When required for Medicare claim submission, all 837P and CMS-1500 claims must have a National Provider Identifier (NPI) or NPI/legacy pair in the required primary provider fields, effective March 1, 2008. Failure to include an NPI will cause the claim to reject.
Providers that have been submitting claims with both an NPI and a Medicare legacy number should test their ability to get paid using only the NPI by submitting one or two claims with just the NPI (no Medicare legacy number). If the Medicare NPI crosswalk cannot match a provider’s NPI to the provider’s Medicare legacy number, the claim with an NPI-only will reject. Providers whose claims are processed and are paid should continue to increase the volume of claims sent with only their NPI. If the claims reject, those providers should go into their National Plan and Provider Enumeration System (NPPES) record and validate that the information they are sending on the claim is the same information in NPPES. If it is different, the updates should be made in NPPES and resent in a small batch of claims three to four days later. If claims are still rejecting, those providers may need to update their Medicare enrollment information; those providers should call their Medicare carrier, fiscal intermediary, A/B Medicare administrative contractor enrollment staff, or the National Supplier Clearinghouse for advice as soon as possible, with a copy of their NPPES record available. Learn more.
