Health Information Compliance Alert

Published on Mon Jan 28, 2008 PDF

You may be seeing claims rejections if you're not on top of NPI issues. As of Jan. 1, Medicare requires providers' claims to have a National Provider Identifier number in the primary provider (billing and pay-to) fields, CMS notes in a message to providers.

But even if you do include your NPI, you could still see rejections if the NPI doesn't match the legacy number you're also using on the claims.

Do this: If you're submitting an NPI and legacy number pair and seeing rejections, "go into the NPPES website located at http://nppes.cms.hhs.gov and validate that your NPPES information is correct and that you reported your Medicare legacy identifier in the appropriate Medicare sections of the 'Other Provider Identification Numbers' field," CMS instructs.

If the information in your NPPES record is correct and contains your Medicare legacy identifier, "print the screen (so you have a copy of this portion of your NPPES record on paper), call your Medicare contractor, and ask that they confirm that this information is present in the Medicare NPI Crosswalk," CMS details. "If your contractor confirms you are not on the crosswalk, please ask them to validate what information they have in their provider file."

Don't forget: You'll have to use NPIs in claim secondary fields starting May 23, CMS reminds in the message. That means you'll need NPIs for any referring physicians by then.