NPPES Information for Organization Provides, Importance of “Complete” Medicare Enrollment Applications and a New MLN Matters Article
The NPI is here. The NPI is now. Are you using it?
Important National Plan and Provider Enumeration System (NPPES) Information for Organization Providers
When organization health care providers apply for NPIs, it is important that they enter their correct legal business name and Employer Identification Number (EIN).
NPPES will be establishing a verification process with the Internal Revenue Service (IRS) to verify the legal business name and the associated EIN submitted on the NPPES applications and updates. Providers will be notified as CMS develops and implements this process. In the meantime, CMS encourages providers to be proactive and verify that this information is correct in order to avoid any potential issues in the future.
Importance of "Complete" Medicare Provider/Supplier Enrollment Applications
Correcting your 855 enrollment form can be critical to assuring your claims are processed. We are urging providers to avoid delays in 855 processing that are caused by missing or incomplete information.
CMS has instructed its Medicare Fee-For-Service (FFS) contractors to process complete Medicare provider/supplier enrollment applications that contain all supporting documentation, including the electronic funds transfer authorization agreement (CMS-588) and licensing information, within prescribed processing timeframes. Incomplete or incorrect application information will result in an extension of these processing times for as long as it takes to obtain the correct information from the provider. This wastes precious time, especially for those seeking to rectify NPI/legacy conflicts and poses unnecessary work for both the contractor and the provider.
For an enrollment application to be considered complete:
- All applicable sections of the CMS-855 and fields, including check boxes, within a section must be filled-out at the time of filing,
- The application must contain an original signature (blue ink is preferred) and date of signature (blue ink is preferred), and
- The application must be accompanied by all supporting documentation listed in section 17 of the enrollment application.
Make Sure you Understand the Key Dates: New MLN Matters Article Now Available
The latest NPI-related MLN Matters Article is now available and illustrates information, in chart form, regarding the difference between the March 1st and May 23rd FFS Medicare NPI implementation dates.
REMINDER for FFS Medicare Physicians, Non-Physician Practitioners & Other Suppliers
Effective March 1, 2008, all 837P and CMS-1500 claims must have an NPI or NPI/legacy pair in the required primary provider fields. Failure to include an NPI will cause the claim to reject.
Visit the CMS NPI Web page for more details.
TEST NPI-only NOW: If you have been submitting claims with both an NPI and a Medicare legacy number and those claims have been paid, you need to test your ability to get paid using only your NPI by submitting one or two claims today with just the NPI (i.e., no Medicare legacy number). If the Medicare NPI Crosswalk cannot match your NPI to your Medicare legacy number, the claim with an NPI-only will reject. You can and should do this test now! If the claim is processed and you are paid, continue to increase the volume of claims sent with only your NPI. If the claims rejects, go into your NPPES record and validate that the information you are sending on the claim is the same information in NPPES. If it is different, make the updates in NPPES and resend a small batch of claims 3-4 days later. If your claims are still rejecting, you may need to update your Medicare enrollment information to correct this problem. Call your Medicare carrier, FI, or A/B MAC enrollment staff or the National Supplier Clearinghouse for advice right away. Have a copy of your NPPES record available. The enrollment telephone numbers are likely to be quite busy, so don't wait.
Need More Information?
Not sure what an NPI is and how you can get it, share it and use it? As always, more information and education on the NPI can be found through the CMS NPI page on the CMS Web site. Providers can apply for an NPI online or can call the NPI enumerator to request a paper application at 1-800-465-3203. Having trouble viewing any of the URLs in this message? If so, try to cut and paste any URL in this message into your web browser to view the intended information.
Note: All current and past CMS NPI communications are available by clicking "CMS Communications" in the left column of the CMS Web page.
Page last updated: Feb. 29, 2008
