Referring provider
The professional identified as referring the patient or directing a service when that role is applicable to the claim.
Updated
A referring provider is the professional whose referral directed the patient or service when the applicable claim, program, payer, and service circumstances require that role. The identifier should represent the actual referral relationship and current governed provider data.
Referring, ordering, supervising, rendering, and billing roles can differ. Populate only the roles supported by the service and controlling instructions.
In practice
Source the referring provider from the approved referral or encounter workflow and validate identifiers and applicable requirements without substituting another provider to clear an edit.
Commonly confused with
- Rendering provider: The rendering provider performs the service; the referring provider directs the patient or service when applicable.
- Ordering provider: An ordering provider orders a service or item; referral and ordering roles may overlap in some situations but are not universally identical.