Knowledgebase: Claim Rejections
Champus CH002, UHC Military and Veterans 99726 - RENDERING PHYSICIAN IS REQUIRED
Posted by Will Morrow, Last modified by Charmagne Williams on 22 May 2017 11:47 AM

Rejection: RENDERING PHYSICIAN IS REQUIRED

What happened: Payer was expecting a rendering and billing loop, but we did NOT send both loops because of specific instructions with this payer to NOT send both loops when the NPI IS the same.

Resolution: Contact provider relations to verify how provider is set up at 877-988-9378. More than likely, the provider should be an individual but is set up as a group. IMPORTANT NOTE: Be sure to go through these EXACT steps/prompts when calling this number:

1: Say 'Provider'
2: Enter the TIN.
3: Enter a patient ID
4: Enter the patient's DOB
5: Say 'Help with something else'
6: Say 'Credentialing'
7: Say 'Help with something else'

This will get the provider to the correct department who can verify how the TIN is set up. It's very important that they are verifying provider TIN and NOT the NPI.

UPDATE: 5/2/13 Received word that there was an issue in the provider data transmission from WPS to Palmetto. To resolve this issue, the provider must send a fax on company letterhead to the attention of: Provider Data Management, 855-831-7044. On the fax, must include: Tax ID, NPI, contact phone number/name, and a statement that says the provider is an individual provider billing with a TPO of 1. That team will update the information and call the provider back when that has been completed.