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CMS to Host NPI Roundtable Q&A Session on May 19th, 2008 CMS will host a national NPI Roundtable Q&A session to address last minute questions from the Medicare provider community in advance of the NPI implementation deadline of May 23, 2008. 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, see the document "Registration Details for May 19th NPI Roundtable Q&A Session" in the Downloads section below. CMS to Host NPI Roundtable on May 14th, 2008 CMS will host a national NPI Roundtable to address additional questions from the provider community regarding Medicare's NPI implementation. The Roundtable will be 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 the call. For registration details, see the document "Registration Details for May 14th NPI Roundtable" in the Downloads section below. Transcript for February 6th NPI Roundtable Now Available See the Downloads section below to access the transcript from the latest NPI Roundtable MARCH 1ST IS A CRITICAL DATE! Prior to March 1, 2008: Claims with both an NPI and a Medicare legacy number are rejected if the pair is not found on the Medicare NPI Crosswalk. Claims submitted with just a Medicare legacy number are being paid (unless of course, they have other errors that cause them to be rejected). As of March 1, 2008: Claims with both an NPI and a Medicare legacy number will continue to be rejected if the pair is not found on the Medicare NPI Crosswalk. Claims without an NPI in the primary provider field will be rejected! Claims with only a Medicare legacy number in the primary provider field will be rejected! This means that you will not be able to get paid for any Medicare services you provide until you begin using your NPI. Also, if needed, you must correct any data which may be preventing an NPI/legacy match on the NPI crosswalk. The correction might require that you file a CMS-855 Medicare Provider Enrollment form with your Medicare carrier, A/B MAC, or DME MAC a process which can take a number of months to accomplish. Test Your Medicare Claims Now! After you have submitted claims containing both NPIs and legacy identifiers and those claims have been paid, Medicare urges you to send a small batch of claims now with only the NPI in the primary provider fields. If the results are positive, begin increasing the number of claims in the batch. (Reminder: For institutional claims, the primary provider fields are the Billing and Pay-to Provider fields. For professional claims, the primary provider fields are the Billing, Pay-to, and Rendering Provider fields. If the Pay-to Provider is the same as the Billing Provider, the Pay-to Provider does not need to be identified.) Key Medicare NPI Implementation Dates January 1, 2008 - As of this date, 837I electronic claims and UB04 paper claims without an NPI in fields identifying the primary provider (billing and pay-to) will be rejected. Legacy identifiers paired with NPIs in the primary provider fields on the claim will still be acceptable as will legacy-only numbers in secondary provider fields (see clarification below). March 3, 2008 - Medicare fee-for-service 837P and CMS-1500 claims must include an NPI in the primary fields on the claim (i.e., the billing, pay-to, and rendering fields). You may continue to submit NPI/legacy pairs in these fields or submit only your NPI on the claim. You may not submit claims containing only a legacy identifier in the primary fields. Failure to submit an NPI in the primary fields will result in your claim being rejected or returned as unprocessable beginning March 1, 2008. Until further notice, you may continue to include legacy identifiers only for the secondary fields. May 23, 2008 -In keeping with the Contingency Guidance issued on April 3, 2007, CMS will lift its NPI contingency plan, meaning that only the NPI will be accepted on all HIPAA electronic transactions (837I, 837P, NCPDP, 276/277, 270/271 and 835), paper claims and SPR remittance advice. This also includes all secondary provider fields on the 837P and 837I. The reporting of legacy identifiers will result in the rejection of the transaction. CMS will also stop sending legacy identifiers on COB crossover claims at this time. Helpful MLN Matters Articles for Medicare NPI Implementation - SE0725 – common enumeration errors in NPPES, helpful enumeration Dos & Don'ts, and how to use your NPI on Medicare claims
- SE0744 – Important NPI and Enrollment Information for Physicians and Non-Physician Practitioners
- MM5595 – Implementation of Medicare FFS Contingency Plan
See below for NPI Related MLN Matters Articles in the Related Links section to view these articles. The Importance of Reporting Medicare Legacy Numbers in NPPES The reporting of legacy numbers in the "Other Provider Identifier"/"Other Provider Identifier Type Code" fields in the National Plan and Provider Enumeration System (NPPES) will assist Medicare in successfully creating linkages between providers' NPIs and the identifiers that Medicare has assigned to them (such as PINs). You should be aware that if you remove your legacy numbers from the "Other Provider Identifier"/"Other Provider Identifier Type Code" fields, linkages that Medicare has established using the reported Medicare legacy numbers will be broken and your Medicare claims could be rejected. Transcripts from Medicare Fee-For-Service (FFS) Roundtables Available See the Downloads section below for transcripts form: - August 2, 2007 Common Billing Errors Roundtable
- May 10, 2007 Medicare FFS Contingency Plan Roundtable
Medicare Fee-For-Service (FFS) Contingency Plan Announced! FFS Medicare has announced its contingency plan. View the associated Change Request at, as well as the related MLN Matters article in the Downloads section below. Medicare Implementation Timeframes Medicare's implementation involving acceptance and processing of transactions with the NPI will occur in separate stages, as shown in the document below (See Downloads section.) Medicare Expectations on Determination of Subparts The NPI Final Rule requires health care providers who are organizations and who are covered entities under HIPAA to determine if they have "subparts" that should be assigned NPIs. The NPI Final Rule provides guidance to those health care providers in making those determinations. We have communicated to the Provider Enrollment staff at the carriers and fiscal intermediaries the Medicare program's expectations concerning the determination of subparts for NPI assignment purposes. We have prepared a document describing the subpart concept and its relationship to the way in which Medicare enrolls its organization providers. This document will be helpful to carrier and fiscal intermediary staff in understanding the issue of subparts and how subpart determination could be done in a way that helps to promote smoother and more efficient Medicare claims processing during the implementation of the NPI in the Medicare program. The health care industry in general has expressed an interest in being informed of this type of information. We post it here so that it is easily available to interested parties. NPI Question Resource Sheet Many NPI questions that providers and their staff may have can be answered by the resources provided here on the CMS NPI page. The "NPI Question Resource Sheet" points to specific resources that can help answer common questions (see Downloads section below). Please note that CMS cannot respond individually to every question submitted as feedback via the website. However, be assured that we are reviewing all questions to determine if new educational products or "Frequently Asked Questions (FAQs)" are needed or if revisions to existing products or FAQs are warranted. Please bookmark this website and continue to check for updates to official information and education. You can also visit the NPI Question Resource Sheet (see Downloads below) for resources on this website that will help answer common questions.
Page Last Modified: 05/08/2008 11:53:23 AM
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