Professional Claim Ordering or Referring Provider Edits

The submission of ordering or referring provider information is required on 837 professional claims with a radiology procedure, laboratory service, diagnostic or HCPC (excluding Ambulance).

Referring provider information must be submitted in the 2310A and/or 2420F or ordering provider information must be submitted in the 2420E or the claim will reject. Please refer to the 837P TR3 implementation guide or contact your vendor for more information.

For questions regarding BCBSKS policy memos, contact your professional relations representative or call provider network services at 1-800-432-3587.

For questions regarding 837 professional transactions, contact the EDI help desk at 1-800-472-6481 option 1, then 2.

Implemented 02/20/2014.

Updated 12/21/2021 to change the language that an ordering or referring provider is required as opposed to a referring and ordering provider is required.