Thank you sponsors:
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Members: CMS recently announced that contractors should begin editing and rejecting claims that do not match on the NPI crosswalk file. This essentially means that any solo incorporated physician (who also needed both a type I and type II NPI number) should have re-enrolled in the Medicare program using the 8551 form. If they haven't they wouldn't know that a problem loomed since they are currently still being paid on the basis of their legacy (old fashioned) identifier. However, what this warning means is that if they don't submit the 8551, when NHIC ceases to accept the old identifier, they won't be in the system and won't be paid. If they delay submitting until they see the problem, they may still be paid but it will delay payments quite a long time causing considerable hardship. See full text of letter from NHIC below. Dr. Jeffrey Kaufman. Since October 2, 2006, providers have been encouraged to submit both the NPI and Medicare legacy identifier (PIN) on their claims. During this timeframe providers were not penalized for invalid NPI/legacy ID combinations. Effective September 17, 2007, NHIC, Inc. will begin editing the NPI/legacy ID combinations for validity against the NPI crosswalk file. Where a match cannot be located on the crosswalk, claims will be rejected or returned to the provider. When the claim is returned, a provider should first verify that the correct NPI was submitted. If correct, you will need to verify that your legacy identifier (PIN) number corresponds with the information on file with the National Plan and Provider Enumeration System (NPPES). NPPES data may be checked on line at https://nppes.cms.hhs.gov. If your NPPES information is correct and you have included and matched ALL Medicare legacy identifiers with a corresponding NPI in NPPES, but you are experiencing provider identifier problems with your claims that contain an NPI, you may need to submit a Medicare enrollment application (i.e., the CMS-855). Please contact Customer Service at 877-527-6613 if you need more information. More information and education on the NPI may be found at the CMS NPI page, http://www.cms.hhs.gov/NationalProvIdentStand on the CMS website. Also, providers can apply for an NPI online at https://nppes.cms.hhs.gov. If your claims are processing properly with the NPI / Legacy cross-walk, we urge you to send a small batch of 3-10 claims with the NPI number only to validate that the cross-walk of the legacy number, formerly Provider Identification (PIN) or Provider Transaction Access Number (PTAN), with the NPI is correct. This approach will be helpful in detecting any NPI problems for the provider without effecting cash flow. Thank you for your assistance in getting the word out about this change. NHIC,
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