May 12, 2008
The NPI is here. The NPI is now. Are you using it?
Important Information for Medicare FFS Providers
Clarification for Identifying Secondary Providers in Medicare Claims & More NPI Roundtable Information
Additional Guidance and Clarification for Identifying Secondary Providers in Medicare Claims
In accordance with the NPI final rule, when an identifier is reported on a paper or electronically submitted claim for ordering/referring /attending/operating/supervising/purchased service/other/service facility provider (in the x12N 837 claims transactions) or for prescriber (in the NCPDP 5.1 retail drug claim transaction), that identifier must be an NPI. For Medicare purposes, this requirement is effective May 23, 2008. If the entity to be identified as the ordering/referring/attending/operating/supervising/purchased service/other/service facility provider or prescriber does not furnish an NPI at the time of the order/referral/purchase or time of service, the billing provider must attempt to obtain that NPI in order to use it in the claim. The billing provider may use the NPI Registry or may need to contact the ordering/referring/ attending/operating/supervising/purchased service/other/service facility or presciber in order to obtain the NPI. While the Implementation guides for the X12N claims transactions permit the reporting of the Social Security Number (SSN) for some secondary providers if there is no NPI, we do not believe the billing provider will be successful in the obtaining the SSN.
- If unable to obtain the NPI of the entity to be identified in the service facility location loop, no identifier should be reported in that loop.
- If unable to obtain the NPI of the ordering/referring/attending/operating/supervising/purchased service/other or prescriber, the billing provider (in the X12N 837 transactions) or the service provider (in the NCPDP 5.1 transaction) shall use its own NPI to identify those secondary providers. Medicare will not pay these claims if these secondary providers are not identified by NPIs.
CMS will Host NPI National Roundtable Q&A Session on May 19, 2008
CMS will host a national NPI Roundtable Q&A session to address
questions from the Medicare provider community prior to May 23rd.
This Roundtable will be on May 19th from 2-3: 30PM EDT. Questions
will not be collected during the registration process for this call.
There will be no presentations during this call; we will open the
lines to take questions following a brief introduction. For registration
details, visit http:
//www.cms.hhs.gov/NationalProvIdentStand/Downloads/listserv_wording_5-19-08_call.pdf 
on
the CMS website.
REMINDER: CMS will Host NPI National Roundtable on May 14, 2008
Registration is still open for the Roundtable to be held on May
14th from 2-3: 30PM EDT. Providers will be able to submit questions
through the online registration system at the time of sign up for
this call. Similar to the most recent NPI Roundtable, Subject Matter
Experts will create presentations based on the questions submitted.
For registration details, visit http:
//www.cms.hhs.gov/NationalProvIdentStand/Downloads/listserv_wording_5-14-08_call.pdf on
the CMS website.
Need More Information?
Still not sure what an NPI is and how you can get it, share it and use it? As always, more information and education on the NPI can be found through the CMS NPI page www.cms.hhs.gov/NationalProvIdentStand on the CMS website. Providers can apply for an NPI online at https: //nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203. Having trouble viewing any of the URLs in this message? If so, try to cut and paste any URL in this message into your web browser to view the intended information.
Note: All current and past CMS NPI communications are available by clicking "CMS Communications" in the left column of the www.cms.hhs.gov/NationalProvIdentStand CMS webpage.
