RARC N574: Ordering/Referring Provider Type Cannot Order or Refer
The ordering or referring provider on the claim has a specialty or provider type that is not authorized to order or refer the billed services — verify the provider's credentials and payer enrollment records.
What Does RARC N574 Mean?
RARC N574 indicates that the payer's records show the ordering or referring provider listed on the claim does not have a specialty or provider type that is authorized to order or refer the billed service. Each payer maintains rules about which provider types can order specific services — for example, only certain specialties may be permitted to order advanced imaging, genetic testing, or durable medical equipment.
This denial frequently results from data mismatches rather than actual credentialing problems. The ordering provider may be fully qualified to order the service, but their specialty or provider type in the payer's enrollment records may be incorrect or outdated. It can also occur when the wrong ordering provider NPI is entered on the claim — for example, using a nurse or technician's NPI instead of the supervising physician's NPI.
In some cases, the denial reflects a genuine scope issue. Certain services have strict ordering requirements under Medicare and other payers, and not every provider type is eligible to generate orders for those services regardless of their clinical qualifications.
What to Do
Verify that the correct ordering or referring provider NPI is listed on the claim. Confirm the provider's specialty and provider type in the payer's enrollment system matches their actual credentials. If the payer's records are incorrect, submit a provider enrollment update with the correct specialty and taxonomy code.
If the ordering provider information on the claim is wrong — for instance, a clinical staff member's NPI was used instead of the ordering physician's — correct the NPI and resubmit. For services with strict ordering requirements (such as Medicare's requirement that only physicians and certain non-physician practitioners can order DMEPOS), ensure the order originates from an eligible provider type. Once the enrollment records are corrected or the claim is updated with the correct provider, resubmit.
Common Scenarios
- A lab order is submitted with a nurse practitioner's NPI as the ordering provider, but the payer requires a physician for that specific test category
- The ordering physician's specialty in the payer's enrollment system is outdated and does not reflect their current scope of practice
- A DME claim lists an ordering provider whose provider type is not on Medicare's approved list of providers who can order durable medical equipment
- A referral for a specialist consultation lists the referring provider's group NPI instead of their individual NPI, and the group's enrolled specialty does not match
Commonly Paired With
RARC N574 commonly appears alongside these CARC denial codes:
| Code | Name | |
|---|---|---|
| CO-95 | Plan Procedures Not Followed | → |