Start Using and Sharing Your NPI Now
It is critical that you start sending your NPI on all of your Medicare claims.
If any claim is rejected due to provider identifier issues, verify your NPI to make sure it was entered on your claims correctly. If the NPI is incorrect, then the data in either NPPES or the Medicare provider's files is incorrect.
Common Errors that May Result in Claim Rejections
- Errors in Employer Identification Number (EIN), or Tax ID (TIN).
- Invalid or incomplete data within the 'Other Provider Identifiers' section of the NPPES online application, such as:
- The absence of the Medicare Identification Number/Provider Number
- Not having the 'Type' listed as Medicare for a Medicare Identification number/provider number
- Having extra Medicare Identification Numbers/Provider numbers that should not be linked to the NPI of the applicant
- Delays in reporting Change of Ownership. Whenever there is a change of ownership, the provider is responsible for reporting that change to the appropriate Medicare contractor within 30 days. Providers are supposed to report that change on the CMS-855.
CMS published a special edition MLN Matters article (SE0725, Important Information for Providers/Suppliers Regarding NPPES Errors, Using the NPI on Medicare Claims and 835 Remittance Advice Changes ) regarding verifying NPPES data and correct billing for Medicare claims. This article is available on the CMS Website at:
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0725.pdf
You must check the accuracy of the following fields in your NPPES record and/or 855 provider enrollment record:
- EIN (for organization providers), SSN (for individual providers)
- Other Provider Identification Numbers (in NPPES where type = Medicare. This is where providers, when they apply for their NPIs, as an option, may list the Medicare legacy identifier(s) that needs to be linked to the NPI.)
- Business Location (Practice Location) Address (from NPPES and provider enrollment records)
- Master Address (from provider enrollment records)
- Other Address (from provider enrollment records)
- Legal Name or Legal Business Name
Please share your NPI with Medicare by submitting it on all of your Medicare claims.
Still not sure what an NPI is and how you can get it, share it, and use it? More information and education on the NPI can be found at the CMS NPI page on the CMS Website. Providers can apply for an NPI online at https://nppes.cms.hhs.gov
or can call the NPI enumerator to request a paper application at 1-800-465-3203.
Page Last Updated: Monday, 09-Jun-2008 15:27:01 CDT
