Reason Code: 34963

The attending physician information on claim page 5 is not correct due to:

Claim submitted with an organizational NPIs in place of individual attending physicians NPI
Or, the attending physician on claim page 5 is either invalid or not present in the PECOS Enrolled Physicians file, Type C records.
Or, the attending physician NPI is present on the PECOS Enrolled Physicians file but the first four digits of the last name do not match.
Or, the claim contains a through date of service equal to or greater than the terminations date on the PECOS Enrolled Physician inquiry screen
Or, the claim submitted with an NPI for a physician or non-physician practitioner specialties that is NOT eligible as an attending physician enrolled in PECOS in an approved status. Valid values are:
- Doctor of medicine or osteopathy
- Dental surgery (19)
- Podiatric medicine (48)
- Optometry (41)
- Chiropractic medicine (35)
- Physician assistant (97)
- Certified clinical nurse specialist (89)
- Nurse practitioner (50)
- Clinical psychologist (68)
- Certified nurse midwife (42)
- Licensed clinical social worker (80)
- Certified registered nurse anesthetist (43)
- Registered dietitian/nutritional professional (71)
Note: If the claim is for therapy services, then the physician or NPP who certified the patient's treatment plan, or POC, can be the attending physician

Verify billing and, if appropriate correct and return the claim. Online providers should press PF9 to restore the claim.