Agency Header

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.

Follow us on Facebook