Missing NPI Won’t Delay Processing – CMS

A recent change to Medicare policy made by the Centers for Medicare & Medicaid Services (CMS) helps ensure claims processing isn’t delayed when the only missing information on the CMS-1490S form is the provider or supplier’s National Provider Identifier (NPI).

CMS Transmittal 1747, Change Request 6434, issued May 22, notifies A/B Medicare Administrative Contractors (MAC) and carriers of editorial changes to Medicare policy in Pub. 100-04, Medicare Claims Processing Manual, chapter 1, regarding the monitoring of claims submission violations and the handling of incomplete or invalid claims.

In either case, as stated in the transmittal, “If the beneficiary furnishes all other information but fails to supply the provider or supplier’s NPI, the contractor shall not return the claim but rather look up the provider or supplier’s NPI using the NPI registry.”


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6 Responses to “Missing NPI Won’t Delay Processing – CMS”

  1. D. Kellus Pruitt DDS says:

    What if the provider has no NPI number at all? D. Kellus Pruitt DDS

  2. Grnerod says:

    How on earth are you billing and getting paid without an NPI?

  3. Lisa says:

    These are for CMS-1490s claims not CMS-1500 claims

  4. Thomas Fitzsimmons says:

    This is a welcome change, as the messy NPI issue should not be the patient’s problem when they send in a claim directly to their Medicare MAC on a 1490s claim form (for payment to the patient), and the MAC can just check the NPI registry for the valid information.

    However, if the provider has no NPI, the provider MIGHT also not be Medicare Certified. Medicare would need to contact the provider, send them certification forms and request credentialing information to demonstrate the provider has a license in good standing and is acting within the scope of that license before paying services for that provider. In this process Medicare would also have the provider to obtain an NPI. The patient’s payment would be delayed until the provider is added to Medicare’s Certification database and the NPI registry.

  5. D. Kellus Pruitt DDS says:

    Grnerod asked “How on earth are you billing and getting paid without an NPI? My answer is, the same way I’ve always done business. I do the work, and my patients see to it that I am paid, or they don’t get any more of my time. Why would I want an NPI? How does it improve patient care?

  6. D. Kellus Pruitt DDS says:

    “How does an NPI number improve patient care?” – D. Kellus Pruitt DDS, posted on AAPC Website, 6.4.09

    I see that nobody from the American Academy of Professional Coders has yet attempted to answer my question. Some visitors to the AAPC Website who have followed the comments to the article “Missing NPI Won’t Delay Processing – CMS” (no byline) may think the lack of an answer is odd – that is if they happen to notice. The novice professional coder who still does not know much about HIPAA could easily assume that since the article itself is almost a week old, the lack of a response to my question is nothing more than the natural fading of interest. At some point, people logically move on to newer posts and other parts of their lives.

    But I know a secret.

    Based on nothing more than glaring silence from anonymous officials of AAPC, I know that my question of whether the NPI number improves care did not go unnoticed by a few knowledgeable and sharp individuals. They know enough not to touch a transparently trick question. The answer of course is: The NPI number does nothing to improve patient care. (Gasp!)

    There’s more. Five years ago informatics experts (coders), promised that the ten digit identification number for providers will speed payments lightning fast. When is the last time you heard that fib? I cannot fault abundant optimism, AAPC, but by now you are surely aware that physicians have had to wait for a year or more for payment because of foul-ups at NPPES. Some have had to take out loans to pay the salaries of coding professionals and other new IT members of their staffs.

    And as far as “improving” patient care? That would be worse than a fib. That would be called a harmful lie that upsets me in a very personal way. I know where it is documented that dental patients have been forced to leave dentists they preferred simply because one-third of the dentists in Texas do not have NPI numbers. BCBSTX requires that their clients only see dentists who have the numbers. Otherwise, the client has to pay their dental bill in full and BCBSTX isn’t even obligated to refund the employer the insurance premium. Yet BCBSTX sales reps tell these employers that their employees can see any Texas dentist they choose.

    I’m sorry. Sometimes I ramble.

    To keep it fair, I will ask if there is anyone who would like to point out the benefits of the NPI number. Your AAPC members and many others, including enthusiastic newbie coders, are interested in hearing from leaders of the organization. Many careers are built upon the complexities caused by digitalization and informatics. I don’t blame you for the complications. After all, you don’t make the rules – you just get along with them really well. It’s like our unavoidably complicated tax code and accountants. Accountants call themselves professionals. So why the hell shouldn’t you?

    Let me say that I am grateful that you believe enough in transparency that this comment remains posted. It wouldn’t surprise me if someone briefly considered deleting it until they discovered that it will be on the PennWell forum and probably on the Medical Executive-Post anyway. And of course, we can all see that you chose the honorable thing to do.

    The NPI fallacy reminds me of a scene in the Mike Judge movie “Idiocracy,” when a character 500 years in the future named Frito is asked why fields are fruitlessly irrigated with a politically-correct brand of green colored sports drink instead of water. Frito, who got his law degree from Costco, doesn’t even have to suffer minimal thought before he quickly repeats what he’s heard so many times, “’Cause it’s got ‘lectrolytes.”

    Grnerod finds it incredible that I don’t have an NPI number. “How on earth are you billing and getting paid without an NPI?”

    I told him (?) that I don’t work if I don’t get paid. Call me an old school radical.

    D. Kellus Pruitt DDS

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