Correction to the Multi-Carrier System (MCS) Editing on the Service Location National Provider Identifier (NPI) Reported for Anti-Markup and Reference Laboratory Claims

CR 8806 implemented a new policy that physicians and other suppliers would no longer be permitted to submit their own National Provider Identifier (NPI) in Item 32a of the CMS-1500 claim form for anti-markup and reference laboratory claims when the performing physician or supplier is located in another jurisdiction. CR 8806 instructed MACs to return reference laboratory and anti-markup claims as unprocessable when the billing and service location NPIs match. The MCS created edit 043H to satisfy this requirement. It has come to the attention of CMS that edit 043H is erroneously comparing the rendering physician NPI in Item 24J of the CMS-1500 to the service location NPI, rather than comparing the billing NPI to the service location NPI. A new CR9150 instructs the MCS to correct edit 043H to compare the billing NPI to the service location NPI and delays implementation of this requirement until October 1, 2015.