Alert: Medicare Starting to Reject Claims with NPI Discrepancies

American Academy of Sleep Medicine (AASM) members should be aware that Medicare must be able to match a physician’s appropriate PIN to his or her correct National Provider Identifier (NPI) or risk the possibility of a claim rejection if a match can’t be made.

Prior to September 4, most Medicare carriers permitted claims to process through their computer systems even if an appropriate match between the physician’s NPI number and their old legacy billing number(s) couldn’t be made. However, effective September 4, Medicare has activated the edits that previously allowed these claims to process.The AASM and American Medical Association strongly encourage all members to immediately check with their billing office to determine what, if any, error reason codes have been returned over the summer and rectify these discrepancies. Members who use a clearinghouse should check to ensure that the NPI or these reason codes are not being stripped off of their claims.

NOTE: Medicare must be able to match single, incorporated physicians – those who have an LLC or other incorporated business arrangement. These physicians must have two NPIs – one for themselves and one for their corporation. In some cases Medicare may have originally assigned these physicians one PIN rather than the two that are now needed to match a physician to his or her correct NPI number. In these cases, re-enrollment in Medicare is required. In addition, physicians in large group practices who may have multiple Medicare PINs could also experience claims interruptions if there are matching problems.

2007-09-14T00:00:00+00:00 September 14th, 2007|Professional Development|