Medicare Mandates NPI by January 1, 2008
As expected, Medicare has announced that it will mandate NPIs to appear on claims long before the end of the May 23 contingency period. The January 1 deadline is short of a full compliance mandate: Essentially it says you must send an NPI, but may continue to include the legacy ID for primary providers (billing and pay-to); they will continue to allow NPI, NPI+legacy, or legacy only for secondary providers (referring, ordering, etc.). The guidance applies specifically to institutional claims.
They are not explicit in whether the guidance applies to the "rendering or performing provider," which they previously included in the definition of "Primary Provider" with respect to NPI (see MLM Matters article MM4023) . We've requested clarification and will update you if and when we receive it.
The NPPES site is up and running again!
Posted by: Eve West | October 03, 2007 at 08:59 AM
Martin,
Is this announcement available anywhere on-line? I'd like to review the details.
Thanks.
Posted by: Andy | October 03, 2007 at 09:17 AM
I could not find the information in a FAQ. I will forward the email to you.
Posted by: Marty | October 05, 2007 at 11:44 AM
Yes. And, more significantly, so is the NPI Registry (see link in right column). I checked it out. No new features, same bad data. Oh and well.
Posted by: Marty | October 05, 2007 at 12:24 PM
Just received notice from CMS that they do not consider any of the individual provider loops in the 837 Institutional claim to be a "rendering or performing provider." The implication is that by "rendering provider" they are referring to the explicit loops labelled as such (i.e. in the 837 Professional). See my update on 10/16/2007.
Posted by: Marty | October 16, 2007 at 06:12 PM