What steps should I take now? Do I need to validate my NPI information?
Prepare Systems and Send Test Claims
In addition to obtaining the NPI, physicians must make sure that their practice management systems are able to incorporate the NPI number on both their electronic claims and paper claims. It will also be necessary to find out if their clearinghouse for electronic claims can receive and transmit the NPI and when private insurance payers will begin accepting the NPI. Some payers will require the submission of test files prior to NPI conversion.
Validate NPI Information
To avoid having claims rejected it is important to verify all information . The National Plan and Provider Enumeration System (NPPES) information can be verified online at: https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart.
For Medicare claims, it is important to begin sending claims with the NPI number as soon as possible and verify with the Medicare Carrier for the area that the physician and group NPIs were received on the claims and that the information in the NPI record matchs that of the Carrier's records (informational messages will be included on the Medicare Explanation of Benefits if the information does not match). More information on the Medicare NPI / Legacy crosswalk and the associated informational messages can be found in the MedLearn Matters article SE0725 (10-page PDF file; About PDFs).
For Medicare claims, it is important to begin sending claims with the NPI number as soon as possible and verify with the Medicare Carrier for the area that the physician and group NPIs were received on the claims and that the information in the NPI record matchs that of the Carrier's records (informational messages will be included on the Medicare Explanation of Benefits if the information does not match). More information on the Medicare NPI / Legacy crosswalk and the associated informational messages can be found in the MedLearn Matters article SE0725 (10-page PDF file; About PDFs).
