This means two things, according to the Centers for Medicare and Medicaid Services:
- 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.
“Now that the NPI is required on all Medicare claims in the primary provider fields, if your claims are being successfully processed with NPI/legacy pairs (and most are) now is the time to begin testing claims using the NPI alone,” writes CMS. “If the Medicare NPI Crosswalk cannot match your NPI to your Medicare legacy number, the claim with an NPI-only will reject.”
If your claim is processed and you receive payment, you may continue to increase the volume of claims sent only with your NPI in anticipation of May 23. If the claims reject, you may need to validate that the information sent on the test claim is consistent with the information in the National Plan and Provider Enumeration System (NPPES). If it is different, “make the updates in NPPES and resend a small batch of claims three to four days later. If your claims are still rejecting, you may need to update your Medicare enrollment information to correct this problem,” advises the American Society of Anesthesiologists. “Call the Customer Service Representative at your Medicare carrier, FI, or A/B MAC enrollment staff or your DME MAC to discuss your situation and, if necessary, have it investigated. Have a copy of your NPPES record or your NPI Registry record available.”
For more information and education, visit the CMS NPI page; providers can apply online for an NPI or call the NPI enumerator at (800) 465-3203 to request a paper application.
