June 2007
Do you need a Group National Provider Identifier (NPI)?
Group providers must report their group NPI on all claims for payment process on or after May 23, 2007. Claims could be denied or rejected, seriously impacting your cash flow.
During the Stage 2 NPI transition period of October 1, 2006 through May 22, 2007, Medicare is recommending that providers submit claims with both NPIs and legacy provider numbers. Since October 1st, Cahaba GBA, LLC has seen a high error rate with group claims being received without a group payee NPI. If you are a provider who is part of a group, you must identify your claims with not only your own individual NPI, but with a group payee NPI.
The most common definition of a group is an established practice with more than one provider working for that practice under the same tax ID. Incorporated sole practitioners are also considered a group practice. If your practice has not applied for a group payee NPI, you must do so. The Group NPI stays with the group. If your practice currently has a legacy group number, you will need to obtain and bill with a group payee NPI. (The group PIN is located in the upper right corner of the electronic and paper remittance notices in the “Provider #” field. You will need this number when applying for your NPI.)
Electronic claim submitters should contact your vendor, billing service or clearing house, or refer to Change Request (CR) 5229 for additional billing information. This CR can be located at www.cms.hhs.gov/transmittals/downloads/R234OTN.pdf.
Hardcopy claim submitters should continue to submit the original (12-90 version) CMS-1500 form using your legacy numbers through January 1, 2007. From January 2, 2007, through March 30, 2007, either the original Form CMS-1500 (12-90) version or the revised Form CMS-1500 (08-05) version can be used. After April 1, 2007, the revised (08-05) CMS-1500 form must be submitted. Please refer to the NPI 1500 Claim Form for a claim form and NPI references. You may also refer to Change Request (CR) 5060 for NPI billing instructions. This CR can be located at www.cms.hhs.gov/transmittals/downloads/R1058CP.pdf.
For additional information, all providers should refer to the CMS website at http://www.cms.hhs.gov/NationalProvIdentStand/. NPI applications may be submitted online at https://nppes.cms.hhs.gov/NPPES/Welcome.do or you can call the NPI enumerator to request a paper application at 1-800-465-3203.
If you have any questions, please contact the Provider Contact Center servicing your state at: