Remittance Advice Remark Codes crosswalk

If your office is receiving Medicare electronic explanations of benefits (EOB's) you may need to identify the meanings to specific Remittance Advice Remark Codes.

Copy the website and paste it in your toolbar on a new webpage: wpc-edi.com/codes/remittanceadvice
1. Down arrow and select Currently Valid Codes
2. Review the codes you are in need of a few samples are:

M1 - X-ray not taken within the past 12 months or near enough to the start of treatment.
M2 - Not paid separately when the patient is an inpatient.
M3 - Equipment is the same or similar to equipment already being used.
M4 - Alert: This is the last monthly installment payment for this durable medical equipment.Note: (Modified 4/1/07)
M5 - Monthly rental payments can continue until the earlier of the 15th month from the first rental month, or the month when the equipment is no longer needed.
M6 - Alert: You must furnish and service this item for as long as the patient continues to need it. We can pay for maintenance and/or servicing for every 6 month period after the end of the 15th paid rental month or the end of the warranty period.Note: (Modified 4/1/07)

These codes were valid as of last update on 8/1/07. Each quarter these codes are revised so please validate the most current valid codes through the above website.

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How to validate Referring Provider National Provider Indicator (NPI#)

The National Plan & Provider Enumeration System has recently released a website for medical practices to use to verify provider's NPI#. This website is extremely easy to use and will help medical offices identify providers NPI#'s without having to call the doctor directly.

1. Pull up this website: https://nppes.cms.hhs.gov/NPPES/NPIRegistrySearch.do?subAction=reset&searchType=ind
2. Enter in the providers or referring providers NPI#
*You can choose to enter in the following information
3. Provider First Name
4. Provider Last Name
5. Practice Address City
6. Practice Address State
7. Practice Address Zip Code

Click Search and you will receive the following information:
Organization Information
Authorized Official Information (office contact information)
NPI Information:
Provider Business Mailing Address including phone and fax #
Provider Business Practice Location Address including phone and fax #
Organization Taxonomy: What taxonomy #'s to use when billing claims
Other Provider Identifier: Unique ID#'s for Medicare, BCBS and possibly other state carriers

Click Back to results to begin search again.

*If NPI# is not known complete steps 3-7 and click search results.


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How to Validate your medical providers NPI numbers

Copy the following link and add it to the above Google Search to pull up this website in a new window: barrydebruin.com/php.npi/ to validate your medical providers National Provider Identifier (NPI) number. This is also helpful to validate Referring Provider NPI#'s.

If for any reason you do not have access to the internet and you need to validate the NPI# manually you can follow the following steps:

NPI #'s are generated using the Luhn formula so that the final digit can be derived by performing mathematical operations on the first 9.

NPI Check Digit Calculation:
The NPI # format consists of ten digits (9 numerics followed by 1 numeric check digit). The National Provider Identifier check digit is calculated using the Luhn formula. Example of Check Digit Calculation for NPI: Assume the 9-position identifier part of the NPI# is 123456789. Using the Luhn formula on the identifier portion, the check digit is calculated as shown below. NPI # without the check digit: 1 2 3 4 5 6 7 8 9
Step 1:
Double the value of alternate digits, beginning with the rightmost digit. Therefore, you would start with the first digit and double every other number.2 6 10 14 18
Step 2:
Add 24, plus the individual digits of products of doubling (shown in blue from step 1), plus unaffected digits from the original NPI.
24 + 2 + 2 + 6 + 4 + 1 + 0 + 6 + 1 + 4 + 8 + 1 + 8 = 67
Step 3:
Subtract the final product (from step 2) from the next higher number ending in zero.
70 – 67 = 3Check digit = 3NPI with check digit = 1234567893

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