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CMS: Identifying Secondary Providers in Medicare Claims

05/15/2008

In accordance with the NPI final rule, when an identifier is reported on a paper or electronically submitted claim for ordering/referring/attending/operating/supervising/purchased service/other/service facility provider (in the x12N 837 claims transactions) or for prescriber (in the NCPDP 5.1 retail drug claim transaction), that identifier must be an NPI. For Medicare purposes, this requirement is effective May 23, 2008. If the entity to be identified as the ordering/referring/attending/operating/supervising/purchased service/other/service facility provider or prescriber does not furnish an NPI at the time of the order/referral/purchase or time of service, the billing provider must attempt to obtain that NPI in order to use it in the claim. The billing provider may use the NPI Registry or may need to contact the ordering/referring/ attending/operating/supervising/purchased service/other/service facility or presciber in order to obtain the NPI. While the Implementation guides for the X12N claims transactions permit the reporting of the Social Security Number (SSN) for some secondary providers if there is no NPI, we do not believe the billing provider will be successful in the obtaining the SSN.
CMS also is hosting a conference call on May 19, from 2-3 p.m. EDT, titled CMS NPI Roundtable: Medicare Implementation Q&A Session. To register for the call, click here. The call in data for the replay is (800) 642-1687 and the passcode is 46175614.
Source: Centers for Medicare and Medicaid Services (CMS)

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