Ordering Referring Edit Warning

Based on regulations from the Affordable Care Act, provisions have been put into place to identify those claims that lack or have invalid ordering / referring information as required. Effective for claims with dates of service 7/1/14 and beyond, providers that are required to bill ordering / referring information on claims may begin to see the following warning reason and remark codes on their remits or 835s: Reason Code 16 (Claim / service lacks information or has submission / billing error(s) which is needed for adjudication) and Remark Code N286 (Missing / incomplete / invalid referring provider primary identifier). This combination of codes indicate that either 1) the required ordering / referring information is missing / invalid or 2) the ordering / referring information is present on the claim but the provider is not enrolled with WV Medicaid. This WARN will not affect the processing of the claims at this time; however, in the near future providers will be notified that the WARN will be changed to DENY. If you have any questions regarding this information, please notify Molina Provider Relations.