Reason Code: 34963

Error Description:

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

• 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

Avoiding/Correcting This Error

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

Related Content

• New Fiscal Intermediary Shared System Consistency Edit to Validate Attending Physician National Provider Identifier
• MLN Matters® article MM12889 “New Fiscal Intermediary Shared System Edit to Validate Attending Provider NPI”