NPPES Errors, Using the NPI on Medicare Claims

Important Information for Providers/Suppliers Regarding National Plan and Provider Enumeration System (NPPES) Errors, Using the NPI on Medicare Claims and 835 Remittance Advice Changes

The following are some of the more frequent errors providers have been making when applying for NPIs:

• Errors in Employer Identification Number (EIN): As a reminder, providers that are organizations are required to report the EIN when they apply for an NPI. When the EIN error is on the Medicare provider enrollment record, the provider should submit a CMS-855 to the Medicare contractor to correct it.
• Invalid or incomplete data within the “Other Provider Identifiers” section of the NPPES online application, such as:
• The absence of the Medicare legacy number,
• Not having the “Type” listed as Medicare for a Medicare provider number, and/or
• Reporting Medicare provider numbers that do not belong to the provider applying for the NPI and, therefore, should not be linked to the assigned NPI.
• Reporting an Incomplete Identifier: When reporting the Medicare legacy identifiers to NPPES, report the full identifier. This means that suffixes to the OSCAR/Certification Numbers are to be reported.
• Having More than the Allowable Number of Legacy Numbers: At the present time, the NPPES can capture a grand total of 20 Ã’Other Provider Identification Numbers. NPPES will be expanded to capture more than 20 Other Provider Identification Numbers at a future date.
• Listing Legacy Numbers that Do Not Belong to the Applicant: The provider/supplier should make sure that any Medicare legacy identifier(s) entered in that field in NPPES are those that will need to be linked directly to the NPI to be assigned.

Dos and Don’ts When Reporting ‘Other Provider Identification Numbers’ in NPPES

• For a Medicare physician or other practitioner applying for an NPI: DO include your UPIN and your PIN when applying for an NPI. DO NOT include the PIN of your group practice or clinic if you are affiliated with a group practice or clinic.
• For a Medicare group practice or clinic applying for an NPI: DO include your PIN. DO NOT include the PINs or UPINs of any of the members of the group practice or clinic.

If Medicare providers/suppliers determine that they should make changes to their NPPES records, they may do so by going to NPPES at https://nppes.cms.hhs.gov/ at any time and updating their information.