Rendering Provider Information

The CEDI Help Desk has seen an increase in 5010A1 claim rejections and calls due to the rendering provider information being submitted in Medicare durable medical equipment (DME) claims. CEDI would like to provide the following information as clarification on why the Rendering Provider Loop should not be submitted in Medicare DME claims.

• The rendering provider information will be verified in the 5010A1 format where it was not being verified in the 4010A1 format. Sending this information can cause a front-end rejection.
• The NPI of the rendering provider must be on the DME supplier crosswalk. Since the rendering provider is typically an individual provider and not listed on the DME supplier crosswalk, this can cause a front-end rejection if sent.
• The rendering provider information is a sub-set of the billing provider information which is only used in Medicare Part B claims to indicate the physician that saw the patient. Medicare DME does not use sub-sets making the rendering provider information identical to the billing provider information. When the billing provider and rendering provider are the same, the rendering provider should not be sent.
• The rendering provider information is not used by Medicare to process the Medicare DME claims. The rendering provider information is also not forwarded by Medicare to secondary payers for use in processing.

Post Date 01/19/12

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