"Suris-Fernandez, Rosali C. (CMS/OESS)" <rosali.surisfernandez@...> wrote:

The NPI is here.  The NPI is now.  Are you using it?

 

Many of you have noted the recent instability of NPPES and the NPI Registry.  CMS has begun implementing changes that should eliminate the instability.  We expect that these changes will be completed as soon as possible.  NPPES will remain in operation while these changes are being made but the NPI Registry will remain down until all changes have been implemented.  We expect the NPI Registry to be back in operation as soon as possible.  We apologize for this inconvenience.

 

The downloadable file is available at http://nppesdata.cms.hhs.gov/cms_NPI_files.html on the web. 

 

Important Information for Medicare Providers

 

For Physicians and Non-Physician Practitioners who Bill Medicare

Your Medicare carrier has contacted, or will be contacting you, about the date Medicare will begin rejecting your claims if the NPI and legacy number pairs used on your Medicare claims are not compatible.  If you bill using only the NPI, please skip to the last paragraph.

 

Some incorporated physicians and non-physician practitioners have obtained NPIs as follows:  an individual (Entity Type 1) NPI for the physician or non-physician practitioner and an organization (Entity Type 2) NPI for the corporation.  If you enrolled in Medicare as an individual and obtained a Medicare Provider Identification Number (PIN) as an individual, and you want to use your NPI and your PIN pair in your Medicare claims, be sure you use your individual NPI with your individual PIN.  Pairing your corporation’s NPI with your individual PIN will result in your claims being rejected.  If you wish to bill Medicare with your corporation’s NPI, then you must be sure your corporation is enrolled in Medicare so that it can be assigned a PIN.  Please contact your servicing Medicare carrier for more information about this enrollment.  Until your corporation has been enrolled in Medicare, you may continue to bill by using your individual NPI with your individual PIN to ensure no disruption in your claims being processed and paid.  Please note that similar problems may result if you bill Medicare by using your individual NPI with your corporation’s PIN (if the corporation is enrolled and has been assigned a PIN).  In other words, when billing with the NPI/PIN pair, you must use compatible NPIs and PINs.

 

NPI-Only Billers:  Make sure the NPI you are using is compatible with your Medicare enrollment.  For example, if you enrolled in Medicare as an individual, then you should be using an individual (Entity Type 1) NPI.

 

Enumeration Tip for DME Suppliers

Medicare has also reported instances of incorrect billing by DME suppliers to DME MACs.  DME suppliers must ensure that if they enumerate as individuals in the National Supplier Clearinghouse (NSC), they must obtain NPIs for themselves as individuals (Entity type 1) in NPPES.  If they enumerate as organization in the NSC, they must obtain NPIs for the organizations (Entity type 2) in NPPES.

 

Pay Attention:  Informational Edits Today = Future Claim Rejections!

We strongly urge Medicare providers to pay attention to the informational edits they may be receiving on the remittance advice (either electronic or paper). These edits are generated to help providers identify problems that will cause claims to reject in the future.  A recent MLN Matters article lists these informational edits and their meanings.  Visit http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0725.pdf on the CMS website to view the article.

 

Reminder ---Medicare Carriers and DME MACs Will Begin Transitioning their Systems to Start Rejecting Claims when the NPI and Legacy Provider Identifier Pair cannot be found on the Medicare Crosswalk

Since May 29, 2007, Medicare Fiscal Intermediaries, as well as Part B CIGNA Idaho and Tennessee, have been validating NPIs and legacy provider identifier pairs submitted on claims against the Medicare NPI Crosswalk.  Between the period of September 3, 2007 and October 29, 2007, all other Part B carriers and DME MACS will begin to turn on edits to validate the NPI/legacy pairs submitted on claims.  If the pair is not found on the Medicare NPI crosswalk, the claim will reject.  Contractors have been instructed to inform providers at a minimum of 7 days prior to turning on the edits to validate the NPI/legacy pairs against the NPI Crosswalk.       

 

If your remittance advice contains informational edits today, we strongly urge you to validate that the NPPES has ALL of the NPI and legacy numbers you intend to use on claims and for billing purposes.  If NPPES is correct, and you continue to receive informational edits, you should ensure that your Medicare enrollment information is up to date.  If it is not, you may need to submit a completed CMS-855 (Medicare provider enrollment form).  When completing the CMS-855, please list all of the NPIs that will be used in place of legacy identifiers.  When applying for an NPI, please include ALL of your Medicare legacy numbers.  (NPPES can accept only 20 Other Provider Identifiers, but is being expanded to accept more in the future.) If the information is different between Medicare and NPPES, there is a very good chance your claims will reject. NPPES data may be verified at https://nppes.cms.hhs.gov on the web.

 

Clarification Regarding Provider Response Times for Contractor Inquiries

As stated in CR 5649, Transmittal number 1262 dated June 8, 2007, all Medicare providers could receive phone calls and/or letters from their contractors in the event that a claim suspends due to problems with mapping a provider’s NPI to a legacy provider identifier.  In last month’s NPI message, we noted the number of days for a provider to respond to this type of contractor inquiry.  To clarify, if the provider does not respond within the timeframe issued during the phone call with, or on the letter they receive from their contractor, the contractor will return the claim as unprocessable.  The contractor will ensure that it is in compliance with the Medicare Program Integrity Manual (Publication 100-08), chapter 10, section 17.2 regarding the release of information. 

 

Upcoming WEDI NPI Audiocast

The Workgroup for Electronic Data Interchange will host an NPI audiocast on October 17th.  Visit  http://www.wedi.org/npioi/index.shtml on the WEDI website to learn more.  Please note that there is a cost to participate in WEDI events. 

 

 

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.

 

 

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