.com/watch?v=m175PzSmpe8

Claim denied for missing/invalid REFERRAL :(BLOCK 23)

RENDERING PROVIDER:

A provider who provides actual service.

REFERRING PROVIDER/Primary Care Physician/ Family Doctor:

A provider who provides initial service.

² Questions to probe with Payer Rep:

²Claim received date?

²Claim denied date?

²Check system for referral is available or not if found give that to rep and reprocess

²Check claim image if referral# found in Block#23 give that to rep for reprocess

²If referral# not found in anyway, ask rep what is PCP (primary care physician) name and PCP phone# and get the corrected claim address and time filing limit

²Claim# and Call reference#

²Thank you.

²

***Note:

PPO & EPO plan doesn't require a referral, if the patient plan is PPO & EPO ask the rep to reprocess.