NPI Utilization Required by March 1

Beginning March 1, 2008, Medicare claims that do not have both a National Provider Identifier (NPI) and a Medicare legacy number will be rejected if the pair is not found on the NPI Crosswalk. Providers who are not using their NPI numbers as of March 1 will not be reimbursed for any Medicare services provided until they begin using it.

NPI was established as part of the 1996 Health Insurance Portability and Accountability Act (HIPAA), which requires that each physician, supplier, and other health care providers conducting HIPAA standard electronic transactions be issued a unique NPI. All providers should already have obtained an NPI number.

Physicians are encouraged to test their ability to get reimbursed using only the NPI by submitting one or two claims per day with just the NPI and no legacy number. If the Medicare NPI Crosswalk cannot match a provider’s NPI with a legacy number, the claim will be rejected. If this occurs, physicians should call their Medicare carrier enrollment staff. If the claim is processed and reimbursed, the volume of NPI-only claims should be increased.

More information on NPI can be found on the Centers for Medicare and Medicaid Services (CMS) Web site.