What is a group NPI vs. individual NPI?

Answer: The group NPI is the equivalent of your Group PIN number assigned to your Practice. The individual NPI is assigned to the individual Physician within the group. The group NPI is set-up at the company level within Centricity and the individual NPI is set-up at the Doctor level.

How do I know what payers accept NPI?

Answer: This information can be found at the website listed below: or you can contact the payer directly.

I thought the deadline was extended, why should I send my NPI now?

Answer: Although there was some mention of the date being extended, payers and clearinghouses are still accepting the NPI; it is important to submit your NPI as soon as possible to ensure the NPI is mapped correctly at the clearinghouse and for each payer. This will prevent possible claims processing delays when the old legacy number is no longer required when sending claims with NPI numbers.

Are all carriers setup the same?

Answer: The majority of payers are set-up the same; there are a few payers that require a slight set-up difference. Please contact HealthSystems support if you feel a payer is rejecting your claim because of NPI set-up within Centricity.

How do I locate the new CPIDs (payer i.d.) for the new CMS1500 form?

Answer: The CPID for the paper CMS1500 has changed, please visit Note: Commercial CPID = 4300

Can I still use UPIN for referring doctors instead of NPI?

Answer: You can continue to submit claims with the UPIN, but you need to contact the doctors and get referring UPIN numbers ASAP. Your claims will begin to reject for referring NPI. Please visit the website below for additional information regarding UPINs.

How will we know when to stop sending legacy (PIN) numbers?

Answer: The major payers will notify you when you are no longer allowed to send the legacy number, unfortunately the smaller payers may begin rejecting claims when they no longer want to see the legacy number. HealthSystems will provide setup instructions once the legacy number is no longer required. Note: Blue Cross Blue Shield of Georgia is no longer accepting claims with the legacy number on them, NPI only claims accepted.

Why does my CMS form print “signature on file” in Box 31?

Answer: The HIPAA guidelines allow for “signature on file” to be used in box 31; however, many payers are still requiring the doctor’s name to appear in that box. HealthSystems has developed a custom CMS1500 form that will print the doctor’s name in box 31. Please contact support if you are receiving rejections for this reason.

What is the deadline to stop sending the NPI and PIN number combination?

Answer: RelayHealth is again reminding everyone of the upcoming CMS Medicare Part B NPI requirement that will take effect on March 1, 2008.

March 1, 2008, you must send National Provider Identifiers (NPIs) in primary provider fields within your EDI claims or they will be rejected. The edits that are currently set to informational and that show on your electronic edit report (RAR04) are M389 – M392. If you were told to use your legacy identifier or Provider Transaction Access Number (PTAN, formerly the Provider Identification Number (PIN)), instead of your NPI, while resolving National Plan and Provider Enumeration System (NPPES) or enrollment issues at the Medicare office, working out those problems MUST be completed no later than March 1, 2008. Claims with only a PTAN will be rejected.

IN ADDITION, the NPI submitted must be matched to the proper legacy identifier on the NPI-PIN crosswalk or the NPI will be rejected. Those edits are M340, M341, M343, and M347 and apply to the primary provider fields (i.e., billing, pay-to provider, and rendering provider number at the claim and/or line level). Also, the tax ID associated with the NPI (SSN or EIN) must be on the crosswalk. These edits are M389 – M392.

If you are ONLY USING A PTAN you are hitting informational messages now. These edits will be set to delete March 1, 2008. Please take any action necessary to ensure that your NPI is being received and linked to the correct legacy identifier now, if you are still only sending your PTAN/PIN.

The Centers for Medicare & Medicaid Services (CMS) instruction regarding this mandate is as follows:
Effective March 1, 2008, your Medicare fee-for-service claims must include an NPI in the primary provider fields on the claim (i.e., the billing, pay-to provider, and rendering provider fields). You may continue to submit NPI/legacy pairs in these fields or submit only your NPI. The secondary provider fields (i.e., referring, ordering and supervising) may continue to include only your legacy number, if you choose. Failure to submit an NPI in the primary provider fields will result in your claim being rejected, beginning March 1, 2008.

In addition, if you already bill using the NPI/legacy pair in the primary provider fields and your claims are processing correctly, now is a good time to submit to your contractor a small number of claims containing only the NPI in the primary provider fields. This test will serve to assure your claims will successfully process when only the NPI is mandated on all claims.