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S ECTION 1: P ROVIDER E NROLLMENT AND R ESPONSIBILITIES TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 DECEMBER 2023TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1DECEMBER 2023SECTION 1: PROVIDER

How to fill out ordering- or referring-only providers

How to fill out ordering- or referring-only providers

1. To fill out ordering- or referring-only providers, follow the steps below:
2. Obtain the necessary form or document for ordering or referring providers. This may vary depending on the specific system or organization you are working with.
3. Fill out the provider's personal information, including their name, contact details, and any relevant identification numbers such as a National Provider Identifier (NPI).
4. Provide detailed information about the patient or individual that the provider is referring or ordering services for. This may include their name, date of birth, medical history, and any specific tests or treatments that are being requested.
5. Include any supporting documentation or medical records that are necessary for the referral or order. This may involve attaching copies of relevant lab results, imaging reports, or consultation notes.
6. Review the completed form for accuracy and completeness, making sure all required fields are filled out and all supporting documents are attached.
7. Submit the filled-out form and any required attachments to the appropriate department or individual as specified by the system or organization's guidelines. This may involve submitting via mail, fax, electronic submission, or another designated method.
8. Keep a copy of the completed form and any related documents for your records, ensuring documentation of the referral or order.
9. It is essential to follow the specific instructions provided by the system or organization to ensure the ordering or referring process is conducted accurately and efficiently.

Who needs ordering- or referring-only providers?

1. Ordering- or referring-only providers are needed by individuals or organizations involved in healthcare, including:
2. - Physicians and other healthcare professionals who need to refer patients to specialists or order diagnostic tests, treatments, or procedures.
3. - Hospitals and clinics that require healthcare providers to make referrals or orders for patients under their care.
4. - Insurance companies and third-party payers who need documentation of referrals or orders to approve payments for services.
5. - Patients who need a referral from their primary care physician to see a specialist or receive specific medical treatments or tests.
6. - Medical laboratories and imaging centers that require orders from healthcare providers to perform certain tests or procedures.

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What is ordering- or referring-only providers?

Ordering- or referring-only providers are healthcare professionals who are permitted to order tests, treatments, or services for patients but do not directly provide the services. They typically include certain types of specialists and primary care providers.

Who is required to file ordering- or referring-only providers?

Healthcare organizations and providers who submit claims to Medicare for services ordered or referred by these providers are required to file information about ordering- or referring-only providers.

How to fill out ordering- or referring-only providers?

To fill out the information for ordering- or referring-only providers, providers should collect the National Provider Identifier (NPI) number, name, address, and specialty of these providers and include this information on claims submissions.

What is the purpose of ordering- or referring-only providers?

The purpose of identifying ordering- or referring-only providers is to ensure that Medicare can properly track and manage the services provided to patients and to maintain compliance with billing regulations.

What information must be reported on ordering- or referring-only providers?

The information that must be reported includes the NPI, name, address, and the type of services the provider orders or refers for patients.