Beginning next week, California’s Medicare carrier will reject a claim if it is unable to match a physician’s legacy identifier (PIN) to his or her National Provider Identifier (NPI).

Physicians are encouraged to immediately check with their billing offices to determine what, if any, Medicare error codes have been returned over the summer. Such errors could indicate an NPI mismatch in the Medicare system. If you use a clearinghouse, check with it to ensure that these codes are not being stripped off of your claims.

Additionally, changes in the Medicare enrollment process over the years have caused some differences between the NPI and Medicare identification number assignment process. This may require some physicians to complete a new Medicare enrollment form so that their NPI and Medicare “provider types” match.

Particularly affected are solo incorporated practices, which are required to obtain both an organizational NPI and an individual NPI. If you have two NPIs but only one Medicare provider number, a new CMS 855 application may be necessary. Click here for memo from Medicare on this issue.

If you are not sure whether this applies to your practice, call California’s Medicare carrier NHIC for assistance at 877/527-6613.

Contact: Frank Navarro, 916/551-2046 or fnavarro@cmanet.org.