{mosimage}Prior to March 1, 2008:
Claims with both an NPI and a Medicare legacy number are rejected if the pair is not found on the Medicare NPI Crosswalk.
Claims submitted with just a Medicare legacy number are being paid (unless of course, they have other errors that cause them to be rejected).
As of March 1, 2008:
Claims with both an NPI and a Medicare legacy number will continue to be rejected if the pair is not found on the Medicare NPI Crosswalk.
Claims without an NPI in the primary provider field will be rejected!
Claims with only a Medicare legacy number in the primary provider field will be rejected!
Providers will not get paid for any Medicare services until they begin using their NPI. Also, if needed, providers must correct any data which may be preventing an NPI/legacy match on the NPI crosswalk. The correction might require that a CMS-855 Medicare Provider Enrollment form be filed with a provider’s Medicare carrier, A/B MAC, or DME MAC—a process which can take a number of months to accomplish.
Test NPI-only claims NOW
If you have been submitting claims with both an NPI and a Medicare legacy number and those claims have been paid, you need to test your ability to get paid using only your NPI by submitting one or two claims today with just the NPI (i.e., no Medicare legacy number). If the Medicare NPI Crosswalk cannot match your NPI to your Medicare legacy number, the claim with an NPI-only will reject. You can and should 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, call your Medicare carrier or A/B MAC enrollment staff for advice right away. The enrollment number is likely to be quite busy after the March 1 deadline, so don’t wait.
Reminder – CMS to Host National NPI Roundtable on 2/6/2008
CMS will host a national NPI Roundtable on Wednesday, February 6th from 2:30 – 4PM ET. This call will focus on the status of the Medicare implementation and a related question and answer session. Registration details are available at http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/listservwording2-6-08npicall.pdf on the CMS website.
