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Important message from the Centers for Medicare & Medicaid Services regarding NPIs

Patient Financial Services Weekly Advisor, November 2, 2007

Medicare has always required that a provider identifier be reported for ordering/referring/attending/operating/other/service facility providers. Effective May 23, 2008, that number must be an NPI, regardless of whether the provider participates in the Medicare program or not or is a covered entity.

It is the responsibility of the claim/bill submitter to obtain the ordering/referring/attending/operating/other/service facility NPI for healthcare providers.

Providers whose business is largely based upon provision of services or items referred/ordered by other providers must be careful furnishing such services/items unless they first obtain the NPI of the referring/ordering individual, and understand that if they furnish services/items and do not obtain that person's NPI prior to billing Medicare their claim will be denied.

If the NPI is not directly furnished by the ordering/referring provider at the time of the order, the provider expected to furnish the services or items should contact that provider for his/her NPI prior to delivery of the services/items. Providers who have not obtained an NPI by May 23, 2008, are not permitted to refer/order services or items for Medicare beneficiaries. "

Source: The Centers for Medicare & Medicaid Services

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