The Ordering and Referring files are displayed using the National Provider Identifier (NPI) and legal name (last name, first name) of all physicians and non-physician practitioners who are of a type/specialty that is legally eligible to order and refer Part B (clinical laboratory and imaging), DME and HHA claims, in the Medicare program and who have current enrollment records in Medicare. CMS instructed contractors to turn on Phase 2 denial edits on January 6, 2014.
These edits check the following claims for a valid individual National Provider Identifier (NPI) and deny the claim when this information is invalid. It includes Claims from clinical laboratories for ordered tests, Claims from imaging centers for ordered imaging procedures, Claims from suppliers of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) for ordered DMEPOS, Claims from Part A Home Health Agencies (HHAs).
To keep the available information up to date, CMS will update the reports twice a week. At any given time, only one Report (the most current) will be available for export. The file can be exported by users with technical expertise and further sorted or manipulated. It can also be used to search for a particular physician or non-physician practitioner by NPI or by name. The Name suffixes (e.g., Jr.), if they exist, are not displayed. There are no “duplicates” in the file. Many physicians or non-physician practitioners share the same first and last name; their corresponding NPIs are the assurance of uniqueness. Deceased physicians and non-physician practitioners are not included in the file.
The Initial Physician and Non-Physician Applications Pending Contractor Review files are lists of applications pending contractor review. These pending applications have NOT been processed by the CMS contractors. These lists have been compiled to allow individuals the ability to verify that an application has been submitted and is awaiting processing.