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NPI Deadline Approaches
February 13, 2008

Medicare
Before March 1, claims with both a National Provider Identifier (NPI) and a Medicare legacy number are rejected if the pair is not found on the Medicare NPI Crosswalk. Claims submitted with just a Medicare legacy number are paid. As of March 1, claims with both an NPI and a Medicare legacy number will continue to be rejected if the pair is not found on the Medicare NPI Crosswalk and claims without an NPI in the primary provider field (i.e. the billing, pay-to, and rendering fields) will be rejected. Medicare providers will not be paid for any Medicare services provided until the NPI is used. Providers must correct any data that may prevent an NPI/legacy match on the NPI crosswalk. All Medicare providers should have, or be well into the process of obtaining, an NPI so that claims payment will not be interrupted. More information about the NPI is available on the Centers for Medicare and Medicaid Services (CMS) web site (www.cms.hhs.gov/NationalProvIdentStand).

Medical Assistance
Recent statistics indicate that more providers are registering NPIs with the Medical Assistance (MA) Program. However, more work is needed. For Provider Type 11, Mental Health/Substance Abuse, as of February 8 the total active service location registration stood at 1,265 of 3,031; a 41.6 percent response. During the period December 13, 2007 – February 8, 2008, 1,528 service locations were closed. The Department of Public Welfare (DPW) provides the following guidance for providers:

Once NPI is implemented at DPW, the combination of NPI, taxonomy and 9-digit service location zip code will be used to identify the correct 13-digit PROMISe Provider ID for claims processing in PROMISe. Providers cannot register a single NPI in PROMISe to many service locations that have the same taxonomy and 9-digit service location zip code. If there is a business need to enroll multiple service locations in PROMISe that have the same address, providers may have to secure additional NPI numbers from CMS.

DPW Remittance Advice Notices issued in February will announce the availability of training – NPI Provider Awareness for Electronic Billers – on March 4, April 2, and May 6 at 1:00 p.m. A PowerPoint presentation will be available for use during the call. Providers and electronic billing vendors are encouraged to participate in the training. Register through the DPW Provider Education and Training web page at www.dpw.state.pa.us/omap/promise/provconfcalltrng_process.asp.

More information about NPI is available on the DPW web site at www.dpw.state.pa.us/PartnersProviders/MedicalAssistance/DoingBusiness/NPIinfo.

Please contact Betty Simmonds with questions.

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