Medicare claim rejections tied to data in individual provider/supplier National Plan and Provider Enumeration System (NPPES).

The Centers for Medicare and Medicaid Services (CMS) has begun using the National Provider Identifier (NPI) in the processing of Medicare claims. The number of rejected claims prompted CMS to post an MLN Matters (SE0725, July 5, 2007) article that identifies the most frequent errors providers made when they applied for the NPI that are now causing claim rejections. CMS recommends that physicians and other providers validate their NPPES data as soon as possible. Providers need to pay particular attention to possible errors in the Employer Identification Number (EIN) and look for invalid or incomplete data within the “Other Provider Identifiers” section, e.g., absence of Medicare legacy number or listing legacy numbers that do not belong to the applicant. The article includes a listing of the billing codes and descriptions attached to rejected Medicare claims. CMS recommends that staff be aware of these codes and that providers keep a hard copy of their NPPES data as reference. A PDF copy of the full MLN Matters article can be viewed at:

http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0725.pdf

To update NPPES records online, go to:

https://nppes.cms.hhs.gov

To update NPPES records via paper form, call the NPI Enumerator toll-free at 1-800-465-3203, TTY 1-800-692-2326 and ask for the NPI Application/Update Form (CMS-10114 – note that a revised form is to be used as of July 10, 2007), or download the form from the CMS Forms page at:

http://www.cms.hhs.gov/cmsforms