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How to Avoid NPI-Related Medicare Claims Rejections [Posted 09/27/07]
As you likely know, California’s Medicare carrier NHIC has begun rejecting claims if it is unable to match a physician’s legacy identifier (PIN) to his or her National Provider Identifier (NPI). Particularly affected by this are solo incorporated practitioners who have both individual (entity type 1) and organization (entity type 2) NPIs. Physicians using both legacy (PIN) and NPI numbers on their claims must make sure the provider types match. If using an individual NPI, you must also use an individual PIN (and vice versa). Pairing your corporation’s NPI with your individual PIN or your individual NPI with your corporation’s PIN will cause your claims to be rejected. It is possible that physicians experiencing NPI-related claim rejections will have to complete a new Medicare enrollment form. Changes in the enrollment process over the years have caused some differences between the NPI and Medicare identification number assignment process. This may require some physicians to reenroll so that their NPI and Medicare “provider types” match. Physicians experiencing NPI-related rejections can submit claims using their legacy PIN only. Be aware, however, that Medicare may at any time choose to stop accepting claims with legacy numbers. Physicians with NPI problems should contact NHIC immediately so the problem can be identified and solved. For NPI-related questions, call NHIC at 877/527-6613. Below are additional resources to help you avoid NPI-related claim rejections. Contact: Frank Navarro, 888/401-5911 or fnavarro@cmanet.org.
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