Reminder: Referring Provider NPI Required on DME Claims

As a reminder, CarePartners of Connecticut would like to clarify that when submitting durable medical equipment (DME) claims, the referring physician’s NPI must be included on the claim.

This requirement is in accordance with Centers for Medicare and Medicaid Services (CMS) guidelines regarding encounter data associated with Medicare Advantage organizations (MAOs). CMS requires MAOs like CarePartners of Connecticut to submit encounter data that documents the clinical conditions our network providers diagnose, as well as the services and items delivered to our members to treat these conditions — and we rely on providers to include the most accurate information on patient claims so that we can provide a complete picture of the care delivered.

Section 6.3.10 of CMS’s Encounter Data Submission And Processing Guide provides an overview of Edit 30261, which states that the referring physician’s NPI is required on all DME encounters related to MAOs.

One of CarePartners of Connecticut’s most valued assets is our exceptional provider network, and we greatly appreciate your continued efforts to provide us with the highest quality information about the care and services administered to our members.