Update on National Provider Identifier (NPI) for Cahaba Providers
We continue to identify providers submitting claims to Cahaba without a valid NPI number. This means either:
- The provider has not yet filed an application with the National Plan and Provider Enumeration System (NPPES) and therefore, has not received an NPI, OR
- Critical information such as the Provider Transaction Access Number (PTAN) (also known as Oscar or legacy number) and/or Employer Identification Number (EIN) (also known as the Tax ID), which were submitted to NPPES, does not match the information on the Fiscal Intermediary Standard System (FISS) provider file.
To ensure that your claims are not returned because of an invalid NPI, please take the following steps. Failure to do so will result in interrupted claims processing and cash flow.
Step 1: If you have not yet filed an application with NPPES to obtain an NPI, you must do so immediately. Go to https://nppes.cms.hhs.gov/NPPES/Welcome.do to complete an NPI application.
Step 2: If you have filed for and received an NPI, you must submit the NPI number on your claims. Ensure that the NPI number submitted on the claim matches the number that was assigned by NPPES for the PTAN number for which you are submitting claims.
Step 3: Access your NPI application and verify that all fields are complete and the information entered is correct and accurate.
The most common problem identified is the EIN on the FISS provider file does not match the EIN number submitted to NPPES. Review your NPI application carefully and verify that the EIN number was entered correctly. In addition, if your EIN has changed and you did not file an 855A with Cahaba, you must submit an 855A now to update the FISS provider file. If an 855A is not submitted for a change in the EIN number, the FISS provider file can not be updated and therefore, your NPI number will not be recognized in FISS and your claims will not process.
Note: A change in the EIN number is usually indicative of a change of ownership. Please follow the instructions for completing and submitting the 855A form on our Web site.
Step 4: Providers with branch offices or sub-units that include a variety of PTANs, were able to apply for one NPI number for all of the PTANs. If you have one NPI that applies to various PTANs, you must ensure that all the appropriate PTANs are included on the NPI application and are correct. Access the NPPES Web site to verify the all of your organization’s PTANs are entered and are correct.
Step 5: If your PTAN has an alpha suffix (ex. 123456A), access your NPI application on the NPPES Web site to update the PTAN to include the alpha suffix so that is matches the FISS provider file. For example, the provider number 123456A should be entered exactly, including the suffix “A”. If the correction to the NPI application is not made to include the suffix, your claims will be returned, and payments will be delayed.
We strongly recommend that all providers, regardless of whether a problem has been identified, access the NPPES site to verify the information submitted is complete and accurate. Cahaba continues to identify and resolve problems with the NPI implementation and will keep you updated on the status of the identified problems.
Reason Code 19201
Reason code 19201 will cause your claim to go to RTP if the attending physician’s name and/or UPIN number are missing or invalid. Claims will also receive reason code 19201 if an attending physician is submitted with an NPI, but not the attending physician UPIN. Claims will process when only a UPIN is submitted; however, at this time, if an NPI is present, a valid UPIN must also be present. If you have claims in the RTP file, ensure that both the NPI and UPIN number are entered. Make the necessary correction to the claim and press F9 to allow the claim to process.
If you have questions about the NPI implementation, please contact the appropriate Provider Contact Center found on the Contact Us page.
Page last updated: June 8, 2007
