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September 11, 2007
Top NPI Billing Issues
- Claim includes group PTAN and an Individual NPI
- Claim includes an individual PTAN and a group NPI
Claims should include group PTAN and individual PTAN and/or Individual NPI and Group NPI. Providers are strongly encouraged to begin billing claims including their NPI.
- Provider is a group and did not realize they needed an NPI for the Group
- Provider did not register their PTAN in NPPES. If the provider has multiple PTANS they must list all PTANS in NPPES.
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.
- The provider thinks they are sending an NPI number but we are not receiving it. On the batch detail listing electronic billers receive the group NPI and PTAN are listed on the report. Providers need to check the report to see if the group NPI is on the report. If the group NPI is not on the report we are not receiving it.
- Some individuals are signed up as sole practitioners but are incorporated and need to fill out a new 855 form to obtain a group PTAN. All changes to a provider's demographics must be updated by completing an 855 form. The information in NPPES must match what is in our system or the crosswalk will not be updated.
Ways to Avoid Billing Errors:
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 receiving 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.
