Fri, 9 May 2008 09:47:27 -0400
The NPI is here. The NPI is now. Are you using it?
Important Information for Medicare FFS Providers
Additional Guidance and Clarification for Identifying Secondary Providers in=
Medicare Claims
In accordance with the NPI final rule, when an identifier is reported on a=
paper or electronically submitted claim for ordering/referring=
/attending/operating/supervising/purchased service/other/service facility=
provider (in the x12N 837 claims transactions) or for prescriber (in the=
NCPDP 5.1 retail drug claim transaction), that identifier must be an NPI. =
For Medicare purposes, this requirement is effective May 23, 2008. If the=
entity to be identified as the=
ordering/referring/attending/operating/supervising/purchased=
service/other/service facility provider or prescriber does not furnish an=
NPI at the time of the order/referral/purchase or time of service, the=
billing provider must attempt to obtain that NPI in order to use it in the=
claim. The billing provider may use the NPI Registry or may need to=
contact the ordering/referring/ attending/operating/supervising/purchased=
service/other/service facility or presciber in order to obtain the NPI.=
While the Implementation guides for the X12N claims transactions permit the=
reporting of the Social Security Number (SSN) for some secondary providers=
if there is no NPI, we do not believe the billing provider will be=
successful in the obtaining the SSN.
=
=B7 If unable to obtain the NPI of the entity to be identified in the=
service facility location loop, no identifier should be reported in that=
loop.
=B7 If unable to obtain the NPI of the=
ordering/referring/attending/operating/supervising/purchased service/other=
or prescriber, the billing provider (in the X12N 837 transactions) or the=
service provider (in the NCPDP 5.1 transaction) shall use its own NPI to=
identify those secondary providers. Medicare will not pay these claims if=
these secondary providers are not identified by NPIs.
CMS will Host NPI National Roundtable Q&A Session on May 19, 2008
CMS will host a national NPI Roundtable Q&A session to address questions=
from the Medicare provider community prior to May 23rd. This Roundtable=
will be on May 19th from 2-3:30PM EDT. Questions will not be collected=
during the registration process for this call. There will be no=
presentations during this call; we will open the lines to take questions=
following a brief introduction. For registration details, visit=
(http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/listserv_wording_5= -19-08_call.pdf) on the CMS website.
REMINDER: CMS will Host NPI National Roundtable on May 14, 2008
Registration is still open for the Roundtable to be held on May 14th from=
2-3:30PM EDT. Providers will be able to submit questions through the=
online registration system at the time of sign up for this call. Similar=
to the most recent NPI Roundtable, Subject Matter Experts will create=
presentations based on the questions submitted. For registration details,=
visit=
(http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/listserv_wording_5= -14-08_call.pdf) the CMS website.
Need More Information?
Still not sure what an NPI is and how you can get it, share it and use it? =
As always, more information and education on the NPI can be found through=
the CMS NPI page ( www.cms.hhs.gov/NationalProvIdentStand) on the CMS=
website. Providers can apply for an NPI online at (=
https://nppes.cms.hhs.gov) or can call the NPI enumerator to request a=
paper application at 1-800-465-3203. Having trouble viewing any of the=
URLs in this message? If so, try to cut and paste any URL in this message=
into your web browser to view the intended information.
Note: All current and past CMS NPI communications are available by clicking=
"CMS Communications" in the left column of the=
www.cms.hhs.gov/NationalProvIdentStand CMS webpage.
_________________________________________________________________________
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