NPI required on Medicare claims effective March 1, 2008

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Gavin Walker
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NPI required on Medicare claims effective March 1, 2008

Post by Gavin Walker » Thu Nov 15, 2007 1:14 pm

CMS has announced that effective March 1, 2008, Medicare fee-for-service claims received must include an NPI in the primary fields on the claim (i.e., the billing and pay-to fields). You may continue to submit NPI/legacy pairs in these fields or submit only your NPI.

Claims with only a Legacy provider identifier for the primary fields will be returned as unprocessable.

Check with your clearinghouse to find out when this will affect you. This will affect claims submitted to Gateway EDI, Inc. after 2pm on February 29, 2008.
Gavin Walker
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Gavin Walker
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Joined: Wed Apr 04, 2007 10:11 pm
Location: Springfield, MO
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Post by Gavin Walker » Fri Feb 01, 2008 10:02 am

Last week, CMS issued the January NPI message to all providers. (You can view the January NPI message online at http://www.cms.hhs.gov/NationalProvIdentStand/02_WhatsNew.asp on the CMS website.) This week begins a weekly messaging campaign for Medicare Fee-For-Service providers in order to raise the level of urgency as the March 1 implementation date approaches.

Prior to March 1, 2008:
Claims with both an NPI and a Medicare legacy number are rejected if the pair is not found on the Medicare NPI Crosswalk. Claims submitted with just a Medicare legacy number are being paid (unless of course, they have other errors that cause them to be rejected).

As of March 1, 2008:
This means that you will not be able to get paid for any Medicare services you provide until you begin using your NPI. Also, if needed, you must correct any data which may be preventing an NPI/legacy match on the NPI crosswalk. The correction might require that you file a CMS-855 Medicare Provider Enrollment form with your Medicare carrier, A/B MAC, or DME MAC, a process which can take a number of months to accomplish.

TEST NPI-only NOW:
If you have been submitting claims with both an NPI and a Medicare legacy number and those claims have been paid, you need to test your ability to get paid using only your NPI by submitting one or two claims today with just the NPI (i.e., no Medicare legacy number). 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, call your Medicare carrier or A/B MAC enrollment staff for advice right away. The enrollment number is likely to be quite busy after the March 1 deadline, so don't wait.

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