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NPI Information for Medicare Fee-for-Service Providers (GEN)
Posted April 4, 2008
The NPI Will be Required for all HIPAA Standard Transactions on May 23rd
As of May 23, 2008, the National Provider Identifier (NPI) will be required for all Health Insurance Portability and Accountability Act (HIPAA) standard transactions. This means:
- For all primary and secondary provider fields, only the NPI will be accepted and sent on all HIPAA electronic transactions (837I, 837P, NCPDP, DDE, 276/277, 270/271, and 835), paper claims (UB-04 and CMS-1500) and Standard Paper Remittance (SPR) advice.
- The reporting of Medicare legacy identifiers in any primary or secondary provider fields will result in the rejection of the transaction.
Reminder: May 23rd is Only Two Months Away, Be Prepared! Test NPI-only NOW
Now that the NPI is required on all Medicare claims in the primary provider fields, if your claims are being successfully processed with NPI/legacy pairs (and most are), now is the time to begin testing claims using the NPI alone. If the Medicare NPI Crosswalk cannot match your NPI to your Medicare legacy number, the claim with an NPI-only will reject. You can and should do this test now! If the claim is processed and you are paid, continue to increase the volume of claims sent with only your NPI. If the claims reject, go into your National Plan and Provider Enumeration System (NPPES) record and validate that the information you are sending on the claim is consistent with the information in NPPES. If it is different, make the updates in NPPES and resend a small batch of claims 3-4 days later. If your claims are still rejecting, you may need to update your Medicare enrollment information to correct this problem. Call your Medicare carrier, FI, Part A/B Medicare Administrative Contractor (A/B MAC), or Durable Medical Equipment Medicare Administrative Contractor (DME MAC) to discuss your situation and, if necessary, have it investigated. Have a copy of your NPPES record or your NPI Registry record available. The contractor telephone numbers are likely to be quite busy, so don't wait. For the Upstate Medicare Division (UMD), you can call the toll-free provider line at 877-567-7173.
Doing this testing now will allow time for any needed corrections prior to May 23, 2008, the date when only the NPI will be accepted in all provider fields.
Need More Information?
Still not sure what an NPI is and how you can get it, share it, and use it? As always, more information and education on the NPI can be found through the Centers for Medicare & Medicaid Services (CMS) NPI page at www.cms.hhs.gov/NationalProvIdentStand on the CMS Web site. Providers can apply for an NPI online at https://nppes.cms.hhs.gov, or can call the NPI Enumerator to request a paper application at 800-465-3203.
Note: All current and past CMS NPI communications are available by clicking "CMS Communications" in the left column of the www.cms.hhs.gov/NationalProvIdentStand CMS Web page. |
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