Submission of Claims from Vendors Without a Provider

100.4.4 - Submission of Claims from Vendors Without a Provider Primary Identifier for the Ordering Physician (Rev. 3721, Issued: 02-24-17, Effective: 05-25-17, Implementation: 05-25-17) The designated A/B MACs (B) shall edit to determine if a UPIN, (or NPI when effective), of the ordering physician has been entered on the claim. If the UPIN, (or NPI when effective), has not been entered on the claim, the designated A/B MAC (B) shall treat the claim as unprocessable. The contractor shall use the following remittance advice messages and associated codes when rejecting/denying claims under this policy. This CARC/RARC combination is compliant with CAQH CORE Business Scenario Two Group Code: CO CARC: 206 RARC: N265 MSN: N/A