Reason Code: 37236

Error Description:

The covered charges or reimbursement is greater than 0, however, one of the following is true:

• The attending physician NPI on the claim is not present in the eligible attending physician file from PECOS
• The attending physician NPI on the claim is present in the eligible attending physician files from PECOS but the first four letters of the last name of the attending physician on the claim does not match the first four letters of the last name of the NPI record in the eligible attending physician files from PECOS
• The specialty code is not a valid physician specialty code

*Note: The first name is no longer evaluated as part of the matching criteria. Additionally, any special characters in the last name will be ignored.

Avoiding/Correcting This Error

Verify eligibility of the attending/ordering physicians in PECOS. Print that verification and make it part of the medical record. If applicable, submit a reopen request to the Appeals Department indicating error and the correction needed.