Wiki Denial code form Medicare CO183

[almag69]

Any help would be Greatly appreciated. We are gettting numerous laboratory denials with this code 183 indicating * The referring provider in not eligible to refer the service billed* We have looked online and see that as of 1/6/14 there were changes made. My question is do we need to go in and change all of our referring provider information we have in our system to match exactly how they have the list on the CMS website? Thank you.

 

[jlopez6186]

This may have to do with the new PECOS edits that were implemented beginning of the year. The edit says that the referring provider must be enrolled in PECOS. If they are not, you will get that denial. You should contact your software vendor and see if they have anything that will facilitate this for you. What did Medicare say? Is this a self refer claim. Is your provider enrolled with PECOS?

 

[anita.hawthorne@msj.org]

Co-183

I have found out that when you run the referring provider name in NPPES it has to match exactly what is on the claim.