Include Referring and Rendering Provider Details for Accurate Claims Processing

Friday, September 8, 2023

Health Net Federal Services, LLC (HNFS) offers the following claims submission tips to help ensure we apply the correct copayments and cost-shares for your TRICARE patients. 

Include complete provider details
All professional claims must include referring or ordering provider and rendering provider information. Groups or facilities should list the group or facility name rather than an individual provider’s name. This will allow us to accurately apply copayments and cost-shares. Without this provider information, claims for TRICARE Prime beneficiaries may process under the point-of-service option, and claims for TRICARE Select beneficiaries may reflect multiple copayments in error. 

For facility claims, include the:

• Referring or ordering physician: Include the full name, National Provider Identifier (NPI), and NPI qualifier in fields 78-79 of the UB-04 (CMS-1450) form or in Loop 2310C/2310D/2310F of the HIPAA 837I (institutional) form.
  
  
• Attending physician: Include the full name, NPI, and NPI qualifier in field 76 of the UB-04 (CMS-1450) form or in Loop 2310A of the HIPAA 837I (institutional) form. 

As a reminder, providers who file claims electronically must have an NPI. The NPI billed on the claim will determine where payments and remittances are sent. For more information on claims, please visit our Claims page.