Providers may see increase in claims rejections beginning next week

The Centers for Medicare & Medicaid Services (CMS) recently announced that beginning Sept. 3, carriers will no longer correct billing or pay-to provider information submitted on Medicare claims submitted by group practices. This may lead to an increase in claims rejections when not using the correct National Provider Identifier (NPI) or NPI and legacy number combination. Group practices should be reporting the group NPI or group legacy number in combination with the group NPI in the billing or pay-to-provider identifier filed.

CMS advises medical practices that experience an increase in claims rejections to first verify that the correct NPI or NPI-PIN combination was submitted. If the information on file with NPPES is correct and you continue to experience difficulty with claims submissions, CMS suggests that you contact your Medicare carrier. The problem may be related to your Medicare provider enrollment application (CMS-855).Medicare carriers will turn off this edit on a rolling basis. You should receive notification from your carrier prior to the implementation of this policy.

Providers who also act as durable medical equipment suppliers must be consistent in their enumeration. If the provider enumerates as an individual with the National Supplier Clearinghouse (NSC), he/she must enumerate as an individual with the National Plan and Provider Enumeration System (NPPES). If the provider enumerates as an organization with NSC, the same must be done with NPPES.

To verify your information,visit NPPES at https://nppes.cms.hhs.gov or contact (800) 465.3203.

For more information on common billing errors connected with the NPI, read MLN Matters article SE0725, which can be found at www.cms.hhs.gov/MLNMattersarticles/.