Creation of Internal Vendor Provider Files (Rev. 866, 07-03-06) - Competitive Acquisition Program

by  Jared Staheli
July 9th, 2015

The designated carrier shall create an internal provider file for each vendor which includes the names, addresses, and UPINs, (NPI when effective), of those physicians who have elected that vendor.

The designated carrier shall edit incoming vendor claims to verify that the UPIN number on the claim for the ordering physician is one of the UPINs on the provider file for that vendor. The designated carrier shall treat the claim as unprocessable when it receives claims from vendors with ordering physician UPINs that do not match a physician UPIN on the provider file and return the following messages:

Remittance Advice Messages:

Reason Code 96 - Non-covered charge(s).

Remark Code: N265 – Missing/incomplete/invalid ordering provider primary identifier.

Medicare Summary Notice Messages:

17.11 This item or service can not be paid as billed.


9.7 – We have asked your provider/supplier to resubmit the claim with the missing or correct information.


17.11 -Este servicio no se puede pagar según facturado.


9.7 - Le hemos pedido a su proveedor que envíe la reclamación con la información omitida o incorrecta.


Creation of Internal Vendor Provider Files (Rev. 866, 07-03-06) - Competitive Acquisition Program. (2015, July 9). Find-A-Code Articles. Retrieved from

© InnoviHealth Systems Inc

Article Tags  (click on a tag to see related articles)

Publish this Article on your Website, Blog or Newsletter

This article is available for publishing on websites, blogs, and newsletters. The article must be published in its entirety - all links must be active. If you would like to publish this article, please contact us and let us know where you will be publishing it. The easiest way to get the text of the article is to highlight and copy. Or use your browser's "View Source" option to capture the HTML formatted code.

If you would like a specific article written on a medical coding and billing topic, please Contact Us.


innoviHealth Systems, Inc.
62 East 300 North
Spanish Fork, UT 84660
Phone: 801-770-4203 (9-5 Mountain)
free demo
request yours today
for any budget
sign IN
welcome back!

Thank you for choosing Find-A-Code, please Sign In to remove ads.