NPI is here – are you ready?

As previously reported by the AMCNO, the NPI is now required on all Medicare claims in the primary provider fields, therefore, if your claims are being successfully processed with NPI/legacy pairs physician offices should start testing claims utilizing the NPI alone. If the Medicare NPI Crosswalk cannot match your NPI to your Medicare legacy number, the claim with an NPI-only will reject. Practices are encouraged to do this test now. If the claim is processed and you are paid, continue to increase the volume of claims sent with only your NPI. If the claims reject, go into your NPPES record and validate that the information you are sending on the claim is consistent with the information in NPPES. If it is different, make the updates in NPPES and resend a small batch of claims 3-4 days later. If your claims are still rejecting, you may need to update your Medicare enrollment information to correct this problem. Call the Palmetto Provider Contact Center 1-877-567-9232 or Provider Enrollment at 1-866-308-5439. Have a copy of your NPPES record or your NPI Registry record available. Doing this testing now will allow time for any needed corrections prior to May 23, 2008, the date when only the NPI will be accepted in all provider fields. 

And remember, the NPI will be required for all HIPAA Standard Transactions starting May 23rd. This means 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 Medicare legacy identifiers in any primary or secondary provider fields will result in the rejection of the transaction. If you are still not sure about the usage of the NPI more information may be obtained at the CMS NPI page www.cms.hhs.gov/NationalProvIdentStand  on the CMS website.