May 12, 2008

Important Information from Medicare for Clarification for Identifying Secondary Providers

In accordance with the NPI final rule, when an identifier is reported on a paper or electronically submitted claim for ordering/referring /attending/operating/supervising/purchased service/other/service facility provider (in the x12N 837 claims transactions) , that identifier must be an NPI. For Medicare purposes, this requirement is effective May 23, 2008. If the entity to be identified as the ordering/referring/attending/operating/supervising/purchased service/other/service facility provider does not furnish an NPI at the time of the order/referral/purchase or time of service, the billing provider must attempt to obtain that NPI in order to use it in the claim. The billing provider may use the NPI Registry or may need to contact the ordering/referring/ attending/operating/supervising/purchased service/other/service facility in order to obtain the NPI.

• If unable to obtain the NPI of the entity to be identified in the service facility location loop, no identifier should be reported in that loop.
• If unable to obtain the NPI of the ordering/referring/attending/operating/supervising/purchased service/ the billing provider (in the X12N 837 transactions) or the service provider (in the NCPDP 5.1 transaction) shall use its own NPI to identify those secondary providers. Medicare will not pay these claims if these secondary providers are not identified by NPIs.

Go to http://www.cms.hhs.gov/ for additional NPI information.

Medicare has released a notice stating when NPI numbers must be included on claims. As of March 1, 2008 Medicare claims must include an NPI in the primary billing fields such as the Billing Provider data (Box 33) and the Rendering Provider data (box 24J). Medicare states that the provider may continue to submit NPI and Legacy ID numbers or just the NPI. Claims without NPI numbers in these fields will reject.

Provider’s may continue to submit Legacy identifiers without the NPI numbers in secondary fields until May 23rd, 2008.

After May 23rd, 2008, Medicare claims should include only NPI numbers for both primary and secondary fields.

For further information or updates regarding Medicare NPI compliance dates, visit the CMS web site at www.cms.hhs.gov

The start of the BCBS NPI Required phase has been changed to January 7, 2008. Continue to submit claims using dual identifiers (your BCBSIL provider number and your NPI). Claims submitted to BCBSIL without an NPI as of January 7, 2008, will be rejected. If you have any questions, contact Availity at 877.334.8446. www.availity.com

Effective immediately MI Medicaid is requiring that all electronic claims be submitted with an NPI number. Claims received after 12/20/07 without an NPI number will reject.

Welcome to the new EZClaim Blog. EZClaim is a medical billing program used by our customers to fill out their CMS 1500 forms and submit claims to insurance companies either by paper or electronically. EZClaim will be using this blog to provide updated medical billing information such as NPI Crosswalk error information, the latest on electronic billing and many more topics. We will invite users, (and not just EZClaim customers) to share their information and to possibly answer questions posted by other interested parties. Check back as we begin to set up this blog.

The first article EZClaim is posting provides information on NPI Crosswalk guidelines and Medicare error messages. See link below.

NPI Crosswalk Information and Error Messages (PDF)