Health Information Management

Topic: CMS moves mandatory NPI use deadline to January 1, 2008

HIM-HIPAA Insider, October 16, 2007

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CMS has announced that because the majority of institutional providers are already sending claims to Medicare with a NPI, the agency will move up the date for mandatory NPI use in Medicare claims from May 23, 2008 to January 1, 2008 for providers that bill Medicare fiscal intermediaries and A/B Medicare Administrative Contractors, according to Wheatlands Administrative Services, a subsidiary of Blue Cross and Blue Shield of Kansas.

As of January 1, Medicare fee-for-service claims must include a NPI or both a NPI and a legacy provider identifier in the primary fields, such as billing and pay-to fields. Secondary fields may continue to contain only legacy identifiers. Claims sent without an NPI in the primary fields will be returned as unprocessable.

The change of dates is due to the fact that the Medicare NPI crosswalk has been operating successfully since June, according to an October 2 article on Wheatlands' Web site.

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