Wiki Lab & Referring Provider

[donnaacampbell@yahoo.com]

We will for an independent reference lab. Do we need to have a referring provider on all of our claims? Also does box 24J and box 31 need to match?

 

[annettebec]

Referring Provider

I work for an Independent Lab. We have to put a referring provider on all claims. J24 and 31 should match. We had an audit and passed this area on compliance. Hope this helps, Annette

 

[LynneC1]

J24 and 31 - Is the information to enter the medical director or the facility information

 

[annettebec]

Referring Provider

Our Independent Lab has the rendering provider NPI in Box J24 and the Independent Lab NPI in Box 31 for Medicare only. All other Insurance/Carriers are billed under the Medical Director J24, but the Independent Lab NPI is still in box 31.

 

[vazq123]

If you are billing as an independent lab (POS 81) you always need an ordering (referring) provider/NPI listed in box 17 and the laboratory is the rendering provider.
The laboratory's NPI goes in box 24J and 31 and must match, with the physical address of the laboratory in box 32.
This applies to all carriers.

 

[annettebec]

Referring Provider

In Michigan, this is not correct for Medicare. I have documentation stating otherwise.

 

[LynneC1]

Box 31

Could you supply me with the documentation, AB? Our laboratory at this time is not pathology but toxicology. We do have a medical director but I am unsure if the doctor's information needs to be on the claim.