BILLING NEWS

NPI

Effective January 03, 2006, Medicare will begin accepting the NPI on the 837 and 276 4010A1 transactions with certain restrictions. With the scheduled implementation of the National Provider Identifier (NPI) in 2007, CMS has begun the process of making the necessary system changes to accommodate the NPI.

Providers should ensure the following when submitting EDI transactions to Medicare:

  • If NM108 has a qualifier of XX, there must be a corresponding 10 digit numeric number in NM109 as well as an REF01 submitted in the same loop with a 1C (Medicare Provider Number) or 1G (Provider UPIN Number) qualifier.
  • If qualifier XX is submitted in NM108 of the 2010AA or 2010AB loop, there must be a REF01 submitted in the same loop with an EI (EIN) or SY (SSN) qualifier.
  • In 276 transactions, a qualifier XX or FI should only occur once.

INDUSTRY NEWS TAGS: CMS


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