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Referring Physician Information

If a patient is referred to a physician for a consultation or treatment, Blue Shield and Preferred Care requires the National Provider Identifier (NPI) number and name of the referring physician. Also, the NPI and name of the ordering physician is required if the diagnostic services, tests, or equipment were ordered by a physician other than the one filing the claim. This applies to both assigned and non-assigned claims.

Note: Claims without this information will not receive benefits.

List the NPI and name of the referring physician in item 17 of the claim form. For electronic claims submission, the NPI, provider last name, and provider first name fields are required.

Your cooperation in obtaining the NPI number when patients are referred or diagnostic tests are ordered is essential. In order to ensure accuracy, this referring physician NPI number should be provided by the referring physician. Radiologists, pathologists, independent laboratories, physical therapists, audiologists, clinical psychologists and suppliers should have the referring physician NPI on all claims. All claims for consultations or services resulting from a request by another physician should also identify the referring physician's provider NPI and name.

Last Updated January 2010