Reporting the Service Location National Provider Identifier (NPI) on Anti-Markup and Reference Laboratory Claims

Due to a change in the ability of Medicare Administrative Contractor’s (MAC’s) to view other MAC’s enrollment information, resulted in a change to the claims submittal requirement for lab testing referred to another laboratory. Change Request 8806 provides guidance for physicians and suppliers billing anti-markup and reference laboratory claims. Effective January 1, 2015, physicians and suppliers will no longer be permitted to submit their own NPI when the performing physician or supplier is located in another jurisdiction. The changes that will be implemented in PECOS will allow contractors the ability to verify all physician and supplier NPIs, regardless of the jurisdiction in which they are enrolled. Prior to the implementation of the Provider Enrollment Chain of Ownership System (PECOS), contractors used enrollment systems that were specific to each Medicare contractor and did not allow Medicare contractors from one State to view provider enrollment information from another State. This systems limitation prevented contractors from being able to share information about existing providers/suppliers, and increased the potential for fraud.