National Provider Identifier (NPI) - Things to Consider
Effective May 23, 2008, you were required to submit your claims with a National Provider Identifier (NPI) only. However, the Medicare claims processing system must match the NPI you submitted on your claim to the correct Provider Transaction Access Number (PTAN), otherwise known as your legacy number, so payment can be made to the appropriate provider.
If you have one NPI for each of your PTANs, there should be little disruption to your claims processing timeliness due to the NPI to PTAN matching process. For purposes of clarification, organizations may have multiple NPIs.
If you choose to have one NPI that corresponds to multiple PTANs, this may result in additional manual review and development to match your NPI to the correct PTAN. However, in the situation of one NPI that corresponds to multiple PTANs, we recommend you bill your corresponding taxonomy code for each rendering provider to reduce the likelihood of delays in processing due to manual review and development.
Following is some additional information to consider on the options for NPI enumeration. We hope you find this information helpful in making informed decisions that are in your best interest.
Enumerating Option #1 - One NPI to one PTAN
Advantages
- Improved Claims Processing Timeliness, otherwise delayed by the NPI to PTAN matching process.
- Less risk of matching NPI to wrong PTAN, resulting in claims being processed and paid incorrectly.
- Fewer claims suspended due to the NPI to PTAN matching process.
- Fewer claims developed for additional information due to the NPI to PTAN matching process.
- Fewer denied claims due to the NPI to PTAN matching process.
Disadvantages
- Applying for and managing multiple NPI numbers
Enumerating Option #2 - One NPI to many PTANs
Advantages
- Fewer NPI numbers to apply for and manage.
Disadvantages
- Potential for delays in Claims Processing Timeliness due to the NPI to PTAN matching process.
- Increased risk of matching NPI to wrong PTAN, resulting in claims being processed and paid incorrectly.
- Increase in number of claims suspending due to the NPI to PTAN matching process.
- Increase in number of claims developed for additional information due to the NPI to o PTAN matching process.
- Potential for increased denials on claims due to the NPI to PTAN matching process.
If you are interested in making changes to your NPI enumeration, you may contact the NPI Enumerator at 1-800-465-3203 or review information on how to apply for an NPI at https://nppes.cms.hhs.gov/NPPES/Welcome.do. 
More information on the NPI can be found through the Centers for Medicare & Medicaid Services (CMS) NPI page http://www.cms.hhs.gov/NationalProvIdentStand/01_Overview.
asp#TopOfPage on the CMS Website.
If you have questions regarding your Medicare legacy numbers, please contact Provider Enrollment at (866) 734-9444.
Page Last Updated: Wednesday, 31-Dec-2008 10:48:28 CST
