NPI Updates & Alerts

The NPI is here. The NPI is now. Are you using it?
Health plans are progressing to transition to full NPI implementation. Be sure to stay informed about the steps you need to take to bill correctly and test your NPI with all of the health plans with whom you do business.

Lifting the National Provider Identifier Crosswalk Bypass Logic

Since October 2, 2006, providers have been encouraged to submit both the national provider identifier (NPI) and Medicare legacy identifier, also know as the provider identifier number (PIN), on their claims. During this timeframe providers were not penalized for invalid NPI/legacy ID combinations.

Effective September 3, 2007, First Coast Service Options, Inc. (FCSO) 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 Medicare legacy identifier (PIN) corresponds with the information on file with the National Plan and Provider Enumeration System (NPPES).

NPPES data may be checked online at https://nppes.cms.hhs.gov.

What Can You Do to Minimize Impacts?
Verify the information submitted on NPI applications and ensure that NPPES is showing the correct information:
• In section C “Other Provider Identifier” choose “PIN” as your identifier type code.
• The correct Identifier Type Code: 1 for Individual and 2 for organization.
• Employer Identification Number (EIN), Social Security Number (SSN) or The Tax Identification (TIN).
Verify the data in NPPES and the CMS-855 enrollment application submitted to Medicare is correct and consistent. The provider must check the accuracy and consistency of the following fields in the NPPES record and the Medicare enrollment application:

• Employer Identification Number (EIN), Social Security Number (SSN) or Tax Identification Number (TIN).
• Practice Address, Business Address, Master Address and Other Addresses (if applicable)
• Legal Name or Legal Business Name as reported to the Internal Revenue Service (IRS).
Once you have verified your information is correct, test the systems by submitting a small number of claims. We encourage this process to detect problems early without affecting your cash flow.

Still Experiencing Processing Issues?
FCSO has developed the following additional instructions to assist with processing issues:
For paper claim submitters – click link to “Claims Denied with CO-208 and N257 or N290”
For electronic claim submitters – click link to “Medicare Part B—NPI Related Edits”
Note: If you are not currently receiving the EMC Batch Control Listing, which identifies the NPI errors, please contact your clearinghouse.

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 contact your clearinghouse (if applicable). (Click link to “Medicare Part B—NPI Related Edits”)

If you are still experiencing claim processing issues after verifying your NPPES and clearinghouse information, you may need to submit a Medicare enrollment application (i.e., the CMS-855). Please contact your Medicare Part B Customer Service Center at 1-888-760-6950.

Additional Information
More information and education on the NPI can be found at the CMS NPI Web page at http://www.cms.hhs.gov/NationalProvIdentStand . Also, providers can apply for an NPI online at https://nppes.cms.hhs.gov.

For more information regarding common enumeration errors in NPPES and using the NPI on Medicare claims, please refer to the Centers for Medicare & Medicaid Service MLN Matters Special Edition Article SE0725. This article may be found at: http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0725.pdf.

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