RARC N575: Ordering/Referring Provider Name Mismatch on File

What Does RARC N575 Mean?

RARC N575 indicates that the payer compared the ordering or referring provider's name on the claim against the name associated with that NPI in their enrollment system and found a mismatch. The NPI may be correct, but the name attached to it on the claim does not match what the payer has on file.

Name mismatches happen for straightforward reasons. A provider may go by a shortened first name or nickname in daily practice, but the payer's records contain their full legal name. A provider who changed their name — through marriage, divorce, or legal name change — may not have updated the payer's enrollment records. Data entry errors during claim preparation, such as transposed letters or misspellings, are another common cause.

Some payers perform strict name matching as part of their claim validation process, and even minor discrepancies like "William" versus "Bill" or "Robert" versus "Bob" can trigger this denial. The mismatch prevents the payer from confirming the ordering provider's identity and authority, which is why the claim is not processed.

What to Do

Look up the ordering or referring provider's NPI in NPPES (the National Plan and Provider Enumeration System) to confirm the legal name on record. Compare this against the name submitted on the claim and the name in the payer's enrollment database. Correct the claim to match the payer's records exactly.

If the provider has had a legal name change that is not reflected in the payer's system, submit an enrollment update to the payer and update the NPPES record as well. For billing systems that auto-populate provider names from an internal directory, update the directory entry to match the official enrollment records. Resubmit the claim once the name matches the payer's files.

Common Scenarios

• The ordering provider's name on the claim reads 'Bob Smith' but the payer's enrollment records list 'Robert A. Smith'
• A provider changed their last name after marriage but has not updated the payer enrollment record, causing a mismatch on all referral claims
• A data entry error in the billing system misspells the referring provider's name, and the payer's validation catches the discrepancy
• The claim lists a provider's maiden name while the payer's records reflect their current legal name after a recent name change

Commonly Paired With

RARC N575 commonly appears alongside these CARC denial codes: