February 28, 2008
Common Questions and Answers for NPI
Q: I need to contact Customer Service for assistance with a complex NPI issue. What information do I need before calling?
A: Suppliers should be prepared to provide their claim reject number and message before contacting Customer Service. That will assist the call center agent in determining if the reject is related to NPI. Suppliers should also be prepared to provide:
- The legal business name or legal name
- Their business type (sole proprietor, corporation, or partnership)
- The supplier's Social Security Number (for sole proprietorships only)
- Supplier EIN (Tax ID)
- The supplier's NPI and Entity type
- The NSC Number (Medicare legacy identifier)
- Practice location submitted on the claim
Q: What Provider Identifier Qualifier is needed when I submit a claim using my NPI?
A: The appropriate qualifier is determined based upon whether the supplier is set up at the NSC as the "Sole Proprietor" or "Organization." The "SY" qualifier is used when billing with a social security number (as in the case of a sole proprietor). The "EI" qualifier is used when billing with the Federal Tax ID (as in the case of an organization).
Q: I don't know if my business is considered an organization or sole proprietor. How do I find out?
A: Suppliers may need to consult their accountant or attorney to make this determination.
Q: What is the difference between a sole proprietor and sole proprietorship?
A: There is no difference between a sole proprietorship and a sole proprietor. The sole proprietor is the sole (or only) owner of a business that is not incorporated. The unincorporated business is a sole proprietorship. In a sole proprietorship, the sole proprietor owns all of the assets of the business and is solely liable for all of the debts of the business. In terms of NPI assignment, a sole proprietor would be an Entity type 1 (Individual) and is eligible for only one NPI (that is, the sole proprietorship business is not eligible for its own NPI because it, and the sole proprietor, are considered a single legal entity).
Q: Information does not seem to match on the NPI crosswalk. What should I do?
A: Compare the information you submitted to NPPES with the information you provided to the NSC. If the information does not match, you may need to update your enrollment information with Medicare or your NPPES record. It may take several weeks for Medicare to process updates to enrollment records.
Q: Why isn't the 9-digit legacy identify displayed on the NPI Registry?
A: For security reasons, the NPI Registry does not display any 9-digit legacy numbers since they may also be Social Security numbers. Suppliers should review the NPI Notification they received when assigned their NPI. If an update was submitted to the NPPES, the 9-digit legacy identifier will appear on the NPI notification letter. If you are unable to locate the NPI Notification, please contact the NPI Enumerator at 1.800.465.3203 to request a copy of the most recent NPI notification.
Q: What is Medicare's policy as it pertains to NPI?
A: Effective March 1, 2008, all 837p transactions and CMS-1500 claims forms must have an NPI or NPI/Legacy pair in the required primary provider fields. Without this information, claims will reject. Effective May 23, 2008, CMS will lift its NPI contingency plan. Only the NPI will be accepted and sent on all HIPAA electronic transactions (837I, 837P, NCPDP, 276/277, 270/271 and 835), paper claims, and SPR remittance advices. All secondary provider fields on the 837P and 837I (e.g., Referring Physician field 17b) will require and accept the NPI only. The reporting of any primary or secondary legacy identifiers will result in the rejection of the transaction. CMS will also stop sending legacy identifiers on COB crossover claims at this time. If the claim contains a legacy identifier in any field, it will be rejected
Q: Where do I find a complete list of EDI rejection codes related to NPI?
A: The NPI-related reject codes span 20175 through 20347. The list is available at: http: //www.palmettogba.com/palmetto/jcedi.nsf/files/JCEDI%20Front-End%20Edit%20Error%20Manual.pdf/$File/JCEDI%20Front-End%20Edit%20Error%20Manual.pdf
Q: How long does it take for the NPI crosswalk to receive updated information in NPPES?
A: The NPPES information is updated daily by CMS however, it may take several days for the information to be available to contractors.
Q: Why are suppliers being asked to submit NPI number now when requirements for NPI on claims will change again in May 2008?
A: March 1 is an interim date which requires suppliers the use of an NPI and still allows use of the legacy identifier as well. This helps ensure the NPI/legacy pair can be matched on the Medicare NPI crosswalk. For additional information, please review the Medicare Matters article located at: http: //www.cms.hhs.gov/MLNMattersArticles/downloads/SE0802.pdf
