December 26, 2007
Reminder: Clarification on NPI Enumerator's Responsibilities
The NPI is here. The NPI is now. Are you using it?
The topics with which the NPI Enumerator can assist providers are listed below:
- Status of an NPI application, update, or deactivation
- How to apply, update, or deactivate
- Forgotten/lost NPI
- Lost NPI notification
- Trouble accessing NPPES
- Forgotten password/User ID
- Need to request a paper application
Health care providers should not contact the NPI Enumerator for questions other than those related to the above topics. A new MLN Matters article clarifies the specific responsibilities of the NPI Enumerator. This article is located at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0751.pdf on the CMS website.
Important Information for Medicare Providers
Reminder: NPI Requirement on Medicare Electronic and Paper Institutional Claims Begins 1/1/08!
Effective 1/1/08, NPIs will be required to identify the primary providers (the Billing and Pay-to Providers) in Medicare electronic and paper institutional claims (i.e. 837I and UB-04 claims). You may continue to use the legacy identifier in these fields as long as you also use the NPI in these fields. This means that 837I and UB-04 claims with ONLY legacy identifiers in the Billing and Pay-to Provider fields will be rejected starting on 1/1/08. (Pay-to Provider is identified only if it is different from the Billing Provider.)
You may continue to use only legacy identifiers for the secondary provider fields in the 837I and UB-04 claims, until 5/23/08, if you choose.
Urgent: Test Your Claims Now!
After you have submitted claims containing both NPIs and legacy identifiers and those claims have been paid, Medicare urges you to send a small batch of claims now with only the NPI in the primary provider fields. If the results are positive, begin increasing the number of claims in the batch.
(Reminder: For institutional claims, the primary provider fields are the Billing and Pay-to Provider fields. For professional claims, the primary provider fields are the Billing, Pay-to, and Rendering Provider fields. If the Pay-to Provider is the same as the Billing Provider, the Pay-to Provider does not need to be identified.)
If Your Claims Are Rejecting…
If you are submitting an NPI and a legacy identifier pair on your claims and they are being rejected first go into the NPPES website located at https://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. Your Medicare legacy identifier is the identifier that Medicare assigned to you upon enrollment.
Sometimes, Medicare assigned multiple identifiers to a single provider, usually because the provider had multiple locations or, if the provider is an individual and worked in multiple locations. An enrolled physician/non-physician practitioner and the group practice to which the physician/non-physician practitioner assigns his/her benefits would both have unique legacy identifiers. Legacy identifiers are the ones that were used prior to using NPIs to identify Billing/Pay-to and Rendering Providers.
If the information in your NPPES record is correct and contains your Medicare legacy identifier(s), 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. If your contractor confirms you are not on the crosswalk, please ask them to validate what information they have in their provider file
Reminder - Medicare's Key Dates
| Date | Implementation Steps |
|---|---|
| January 1, 2008 | – 837I electronic claims, UB-04 paper claims and DDE claims without an NPI in fields identifying the primary provider (billing and pay-to) will be rejected. – Legacy identifiers paired with NPIs in the primary provider fields on the claim will still be acceptable as will legacy-only numbers in secondary provider fields. |
| March 1, 2008 | – Medicare FFS 837P and CMS-1500 claims must include an NPI in the primary fields on the claim (i.e., the billing, pay-to, and rendering fields). – You may continue to submit NPI/legacy pairs in these fields or submit only your NPI on the claim. You may not submit claims containing only a legacy identifier in the primary fields. – Failure to submit an NPI in the primary fields will result in your claim being rejected or returned as unprocessable. – Until further notice, you may continue to include legacy identifiers only for the provider secondary fields. |
| May 23, 2008 | – In keeping with the Contingency Guidance issued on April 3, 2007, CMS will lift its NPI contingency plan, meaning that , for all primary and secondary provider fields, only the NPI will be accepted and sent on all HIPAA electronic transactions (837I, 837P, NCPDP, DDE, 276/277, 270/271 and 835), paper claims (UB-04 and CMS-1500) and SPR remittance advice. – The reporting of legacy identifiers will result in the rejection of the transaction. – CMS will also stop sending legacy identifiers on COB crossover claims at this time. |
Need More Information?
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.
Getting an NPI is free - not having one can be costly.
