NPIs become mandatory May 23

Sunday, May 18, 2008

WASHINGTON - It's been years in the making, but the national provider identifier (NPI) program arrives this week.

Starting Friday (May 23), all Medicare fee-for-service claims will require NPI numbers only. Paper and electronic claims that include legacy numbers will be rejected.

"As far as Medicare is concerned, as of May 23, we will not cross over legacy numbers, only NPIs," said a CMS official during an NPI Roundtable Wednesday.

A legacy-free day held May 7 resulted in an 80% spike in NPI-only claims and revealed that most clearinghouses could strip legacy numbers from claims submitted with both NPI/legacy pairs.

"Most trading partners, commercial payers and Medicaid programs, are going to be ready May 23," said a CMS official. "States that will not be ready on May 23 should be communicating with their providers."

However, officials warn, providers using a clearinghouse billing service or software that does not strip legacy numbers must make sure that their claims contain only NPIs.

Providers are also responsible for obtaining the NPI of the secondary provider (such as a referring, supervising or prescribing physician) if the secondary provider does not furnish an NPI. Providers can do this either by contacting the secondary provider directly or using the NPI Registry: