2. Referring provider number (NPI) is missing when billing provider is a non-person entity for Encounter FDOS < 01/01/3999. This edit will set under the following conditions.
October 31: Paper Claims Update Please note the RightCare mailroom has currently moved to 300 S. Riverside Plaza Suite 700, Chicago, IL 60606. All mail sent to P.O. Box 3757 Corpus Christi, Texas 78463 will be forwarded to Chicago. Providers whose mail cannot be forwarded will have mail returned. For more information, please contact RightCare customer service at 855 897-4448 (855-TX-Right). October 1: Ordering and Referring Providers NPI Requirements Implementation Date
Background: As an update to the MCO notification sent June 18, 2018 about the ordering and referring provider’s (ORP) National Provider Identifier (NPI) requirement, the implementation date has been postponed. Previously set to be implemented on September 1, 2018, the new implementation date is October 1, 2018. Beginning October 1, 2018, HHSC will implement the requirement for the submission of the ORP NPI on all managed care encounters.
Additional Information: The edits to be implemented are: 1. Ordering Provider Number (NPI) cannot be identified for Encounter FDOS < 01/01/3999. This edit will set under the following conditions:
- No provider match found
- Detail Ordering Provider NPI is NOT NULL
- Detail Ordering Provider API is NOT Present OR present but first letter is not F/S/A
- Detail Ordering Provider API is present and first letter is F/S/A but is not equal to 10 characters
- OON Exception Code 3 or 4 is not submitted
- OON Exception Code 3 or 4 is submitted but the submitted ordering provider NPI is not found on the NPPES table for the submitted FDOS