NPPES and NPI Registry cross walk to Medicare rejections

NPPES stands for National Plan and Provider Enumeration System. NPI Registry is a online website to identify referring provider NPPES information including NPI number. All information found on the NPI registry website is provided in accordance with the NPPES Data Dissemination Notice.

As of March 1st 2008 all CMS 1500 claims received must hand an NPI or NPI/Legacy pair in the required primary provider fields. If these are not setup correctly the claims will be rejected by Medicare.

If your claim is rejected these are some simple rules to follow to identify how to fix those rejections:
1. Check your record in the National Plan and Provider Enumeration System (NPPES)
2. Verify the Legacy number you are submitting on claims is also reported through the NPPES system.
3. Verify that the legal business name is correct
4. Verify the correct ENTITY type was selected at the time of NPI Application.

• Entity Type 1 is for individuals
• Entity Type 2 is for Organizations

If you have verfiied everything above is correctly entered on your eClaims and paper claims and you are still getting claim rejections please call your Medicare Customer Service department with the following information:

1. Legal Business Name of orginazation
2. Contractor Tracking Number (if known)
3. Approximate date when the CMS-855 enrollment application was submitted or last updated
4. Provider/Supplier Tax ID # (EIN or SSN)
5. NPI
6. Medicare Legacy Identifier or PTAN
7. Practice Location on Claim
8. Your contact information

NPI registry site to verify your providers NPI information: https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do

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