New Fiscal Intermediary Shared System (FISS) Consistency Edit to Validate Attending Physician National Provider Identifier (NPI)

Institutional providers are required to indicate the Attending Provider Name and Identifiers for the patient’s medical care and treatment reported on institutional claims for any services other than non-scheduled transportation claims. Additionally, institutional providers are required on outpatient claims to send the Referring Provider NPI and name when the Referring Provider for the services is different than the Attending Provider. Effective for claims received on or after January 1, 2013, FISS shall install a consistency edit for institutional claims to ensure that the institutional provider has not used their billing NPI in the Attending Provider NPI Data Element.