Will a health care provider’s National Provider Identifier (NPI) ever change?

QUESTION: Will a health care provider’s National Provider Identifier (NPI) ever change?

ANSWER: The National Provider Identifier (NPI) is meant to be a lasting identifier, and is expected to remain unchanged even if a health care provider changes his or her name, address, provider taxonomy, or other information that was furnished as part of the original NPI application process. There are some situations, however, in which an NPI may change such as when health care provider organizations determine they may need a new NPI due to, for example, certain changes of ownership, the conditions of a purchase, or a new owner’s subpart strategies. There also may be situations where a new NPI is necessary because the current NPI was used for fraudulent purposes.

For more information : Join our exclusiveFREE Email Coding News Alert Mailing List http://www.codinginstitute.com/

National Provider Identifier (NPI)?

QUESTION: Under what circumstances will a claim be rejected when using the National Provider Identifier (NPI)?

ANSWER: Claims will be rejected if:
• The NPI included in a claim or claim status request does not meet the content criteria requirements for a valid NPI (begins with 1,2,3, or 4; 10-digits long with no special characters; check digit is correct); this affects:o X12 837 and Direct Data Entry (DDE) screen claims (DDE claims are submitted to Medicare Intermediaries only);o National Council of Prescription Drug Plan (NCPDP) claims (submitted to Medicare DMERCs only);o Paper claims on the revised CMS-1500 form and on the UB-04 form;o Claims submitted using Medicare’s free billing software;o Electronic claim status request received via X12 276 or DDE screen; ando Non-X12 electronic claim status queries, pending elimination of the HIPAA contingency plan for the HIPAA 276/277 format;
• A submitted NPI reported cannot be located in Medicare files;
• The NPI is located, but a legacy identifier reported for the same provider in the transaction does not match the legacy identifier in the Medicare file for that NPI;
• Claims include the NPI but do not have a taxpayer identification number (TIN) reported for the billing or pay-to provider in electronic claims received via X12 837, DDE screen (FISS only), or Medicare’s free billing software; and
• Claims that do not meet Medicare submission requirements, HIPAA implementation guide requirements, or Medicare program reuirements for reasons unrelated to NPIs.


For more information : Join our exclusiveFREE Email Coding News Alert Mailing List http://www.codinginstitute.com/