July 2008

Medicare NPI Update for HIPAA Transactions

Effective May 23, 2008, the National Provider Identifier (NPI) became mandatory on all HIPAA claims transactions and Medicare paper claims transactions. All claims transactions must be submitted with the NPI entered in all fields requiring a provider identifier. Medicare providers are also encouraged to review the following information for reporting Taxpayer Identification Numbers (TINs).

The Centers for Medicare & Medicaid Services (CMS) continues to see progress with NPI compliance and most Medicare contractors report that the NPI is being used on 95% of the claims submitted. However, for the few rejected claims, CMS determined that rejections were caused by the following issues associated with Part B claims:

1. The Employer Identification Number (EIN) or Social Security Number (SSN) was submitted in the 2010AA/REF02 (Billing Provider Secondary Identifier) data field, the 2010AB/REF02 (Pay to Provider Secondary Identifier) data field and/or the 2310B/REF02 (Rendering Provider Secondary Identifier) data field of the X12N 837 professional transaction did not match the TIN on the Medicare crosswalk.

2. Though an EIN or SSN is not required for the 2310B Loop on Medicare claims, if either the EIN or SSN is submitted, the appropriate qualifier must be entered in the 2310B/REF01 data field.

• Qualifier EI must be submitted in the 2310B/REF01 data field when an EIN is being submitted in the REF02 data field.
• Qualifier SY must be submitted in the 2310B/REF01 data field when an SSN is being submitted in the REF02 data field.

3. The Medicare legacy provider identifier was entered in the primary and/or secondary provider loops. Legacy provider numbers are no longer allowed on any Medicare claim or transaction. If a legacy provider identifier was entered on any claim or transaction, it will be rejected.

Medicare providers are encouraged to review the preceding information and take appropriate actions to resolve any issues. As a result, providers may decide to stop submitting segments that are not required such as the TIN in 2310B/REF02 data field of the X12N 837 professional transaction. Providers may also want to consult their clearinghouse or software vendor for additional advice to resolve any issues mentioned in this announcement.

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July 2008

Accurate NPPES Date Required
To ensure data submitted to the National Plan and Provider Enumeration System (NPPES) for organization health care providers is accurate, CMS initiated an NPPES-Internal Revenue Service (IRS) data match to verify that the legal business name (LBN) and EIN recorded by NPPES is consistent with the IRS data.

CMS will mail letters to organization health care providers that have an LBN/EIN combinations recorded by NPPES that are different from those maintained by the IRS. These letters will instruct organization health care providers to review and update their LBN and/or EIN in NPPES. If organization health care providers do not submit data that is consistent with the IRS data, CMS will deactivate the NPI in NPPES. CMS will continue to compare the organizational health care provider data in NPPES to the IRS data to verify its accuracy.

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