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Important message from Medicare regarding NPI

Patient Financial Services Weekly Advisor, October 5, 2007

This is an important message for institutional providers that bill Medicare fiscal intermediaries (FIs) and A/B Medicare Administrative Contractors (A/B MACs).

The Centers for Medicare & Medicaid Services (CMS) is pleased to report that the vast majority of institutional provider claims are being sent to Medicare with a National Provider Identifier (NPI). Moreover, the Medicare NPI crosswalk has been in successful operation for all institutional provider claims since June 2007. Given these favorable results, we are taking the next step toward full implementation of the NPI in Medicare.

Effective January 1, 2008, your Medicare fee-for-service claims received must include an NPI in the primary fields on the claim (i.e., the billing and pay-to fields). You may continue to submit NPI/legacy pairs in these fields or submit only your NPI. Claims with only a Legacy provider identifier for the primary fields will be returned as unprocessable. You may continue to include legacy only for the secondary fields, if you choose. Failure to submit an NPI in the primary fields will result in your claim being returned as unprocessable, beginning January 2, 2008.

In addition, if you already bill using the NPI/legacy pair in the primary fields and your claims are processing correctly, now is a good time to submit to your contractor a small number of claims containing only the NPI. This test will serve to assure your claims will successfully process when only the NPI is mandated on all claims.

Source: The Centers for Medicare & Medicaid Services (CMS).

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