NPI INFORMATION – Hints on
Registration
1.
When
registering for an individual NPI, make sure only individual provider numbers
are on application.
2.
When
registering for a group NPI, make sure only group provider numbers are on
application.
3.
Social
security number can only be tied to one NPI
number. When registering for both group and individual NPI, use SSN on individual application and tax id# on group application. Other wise one of
the applications will be rejected as a duplicate.
4.
You
must
enter either a SSN or tax ID# on application. You may get an
NPI #, but processing issues will arise, due to provider identifying
issues.
5.
When
entering Medicare PIN # make sure it is entered as Medicare
PIN and not Medicare id – type
unspecified or PIN#’s will not
be recognized and claims
will be rejected by Medicare.
6.
The
address on NPI registration must match address that Medicare has on
file.
CROSSWALK NPI/LEGACY
ISSUES
These are findings
when troubleshooting Dr Soleimany’s NPI
issues.
1: NPI taxonomy
codes on NPI record were not correct.
SOLUTION:
correcting the taxonomy codes on NPI record
2: NPI address
does not EXACTLY match record on Existing Medicare enrollment
system.
SOLUTION: We took the SUITE D off the NPI record.
3: Medicare is stating
the original Medicare enrollment file (26 yrs ago) does not list the provider as
incorporated. Asked for REVALIDATION and SUBMISSION OF
new 855I FORM. Cause this validation is
being required, now DR SOLEIMANY will be required to switch to ETF - 588 FORM
Required.
SOLUTION: 855I
form with ETF 588 form completed and mailed a few days
ago.
4: NPI record was
filled out as SOLE PROPRIETOR. Medicare rep says this may stop the
c
SOLUTION: None
yet, I did not see a place where you could
specify INCORPORATED?
(Client or i will check with NPPES today).
5: NPI NPPES does not
seem to send a new email confirming changes NPI? Only send original
EMAIL. (or at least i
have not seen)
SOLUTION: ?
5.1 Many clients
think "We have an NPI number" and do not realize they are going to get unpaid
claims DUE TO A FAILURE OF THE CROSSWALK , caused by VERY MINOR difference
between the NPI/NPPES record and the clients existing MEDICARE ENROLLMENT
FILE. Many clients have no idea what they have in their exisitng medicare enrollment file,
(unless they have recently completed an 855i).
6: What
your Medicare claims (on billing service) very CLOSELY. If paper claims
do not properly CROSSWALK, there is no EOB generated, no denial. (that I have seen w/Dr. S). Perhaps you get a rejection
of batch with electronic? I recommend running an
CUMM JOURNAL, on medicare over 60 days, to see we have
a problem, not reported yet.
The following notice
showed up when i did a search this morn. I had
never seen before.
http://www.medicarenhic.com/edi/download/npimismatch_0807.pdf
NPI/Legacy Number
(PIN/PTAN) Mismatch Will Cause Claims to Reject
In California, Beginning
9/17/2007, In New England On
10/22/2007
“Since
Medicare legacy identifier (PIN) on
their claims. During this timeframe providers were
not penalized for invalid
NPI/legacy ID combinations.
Effective
region,
NHIC, Corp. 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.
(bold/underline added by RICH)
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 legacy identifier (PIN) number
corresponds with the
information on file with the National Plan and Provider
Enumeration System (NPPES). NPPES
data may be checked on line at https://nppes.cms.hhs.gov/.
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 submit a
Medicare enrollment application (i.e., the CMS-855). Please
contact Customer Service at
877-527-6613 if you need more
information.
More information
and education on the NPI may be found at the CMS NPI page,
http://www.cms.hhs.gov/NationalProvIdentStand
on the CMS website. Also, providers
can apply for an NPI online at https://nppes.cms.hhs.gov/.
If your claims are
processing properly with the NPI / Legacy cross-walk, we urge you to
send a
small batch of 3-10 claims with the NPI number only to validate that the
crosswalk of the
legacy number, formerly Provider Identification (PIN) or
Provider Transaction Access Number
(PTAN), with the
NPI is correct. This approach will be helpful in detecting any NPI problems
for
the provider without effecting cash flow.”