When must I report the NPI?

March 1, 2008 was the deadline on which the Centers for Medicare and Medicaid Services (CMS) required that all Medicare FFS 837P and CMS-1500 claims include the NPI number in the billing, pay-to, and rendering provider fields. You may continue to submit both the NPI and legacy numbers in these fields until May 23, 2008, or submit only the NPI. You may not submit only the legacy number in these fields. If the NPI number is not reported in these fields, the claim will be rejected or returned as unprocessable. Other fields on the claim form may contain the legacy number only.

On May 23, 2008, the contingency period for the NPI will end. All claims must be submitted with the NPI only. Inclusion of legacy numbers will result in rejection of the claim.

If you are submitting claims with both the legacy and NPI numbers to Medicare at this time and getting paid, it is important to try sending a small selection of claims with the NPI only. This will give you the opportunity to resolve any issues causing claim rejections prior to the May 23rd deadline for submission of NPI only. If the test batch processes successfully, you can then increase the number of claims submitted with NPI only until you are confident in sending all claims in this manner.

If you receive rejections of Medicare claims submitted with the NPI and legacy number pairs, this may indicate a discrepancy in either your NPI registration information or in the Medicare Contractor provider records. To resolve this, CMS recommends that you first verify the accuracy of your information in the National Plan and Provider Enumeration System (NPPES) web site. Check that your Medicare legacy number is correctly entered in the appropriate Medicare sections of the "Other Provider Identification Numbers" field. Physicians who practice in multiple locations may have been assigned multiple legacy numbers. Likewise, groups or incorporated physician practices may have legacy numbers for multiple locations.

Once it is determined that the NPPES information is accurate and in the correct fields, CMS recommends printing this information and then phoning the Medicare Contractor for your area to confirm that the information is the same in the Medicare NPI Crosswalk. If the contractor confirms that a physician or provider is not in the crosswalk, ask them to validate the information in their provider files. If there are discrepancies in the provider file information, it may be necessary to correct the information by submitting enrollment forms to the contractor. The contractor should be able to assist you in locating the correct form and advise you on the required fields to update your provider file information.