Making do when you don’t have a referring doctor’s NPI

Why This Topic Matters

Missing referring-provider information can delay claim submission or create avoidable denials. This article helps readers understand a CMS-backed workaround and the broader compliance context for claims that include ordering or referring practitioner data.

Article Sections

1. Scenario

   Introduces a claim-submission problem involving an unavailable referring practitioner NPI and the question of whether the claim can still be filed.

2. Answer

   Summarizes CMS guidance on what information may be used on the claim and when this approach is considered appropriate, including the broader context of matching provider information.

3. Tip

   Notes which types of practitioners are generally allowed to order or refer services and highlights a limitation on using the workaround in other referral situations.

4. On the Internet

   Provides a source citation and reference to a CMS transmittal related to the topic.