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Box 17

Skip to the box you’re looking for:

Box 17- Name of Referring Provider or Other Source

What’s in the box?

If the services rendered involved a Referring, Ordering, or Supervising provider, Box 17, Box 17a, and Box 17b are used to identify that additional provider.

There is only room to send information for one additional provider. So, if multiple providers are involved in the services, it’s typically recommended to use the following priority:

  1. Referring Provider
  2. Ordering Provider
  3. Supervising Provider

The first part of Box 17 includes the applicable two-digit qualifier that identifies the type of provider being reported.

Here’s a list of the qualifiers:

DN - Referring Provider

DK - Ordering Provider

DQ - Supervising Provider

Where does this info live in Jane?

You can indicate that a patient’s services involved an additional provider when creating or editing their Insurance Policy (Profile > Billing tab > Insurance Policies > View + Edit or New Insurance Policy).

Since only one additional provider can be set, the first step is to select the provider type.

Once you’ve selected the provider type, you’ll need to enter the provider’s name and credentials. Note that the credentials are in Boxes 17a & 17b.

Enter the provider’s First Name followed by their Last Name. It’s best not to include any commas as they can confuse your clearinghouse!

Is this required?

Entering an additional provider is optional when creating an Insurance Policy in Jane.


What about the EDI file?

Additional provider information is sent in Loop 2300 - Claim Info.

  • The provider type is sent in Loop 2300, Segment NM101
  • The provider’s last name is sent in Loop 2300, Segment NM103
  • The provider’s first name is sent in Loop 2300, **Segment NM104

📍 Key Note

Regardless of the provider type selected in the patient’s Policy, we always send the Referring Provider type in our EDI files (qualifier DN). This is a major difference compared to the CMS1500. We haven’t heard of this being a problem, but let us know if it is!
 

Boxes 17a & 17b- Referring Provider Credentials

What’s in the box?

If the services rendered involved a Referring, Ordering, or Supervising provider, Box 17, 17a and 17b are used to identify that additional provider.

Box 17a can be used to send an additional ID number if required and Box 17b is used to send the additional provider’s NPI. If an additional ID is used to identify the additional provider, both the ID number type and the ID number are sent in Box 17b.

Here’s the list of additional ID numbers that are currently supported:

0B - State License Number

1G - Provider UPIN Number

G2 - Provider Commercial Number

LU - Location Number (paper claims only)

Note that there is only room to send information for one additional provider. So, if multiple providers are involved in the services, it’s typically recommended to use the following priority:

  1. Referring Provider
  2. Ordering Provider
  3. Supervising Provider

Where does this info live in Jane?

You can indicate that a patient’s services involved an additional provider when creating or editing their Insurance Policy (Profile > Billing tab > Insurance Policies > View + Edit or New Insurance Policy).

Once you’ve selected the provider type, you’ll need to enter the provider’s name and credentials. The credentials - which can include a NPI and additional ID number - are sent in Box 17a & 17b.

Is this required?

Entering an additional provider is optional when saving an Insurance Policy. However, if an additional provider is added to a Policy, then the additional provider NPI is required for electronic claim submissions. The additional provider additional ID number is optional.


What about the EDI file?

Additional provider information is sent in Loop 2300 - Claim Info.

  • The provider’s additional ID type is sent in Loop 2300, Segment REF01
    • Note the supported ID types at the top of this document.
  • The provider’s additional ID number is sent in Loop 2300, Segment REF02
  • The provider’s NPI is sent in Loop 2300, Segment NM106