For claims processing, who must be reported as the referring provider?

In claims processing, the referring provider is essential for the accurate billing and reimbursement process. The correct response identifies the requesting provider along with their National Provider Identifier (NPI) as the key individuals that need to be reported. When a healthcare provider refers a patient to another provider for additional services, it is critical to document who requested the consultation or service.

Including the requesting provider and NPI helps in streamlining communications between providers and payers, ensuring that claims can be accurately matched with the appropriate referrals. This is particularly important for services that require pre-authorization or specialized care, where the relationship between the referring provider and the rendering provider needs to be clearly established.

In contrast, the role of the consulting provider is more about providing specialized care rather than initiating the referral process. The patient's primary care physician may or may not be involved in every referral and is not typically the one specified for reporting in claims processing. Reporting the insurance company is also not relevant to identifying the referring provider, as the insurance company is the payer, not a provider.