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| Q: |
NPI, National Provider Identifier – My claims for patients in Managed Care Plans are denied for edit 01173 – Prepaid Cap Recipient, Referral or Specialist ID Invalid. I am using the same data I have always used. Why are the claims being denied?
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| A: |
The Plan ID cannot be used as the referring provider. The actual referral or specialist NPI must be entered as the referring provider. Under NPI regulations, the practitioner who actually made the referral must be entered as the referring provider, NOT the Medicaid Provider ID of the facility or Plan ID. If the referring provider entry was a practitioner and it is known that the practitioner is affiliated with the Plan, then contact the Office of Managed Care at 518-473-0122.
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Notes and Comments
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Created: |
July 17, 2008 |
Last Modified: |
July 17, 2008 |
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