NPI # Only Causes Claim Denials By Medicare

On May 23, 2008 insurance carriers were suppose to accept NPI only on all paper & electronic claims. Not only were you required to include the NPI number, but you were required to EXCLUDE the legacy numbers. Some insurance carriers were not ready for the deadline and applied for an extension (like NYS Medicaid). But Medicare was ready and if you include your PTAN (legacy) number on your claims they are being rejected.

For the insurance carriers who were ready for this deadline, you must make sure you do not have the legacy number in the shaded area of box 24J or box 32A & 33A. If your software is set up to automatically print the legacy number in this box you need to remove it. If you submit claims electronically, make sure your vendor has it set up to exclude the legacy number.

For the insurance carriers who were not ready and applied for an extension, you will need to continue including the legacy number until they have complied. This makes things a little messy. You need to make sure you are submitting the claims that require the legacy number with it, and the ones that don’t allow it, without. Crazy, but it’s what we billing people have to do to make sure the money keeps coming in.

Another little crazy thing to worry about is the NPI number entered in 24J. If you are set up with Medicare as an individual provider (not a group) and you only have a type I NPI, you must leave the NPI part of box 24J blank. You cannot include the individual NPI number here. If you are an individual provider and you put your NPI number in 24J, Medicare may reject your claims.

If you are a group with Medicare then you need to continue putting the rendering provider’s individual NPI in box 24J and the group NPI (type II) in box 33A. If you are not sure if you are an individual or a group you can tell by your PTAN number. If you only have one PTAN number then you are an individual. If you have a PTAN for the individual provider and a separate PTAN for the practice name then you are a group. Just when you thought it couldn’t get much more confusing!

If you want to keep your cash flow steady it is important to make sure you are submitting the claims correctly. If you have any question as to what a particular insurance carrier requires, give them a call. Better to have it right the first time than to have to resubmit!