October 16, 2007
The NPI is here. The NPI is now. Are you using it?
Important Medicare NPI Information & New MLN Matters Article for Physicians and Non-Physician Practitioners
Important Information for All Medicare Providers - What to do if Claims Are Rejected
- Check Medicare Reject Report messages.
- If you use billing companies, clearinghouses and administrative staff, check to find out if they have been contacted by Medicare contractors concerning problems in matching NPI/PIN combinations to the Medicare NPI crosswalk.
- Check your information in the NPPES to ensure that the NPI(s) were properly obtained. For example, if you are a sole proprietor, you should have an individual PIN and you should have obtained an NPI as an Individual (Entity type 1), not as an Organization (Entity type 2).
- Ensure that the NPPES data are correct, and that the NPPES record(s) contains the Medicare legacy identifier(s) that was assigned to the provider to whom the NPPES record belongs. For example, a physician/practitioner applying for an NPI would list his/her Medicare PIN in the "Other Provider Identifiers" section of the NPI application, but would not list the PIN of the group in which he/she is a member. Medicare uses this information in building the Medicare NPI crosswalk and incorrect reporting will flow into the NPI crosswalk and cause problems down the road. To view or edit your NPPES record, go to https://nppes.cms.hhs.gov on the CMS website. For assistance, call the NPI Enumerator at 1-800-465-3203.
- If the NPI(s) was properly obtained and the NPPES information is correct and you continue to get informational NPI edits:
- Ensure that your Medicare enrollment information is up to date.
- If you need to re-enroll or update the enrollment information, ensure that a complete application is submitted.
- Also, make sure that the Medicare enrollment record reflects the correct Taxpayer Identification Number (TIN) for use by Medicare in reporting your income to the IRS on the 1099 form.
Important NPI and Enrollment Information for Physicians and Non-Physician Practitioners
By October 31, 2007, all Medicare carriers (and A/B MACs that service providers who formerly billed carriers) will be rejecting Part B claims if they are unable to "match" a NPI and a PIN combination submitted on a claim to an NPI/PIN combination in the Medicare NPI crosswalk. The NPI/PIN combination may be used to identify the Billing, Pay-to, or Rendering Provider (the Pay-to Provider is identified only if it is different from the Billing Provider). This applies to claims that are submitted by corporations that physicians and non-physician practitioners have formed, or by physicians and non-physician practitioners who bill Medicare directly. In this article, we refer to these physicians and non-physician practitioners as "physicians/practitioners."
For more information, please refer to the Special Edition MLN Matters article on this subject. You can view the article at: http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0744.pdf on the CMS website.
Still Confused?
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.
Getting an NPI is free - not having one can be costly.
