The Centers for Medicare and Medicaid Services (CMS) has issued a special edition MLN Matters article regarding the fact that the national provider identifier (NPI) crosswalk will validate physicians’ claims if they contain a legacy number, such as a Medicare provider identification number (PIN), and an NPI. However, as of Oct. 31, if NPI/ PIN combination in physicians’ claims do not match an NPI/PIN combination in the NPI crosswalk, those claims will reject.
To prevent claim rejection, physicians should take several steps, including checking their information in the National Plan and Provider Enumeration System (NPPES) to ensure that the NPI(s) were properly obtained. For example, physicians who are sole proprietors should have an individual PIN and should have obtained an NPI as an individual (entity type 1), not as an organization (entity type 2).
Physicians who continue to get informational NPI edits even though their NPI(s) were properly obtained and the NPPES information is correct should, among other steps, ensure that their Medicare enrollment information is up to date. Read the article.
