Monday, September 5, 2016

Usage of Modifier TC under ASC setup - Guideline

Effective for dates of service on or after January 1, 2009 for allowed ASC claims, if modifier = TC, contractors must ensure that either:

• ordering physician name and NPI or

• referring physician name and NPI are present on electronic or paper claims.

If this information is missing, contractors shall return as unprocessable and use Claim Adjustment Reason Code 16 - Claim/service lacks information which is needed for adjudication. Also use the appropriate remittance advice remark codes:

N264 - Missing/incomplete/invalid ordering provider name

N265 - Missing/incomplete/invalid ordering provider primary identifier

N285 - Missing/incomplete/invalid referring provider name

N286 - Missing/incomplete/invalid referring provider primary identifier

No comments:

Post a Comment

Popular Posts