NPI required on Medicare claims effective March 1, 2008
- Gavin Walker
- Posts: 4640
- Joined: Wed Apr 04, 2007 10:11 pm
- Location: Springfield, MO
- Contact:
NPI required on Medicare claims effective March 1, 2008
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.
Walker Tek Solutions, LLC
417-890-6777 x0
fax: 417-763-6386
- Gavin Walker
- Posts: 4640
- Joined: Wed Apr 04, 2007 10:11 pm
- Location: Springfield, MO
- Contact:
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.