Claim Forms: Referring Provider Information - Box 17

For some insurance policies, a referral from a physician or other healthcare provider may be required for the claim to be approved. You can contact the insurance payer directly to verify if a referral is needed.  Once the first claim form is completed for a client, this information will autofill for subsequent claims, making quick work of billing processes. 

Referring Provider information that should be completed: 

  • First Name 
  • Last Name 
  • Qualifier 
  • NPI Number 
  • Other ID Qualifier & Other ID (Other ID Qualifier is an optional field that is used when you need to input another ID, if you do not use an NPI number in your work. If you have an NPI number, you can enter that in the "NPI field" and can leave Other ID Qualifier blank) 

The Referring Provider information in Healthie populates Box 17 and 17a on the CMS 1500 claim form

17a. Will only be populated if Other ID Qualifier was selected. 


You'll be prompted to make one of the following selection related to the referrer: 

  • Referring Provider (DN) 
  • Ordering Provider (DK) 
  • Supervising Provider (DQ) 

Include Referrer Information on CMS 1500 

Check the box if you'd like Referring Provider details to be added to the CMS 1500 Claim form. This is necessary if a referral is required for services to be reimbursed by the insurance payer. Please check with the insurance payer to verify if a referral is required.

Referral Information in the Client's Profile 

When editing the insurance eligibility details within the client's profile, there is a section to include the client's referring provider - and to indicate if the referral was received. 

The referring information populated in the eligibility section, or from the Referring Provider's page in settings, will not automatically populate in the claim form at this time. Both of these features are meant to help improve your documentation for insurance benefits, and to keep track of your network of referring providers. 

However, if you fill out this information on the first claim for a client, it will autofill in subsequent claims. 

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