RARC M114: Missing or Invalid Information on Ordering or Referring Provider
The ordering or referring provider's information is missing or fails validation — verify the provider's NPI and enrollment status, then resubmit with correct data.
What Does RARC M114 Mean?
M114 is closely related to M38 but may appear in contexts where the payer's system draws a distinction between the level of detail or validation that failed. This remark code tells you that the claim requires ordering or referring provider identification — typically the NPI and name of the physician who ordered the service or referred the patient — and that this information is either absent or does not pass the payer's validation checks.
The ordering or referring provider requirement applies broadly across healthcare billing. Medicare requires it for diagnostic tests (lab work, imaging), DME, home health, and most services that originate from a physician's order. The provider identified must be individually enrolled with the payer — group NPIs are not accepted in the ordering or referring provider field. If the identified provider's NPI is valid in the NPPES registry but the provider is not enrolled with the specific payer, or if their enrollment has a gap, the claim will fail validation and trigger M114.
M114 commonly accompanies CARC 16 (missing information) or CARC 4 (inconsistency). In some payer systems, M114 may be used specifically when the validation failure relates to provider enrollment status rather than a simple missing-field issue, though this distinction is not universal.
What to Do
Verify the ordering or referring provider's individual NPI against the NPPES registry. Confirm the provider is actively enrolled with the payer — for Medicare claims, use the Provider Enrollment, Chain, and Ownership System (PECOS) to check enrollment status. If the NPI was missing, add it to the claim. If the NPI was present but failed validation, determine whether the provider needs to enroll or re-enroll with the payer. Resubmit with the correct, validated provider information.
Organizations that bill ordered services in high volume — labs, imaging centers, DME suppliers, home health agencies — should maintain an ordering provider validation workflow. Before generating a claim, verify that the ordering provider's NPI is on file, active, and enrolled with the payer. Building a provider lookup step into your order intake process can catch enrollment gaps before they become claim denials. When a provider's enrollment lapses, the claim will fail even if every other element is correct.
Common Scenarios
- A laboratory bills Medicare for a panel of blood tests, but the ordering physician recently retired and their Medicare enrollment was deactivated — the claim fails with M114 even though the NPI is still in NPPES.
- An imaging center receives an order from a nurse practitioner whose NPI is valid but who is not yet enrolled with Medicare as an ordering provider, resulting in M114 on the claim.
- A DME supplier enters the ordering provider's group NPI instead of their individual NPI, and the payer rejects the claim because group NPIs are not accepted in the ordering provider field.
Commonly Paired With
No common pairings documented yet.