CMS-1500 Box 17b: NPI for referring provider

What Box 17b is for

Reports the NPI associated with the provider identified in Box 17 when required.

What to verify before filing

Compare the entry to the current patient, provider, payer, authorization or service documentation that supports the claim. Avoid copying information from an old claim without confirming that it still applies.

How this field connects to the rest of the claim

CMS-1500 fields work together. A value can be valid by itself but still conflict with the patient, provider, diagnosis, service-line, place-of-service or billing information elsewhere on the claim.

• Box 17 — Referring provider or other source
• Box 17a — Other ID for referring provider
• Box 24J — Rendering provider ID / NPI

Common workflow mistakes

• Using a value from a prior claim without checking the current payer or patient record.
• Assuming a field is always required or always optional for every payer.
• Entering data in a reserved or differently designated field because it appears to have open space.
• Failing to reconcile this field with related service-line, provider or claim-level information.