M76: Missing/incomplete/invalid diagnosis or condition.
M81: You are required to code to the highest level of specificity
• Refer to Item 21 on the claim form. Enter the ICD Indicator and diagnosis code on the claim.
• Enter the appropriate ICD Indicator as a single digit between the vertical, dotted lines.
• Indicator ‘9’ is used for ICD-9-CM diagnosis codes.
• Indicator ‘0’ is used for ICD-10-CM diagnosis codes.
• Enter up to 12 diagnosis codes, in priority order. The diagnosis codes must be coded to the highest level of specificity.
• Use the most current year's ICD-9-CM or ICD-10-CM codes, depending on the date(s) of service.
• Do not insert a period in the ICD-9-CM or ICD-10-CM codes.
Example: Diagnosis code 285.21 is entered as 28521, without a period or space.
• Reminder: Do not report ICD-10-CM codes for claims with date(s) of service prior to October 1, 2015.
Common Reasons for Message
Truncated (invalid) Diagnosis Code
Scanning Error (paper claim)
Next Step
Verify diagnosis codes submitted are valid
If there is a 5 digit code, do not use a 3 or 4 digit code
For paper claims, if all diagnosis codes submitted are verified and are valid, contact Provider Contact Center (PCC) to ensure there were no errors in scanning claim
Incorrect claim form/format
N34: Incorrect claim form/format for this service.
• Refer to Items 11b, 12, 14, 16, 18, 19, 24a and 31 on the claim form. You have the option to enter either a 6-digit (MMDDYY) or 8-digit (MMDDCCYY) date. However, the date format you choose must be consistent throughout the claim.
• e.g., if you choose the 6-digit format for the first date field, then that 6-digit format must be used in all subsequent date fields in the provider portion of that particular claim. Conversely, if you use the 8-digit format for the first date field, then you would continue to use the 8-digit format for the remainder of the date fields in the provider portion of that particular claim.
Ordering or referring physician name, qualifier and/or NPI
N264: Missing/incomplete/invalid ordering provider name.
N265: Missing/incomplete/invalid ordering provider primary identifier.
N276: Missing/incomplete/invalid other payer referring provider identifier.
N285: Missing/incomplete/invalid referring provider name.
N286: Missing/incomplete/invalid referring provider primary identifier.
• Refer to Items 17 and 17B on the claim form. Enter the name and qualifier in Item 17, and the NPI in Item 17B
My claim was denied with remittance messages N264 and N575. I submitted the name and NPI of the ordering/referring provider. What is wrong?
The most common reasons for this denial is the are:
The name and NPI combination submitted does not match our provider records. Confirm the correct name and NPI with the provider and/or on the CMS Medicare Ordering and Referring File external link
The provider's name was spelled incorrectly. Confirm the correct spelling with the provider and/or on the CMS Medicare Ordering and Referring File. Do enter Dr. before the name or credentials after the name.
The provider's name was entered in the wrong order. Confirm the correct name with the provider and/or on the CMS Medicare Ordering and Referring File. Confirm you are entering the name in the correct order. On electronic claims, the first and last name are entered in the following ASC 837 v5010 Loop, Segment, Element fields:
Referring Provider Last Name: Loop 2310A or 2420F, NM1/DN, 03
Referring Provider First Name: Loop 2310A or 2420F, NM1/DN, 04
Ordering Provider Last Name: Loop 2420E, NM1/DK, 03
Ordering Provider First Name: Loop 2420E, NM1/DK, 04
The provider's last name is hyphenated and only one part of the last name was entered. The ordering/referring provider edits compare the first four letters of the last name. If, for example, the provider's last name is Allen-Jones, and a claim is submitted with the last name Jones, the claim will fail the edit and be denied.
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