The following information was forwarded via the Trailblazer Listserv. NPI numbers, although intended to streamline and simplify, may cause problems if not utilized appropriately. Please review the following.

Thanks.

Angela S. Brooks, PT

VPTA Payer Relations Specialist

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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 Medicare claims are not compatible. If billing 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 want to use the NPI and the PIN pair on Medicare claims, be sure to use the individual NPI with the individual PIN. Pairing the corporation's NPI with the individual PIN will result in claims being rejected. If you wish to bill Medicare with the corporation's NPI, ensure the corporation is enrolled in Medicare so that it can be assigned a PIN. Contact the Medicare carrier for more information about this enrollment. Until the corporation has been enrolled in Medicare, you may continue to bill by using the individual NPI with the individual PIN to ensure no disruption in claims being processed and paid. Please note that similar problems may result if you bill Medicare by using the individual NPI with the corporation's PIN (if the corporation is enrolled and has been assigned a PIN). When billing with the NPI/PIN pair, you must use compatible NPIs and PINs.

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