N265 remark code
Remittance advice remark code N265. Remark codes add detail to the reason code on the same claim line.
Ordering provider ID problem
Unofficial reference. This is our own plain-English explanation, not the official code text. Payer rules differ. Verify with the payer and the official X12 code list. AlphaPrefix is not affiliated with X12, CMS or any payer. Data last updated .
What N265 means
The NPI or other primary identifier for the ordering provider is missing, incomplete or not valid.
N265 is the identifier half of the ordering provider check. The payer could not confirm the NPI of the provider who ordered the service, so it cannot verify the order.
It typically comes with reason code 16. Some payers also check that the ordering provider is enrolled, so a valid NPI that is not enrolled can lead to a related remark.
Common causes
- The ordering NPI was left blank or entered with a typo.
- A group NPI was used where an individual NPI is required.
- The referring and ordering fields were swapped on the claim.
What to do next
- Look up the ordering provider's individual NPI and confirm it is active.
- Place the NPI in the correct ordering provider field for the claim type.
- Resubmit a corrected claim and watch for any enrollment related follow-up remark.
Related codes
- N264 (remark code) Ordering provider name problem
- N574 (remark code) Ordering provider type not allowed
- N31 (remark code) Prescribing provider ID problem
Source
Official wording: X12 Remittance Advice Remark Codes list. The explanation on this page is our own plain-English wording, not the X12 text.
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