RARC N264: Missing or Invalid Ordering Provider Name

What Does RARC N264 Mean?

RARC N264 indicates that the payer could not validate the ordering provider's name as submitted on the claim. The ordering provider is the clinician who ordered the service — lab tests, imaging studies, DME, home health services, and other items that require a physician's order. Payers cross-reference the ordering provider's name against their enrollment records and the NPPES (National Plan and Provider Enumeration System) database, and any discrepancy triggers this rejection.

Common causes include misspelled names, missing first or last name fields, use of nicknames instead of legal names, name changes that have not been updated in the NPI registry, and suffixes or credentials entered in the name field. Even small differences — a missing middle initial that the payer's system expects, or a hyphenated name entered without the hyphen — can cause a mismatch.

N264 specifically targets the ordering provider, not the rendering or billing provider. This means the issue lies in the referral or order information on the claim, not the provider who actually performed or billed for the service. On CMS-1500 claims, this typically corresponds to Box 17, and on UB-04 claims, the applicable field depends on the claim type.

What to Do

Look up the ordering provider in the NPPES NPI Registry (npiregistry.cms.hhs.gov) to confirm the exact legal name associated with their NPI. Compare this against what is on the claim. Correct any spelling, formatting, or completeness issues so the name matches exactly what is in NPPES. Ensure the name fields are populated correctly — first name in the first name field, last name in the last name field, with no credentials or titles mixed in.

If the ordering provider recently changed their name (due to marriage, for example), they need to update their NPI record through NPPES and their enrollment with the payer. Until the update is processed, you may need to use the name currently on file with the payer. Resubmit the claim once the name is corrected.

Common Scenarios

• The ordering physician's last name is hyphenated in NPPES but was entered without the hyphen on the claim
• A lab order lists the physician as 'Dr. Bob Smith' but the NPI registry has 'Robert A. Smith' — the name mismatch triggers N264
• The ordering provider field on the claim is completely blank because the billing software did not auto-populate it from the order
• A physician recently married and changed their name but has not yet updated NPPES, so the new name on the claim does not match the NPI record

Commonly Paired With

RARC N264 commonly appears alongside these CARC denial codes: