National Provider Identifier (NPI) and Reason Code 32000
When claims are submitted with only the NPI number, and the provider’s NPI applies to various sub-units (e.g., psychiatric unit, rehabilitation unit, swing bed unit), the claim may go to the Return to Provider file with reason code 32000. Reason code 32000 will apply when claims for the sub-units use the same type of bill and the Fiscal Intermediary Standard System (FISS) is unable to determine which Oscar/Legacy to apply to the claim being submitted. For example, a provider that uses one NPI that cross references to the Oscar/Legacy number for all their sub-units submits inpatient hospital claims and psychiatric claims. The claims will receive reason code 32000 because both claims types are submitted with the type of bill 11X and FISS is unable to determine whether to process the claim with the inpatient Oscar/Legacy or the psychiatric Oscar/Legacy number.
To correct claims in RTP with reason code 32000, enter your Medicare provider (Oscar/Legacy) number in the “Oscar” field on the FISS Claim Page 01. To avoid having your claims from going to RTP with reason code 32000, report the Oscar/Legacy number when you initially submit your claim. In addition, providers are encouraged to submit an application with the National Plan and Provider Enumeration System (NPPES) to obtain an individual NPI for each sub-unit that would be using the same type of bill when billing Medicare services.
Page last updated: March 5, 2008
