Remittance Advice Alerts/PROMISe Banner Pages
Subject: Crossover Claims – Ordering and Referring Providers
Banner Date: 8/4/2017, 8/11/2017, and 8/18/2017
Cycles: 06, 07, 08
Provider Type/Specialty: 02, 04, 08, 09, 11, 14, 15, 17, 18, 20, 24, 25, 26, 28, 30, 31, and 32 
 
Subject: Crossover Claims – Ordering and Referring Providers
 
The Department of Human Services (DHS) has identified conflicting guidance given to providers by Medicare and Medicaid in relation to the completion of the ordering and referring field segments within the 837 Professional file layout.
 
Until system changes are implemented, the Department has received approval from CMS to request when applicable; providers submit claims with a valid NPI in both the ordering and referring provider fields on all 837 professional claims submitted to Medicare and crossed over to PA Medicaid for processing.
 
Please see Provider Quick Tip # 208 for additional information. 
 
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