Box Definition
Box 17a is the non-NPI ID of the referring provider and is a unique identifier or a taxonomy code. The qualifier indicating what the number represents is reported in the qualifier field to the immediate right of 17a. The qualifiers appropriate for identifying an ordering, referring, or supervising role are as follows:
- DN -- referring provider
- DK -- ordering provider
- DQ -- supervising provider
In AveaOffice
AveaOffice will assign the appropriate qualifier for the referring provider based upon the role type assigned either on the Utilization Plan (U/R Required Services) or at the time attendance is recorded for Standalone Services.
The taxonomy or Tax ID is not submitted as an Other ID on claim forms through AveaOffice. Instead, the NPI associated with the Rendering provider will be added in Box 17b.
Example of Referring Rendering Provider Role (same drop-down exists on Utilization Plan)
Referring provider qualifier as shown on CMS-1500 in Box 17a
EDI Loop/Segment
Loop 2310A, Segment NM101 (Qualifier), Segment NM103 (Last Name), and NM104 (First Name).
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