Important Message for Institutional Providers

[Gavin Walker]

The Centers for Medicare & Medicaid Services (CMS) has announced that effective January 1, 2008, your Medicare fee-for-service claims 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 unprocessed. You may continue to include legacy only for the secondary fields, if you choose. Beginning January 2, 2008, failure to submit an NPI in the primary fields will result in your claim being returned as unprocessed.

In addition, if you already bill using the NPI/legacy pair in the primary fields and your claims are processing correctly, now is a good time to submit to your contractor a small number of claims containing only the NPI. This test will serve to assure your claims will successfully process when only the NPI is mandated on all claims.

When the claim is returned, you should first verify that the correct NPI was submitted. If correct, you will need to verify that your legacy identifier (PIN or NSC) number corresponds with the information on file withthe National Plan and Provider Enumeration System (NPPES).

The Centers for Medicare & Medicaid Services (CMS) is pleased to report that the vast majority of institutional provider claims are being sent to Medicare with a National Provider Identifier (NPI). Moreover, the Medicare NPI crosswalk has been in successful operation for all institutional provider claims since June 2007. Given these favorable results, CMS is taking the next step towards full implementation of the NPI in Medicare.

Need More Information?

You can find more information about the requirement for an NPI to use EDI transactions, by going to CR 5637.

More information and education on NPI may be found at the CMS NPI page, on the CMS website. Also, providers can apply for an NPI online.

Important Information for All Medicare Providers

CMS recently made available a document that will assist physicians and non-physician practitioners in completing form CMS-855I, Medicare Provider Enrollment Application - Physicians and Non-Physician Practitioners. This document contains several enrollment scenarios and indicates where on the CMS-855I the National Provider Identifier (NPI) is to be reported. It also indicates when the CMS-855R and/or the CMS-855B forms need to be completed. You can read the document here.

Getting an NPI is free-not having one can be costly!