Part B Site LinksAugust 20, 2007
Lifting the National Provider Identifier (NPI) Crosswalk Bypass Logic
Since October 2, 2006, providers have been encouraged to submit both the NPI and Medicare legacy identifier (PIN) on their claims. During this timeframe providers were not penalized for invalid NPI/legacy ID combinations.
Effective October 15, 2007, CIGNA NC Part B, will begin editing the NPI/legacy ID combinations for validity against the NPI crosswalk file. Where a match cannot be located on the crosswalk, claims will be rejected or returned to the provider.
When the claim is returned, a provider 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 with the National Plan and Provider Enumeration System (NPPES). NPPES data may be checked on line at https://nppes.cms.hhs.gov.
If your NPPES information is correct and you have included and matched ALL Medicare legacy identifiers with a corresponding NPI in NPPES, but you are experiencing provider identifier problems with your claims that contain an NPI, you may need to submit a Medicare enrollment application (i.e., the CMS-855). Please contact your contractor if you need more information.
More information and education on the NPI may be found at the CMS NPI page, http://www.cms.hhs.gov/NationalProvIdentStand on the CMS website. Also, providers can apply for an NPI online at https://nppes.cms.hhs.gov.
Submitters are encouraged to send a small batch of claims with an NPI only to validate the legacy selected to match with the NPI is correct. This would be a helpful tool to detect problems early without affecting cash flow.
If you are having billing issues, please refer to the CMS Medlearn article on common billing errors. The address is http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0725.pdf.
Please note, Part B CIGNA Idaho and Tennessee lifted the NPI bypass logic May 21, 2007.
