NPI for Medicare claims now a must

The dreaded deadline has come. As of March 1, providers were required to begin using the National Provider Identifier number. Providers who don't use a workable NPI in the primary provider fields of X12N 837P electronic claims and CMS-1500 papers claims will find that their claims have been rejected. No word yet on just how many providers haven't gotten their house in order on this front. As of a year ago, experts were predicting that smaller physician groups, in particular, might not make the deadline.

If providers find that their NPI isn't working, their next steps will be to go into the National Plan and Provider Enumeration System records and make sure that their provider number matches that of the system. If it doesn't, they can update the NPPES system and resend a few test claims. They'd better hope that this works, though, because if it doesn't, their only other option will be to go through a resolution process with their Medicare carrier, fiscal intermediary, A/B Medicare administrative contractor enrollment staff or National Supplier Clearinghouse. Fun times.

To learn more about the current NPI situation:
- read this HFMA News item
- read the CMS advisory on the NPI

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