Alert: Medicare starting to reject claims with NPI discrepancies

[CAL/AAEM News Service]

Alert: Medicare starting to reject claims with NPI discrepancies

Source: AMA eVoice (http://www.ama-assn.org/ama/pub/category/1827.html) 
Date: September 6, 2007


The AMA is alerting physicians that Medicare must be able to match a physician's
appropriate PIN to his or her correct National Provider Identifier (NPI)—and may reject
claims if a match can't be made.

Prior to Sept. 4, most Medicare carriers permitted claims to process through their
computer systems even if an appropriate match between the physician's NPI number and
their old legacy billing number(s) couldn't be made. However, as of Sept. 4, Medicare has
started to "turn on" the edits that previously allowed these claims to process.

The AMA strongly encourages physicians to immediately check with their billing office to
determine what, if any, error reason codes have been returned over the summer. These
codes could indicate an NPI mismatch in the Medicare system. Physicians who use a
clearinghouse should check to ensure that the NPI error reason code or similar error
reason codes are not being stripped off of their claims.

Note: Medicare must be able to match single, incorporated physicians—those who have an
LLC or other incorporated business arrangement. These physicians must have two NPIs—one
for themselves and one for their corporation. In some cases Medicare may have originally
assigned these physicians one PIN rather than the two that are now needed to match a
physician to his or her correct NPI number. In these cases, re-enrollment in Medicare is
required. In addition, physicians in large group practices who may have multiple Medicare
PINs could also experience claims interruptions if there are matching problems.

The AMA is aggressively advocating for the Centers for Medicare and Medicaid Services to
alleviate the significant administrative burden these developments will place on
physician practices. The AMA is also working to get physicians more time to re-enroll in
Medicare so they can obtain the appropriate PIN and avert claims processing
interruptions.




Cyrus Shahpar & Brian Potts 
Managing Editors, CAL/AAEM News Service
University of California, Irvine

The CAL/AAEM Archives are available at: http://maillists.uci.edu/mailman/public/calaaem/



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