All Medicare Claims (Including Paper Claims) Must Now Include NPI
[Posted 03/03/08]

Physicians are reminded that as of March 1, all Medicare fee-for-service claims must use an NPI as the primary identifier (i.e., in the billing, pay-to, and rendering fields). 

Between March 1 and May 23, you may continue to submit NPI/legacy pairs in these fields or submit only your NPI. Claims containing only a legacy identifier in the primary fields will be rejected or returned as unprocessable. May 24 marks the end of the Medicare contingency plan. As of that date, all Medicare claims must be submitted with the NPI as the only identifier.
Physicians should be aware that HIPAA’s “country doctor” (small practices that submit only paper claims) exemption does not exempt physicians from Medicare’s NPI rules. The NPI is required on all Medicare claims, including paper claims.

Test Your Claims Now!
Since January 1, Medicare has been returning claims without matching NPI and Medicare “provider types.” 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. NHIC, California’s Medicare Carrier, is hosting a live interactive webinar on Tuesday, March 25, to assist physicians with the provider enrollment process.

Once you have successfully submitted (and been paid for) claims containing both NPIs and legacy identifiers, it is time to begin testing claims with only your NPI in the primary provider fields. It is important that physicians resolve any NPI rejection issues by May 23 NPI deadline to avoid any cash flow interruptions.Contact: Frank Navarro, 916/551-2046 or fnavarro@cmanet.org.