• Errors in Employer Identification Number (EIN): Providers that are organizations are required to report the EIN when they apply for an NPI. That EIN may also be the Taxpayer Identification Number (TIN). With the revised NPI Application/Update Form (CMS-10114) (effective July 10, 2007), organizations that are subparts will be required to report the legal business name (LBN) of their “parent” and the “parent’s” TIN. The applicant will continue to be required to report its EIN. If the EIN error is on the Medicare provider enrollment record, the provider should submit a CMS-855 to the Medicare contractor to correct it.
• Invalid or incomplete data within the ‘Other Provider Identifiers’ section of the National Plan and Provider Enumeration System (NPPES) online application, such as:
• The absence of the Medicare legacy number;
• Not having the ‘Type’ listed as Medicare for a Medicare provider number; and/or
• Reporting Medicare provider numbers that do not belong to the provider applying for the NPI and, therefore, should not be linked to the assigned NPI.
• Reporting an Incomplete Identifier: Medicare providers/suppliers need to ensure that, if reporting their Medicare legacy identifiers to NPPES, they report the full identifier. This means that suffixes to the OSCAR/Certification Numbers are to be reported. If the full identifier is not reported, it will be impossible for Medicare to establish the linkage from the NPI to that particular Medicare legacy identifier when using NPPES data and the NPI crosswalk.
• Having more than the Allowable Number of Legacy Numbers: At the present time, the NPPES can capture a grand total of 20 “Other Provider Identification Numbers.” While this adequately accommodates the majority of providers/suppliers, it does not accommodate all of them. NPPES will be expanded to capture more than 20 “Other Provider Identification Numbers” at a future date. Medicare providers/suppliers who have more than 20 Medicare legacy identifiers that need to be linked directly to the NPI to be assigned should contact their Medicare fee-for-service contractors to determine how best to inform those contractors of all of the Medicare legacy identifiers.
• Listing Legacy Numbers that Do Not Belong to the Applicant: The provider/supplier should make sure that any Medicare legacy  identifier (s) (OSCAR/Certification Number, Provider Identification Number (PIN), Unique Physician Identification Number (UPIN), and National Supplier Clearinghouse (NSC) Number) entered in that field in NPPES are those that will need to be linked directly to the NPI to be assigned. That is, do not list in the “Other Provider Identification Numbers” section identifiers that belong to providers other than the one that is applying for the NPI.

1. Incorrect usage of rendering and group NPI. If you are a group, use your group NPI at the billing or pay-to-provider level. Rendering providers must always submit their individual NPI at the claim level or each detail line level.
2. Rendering providers are not indicating the correct individual rendering provider number when applying for their NPI. This causes the crosswalk data to be incorrect. When the provider is associated with a group/clinic, they did not register their 9 digit rendering provider number with NPPES.  The provider will need to update NPPES with this information.
3. Providers can go to the following site www.nppes.cms.hhs.gov  to verify how they enumerated and with what number. Providers can also correct and update information so that correct information may be received on the Medicare crosswalk.
4. Providers are sending claims with the incorrect legacy number for group or individual. Providers should verify what numbers they have loaded within their practice management systems.
5. Crosswalk issues are causing claims to reject. This can be due to many reasons provider name or entity name on NPPES is different than Medicare Provider Enrollment system. This will cause a provider’s name not to match on the crosswalk thus causing a claim to reject. Zip code, address, EIN or SSN, taxonomy codes, UPIN, or the Medicare legacy numbers on NPPES do not match the Medicare Provider Enrollment system, will cause claims to reject.

1. Providers must verify that they are sending the correct NPI. If you are a group you must send your group NPI for the pay-to provider number.
2. Make sure the rendering NPI is used in the 2310B, 2420A or Box 24j on the CMS 1500 claim form.
3. It is imperative that providers review their Medicare H99 accepted and rejected reports daily. This is the best way to verify what is going on with your claims. This report is generated each night for that day’s claim submission. If you are not getting this report you will not know if your claims are rejecting. The report is put into the submitter’s mailbox each morning by 9:00AM on most days. If you use a billing agent or clearinghouse your report is sent to them. Contact them to receive this information.
4. Once you have reviewed the Medicare H99, determine if you have claims rejecting due to one of the edit numbers listed in this document. Follow the guide lines next to the edit for a resolution. If you need additional help reading the Medicare H99 report, download the Report User Guide.
5. If your claims are rejecting due to crosswalk issues, verify the data on your most current 855 Provider Enrollment form compared to what you entered into NPPES. If data is different you can elect to complete an updated 855 or correct the data in NPPES.
6. If a provider has not enrolled for EDI claims and will be doing so after 10/1/2007 they must put their pay-to NPI on the enrollment documents before they can be processed.
7. For more details to assist you with NPI issues please refer to the following links.
    
   • If you do not have an NPI, organizations and individual providers can obtain an NPI at www.nppes.cms.hhs.gov. 
      
   • National Provider Identifier (NPI) - Tip Sheet - this document contains additional NPI information and tips.
      
   • As Medicare implements the NPI number into its systems, several enumeration and billing errors have been identified that may result in claim rejections. Please view the following document for detailed information. National Provider Identifier (NPI) Informational Alert
      
   • CMS has a Web page dedicated to providing the latest NPI news for providers at www.cms.hhs.gov/NationalProvIdentStand/.

These Edits are presently set to reject claims if the NPI/Legacy combinations are incorrect or not found on the Medicare crosswalk file. 
For reference purposes only, the chart below also has the corresponding box from the new paper claim form CMS-1500 version (08/05) that the primary providers’ Medicare PIN would have been submitted in.  Effective May 23, 2007 and later, the Medicare PIN would not be submitted in the shaded portions of boxes 33b and 24j.

Medicare Part B implemented 4 new informational pre-pass edits effective October 15, 2007.  The 4 new edits are M389, M390, M391 and M392.  The edits will appear on your Batch Detail Control Listing report (H99RAR04) as informational if your claims are submitted electronically without the primary providers’ NPI.  Primary providers are billing providers, pay-to providers and rendering providers. 

The chart below shows the specific loop and data element in the ANSI 4010A1 electronic format that the edits are validating along with the logic used to determine if the primary providers’ NPI was submitted.  For reference purposes only, the chart below also has the corresponding box from the new paper claim form CMS-1500 version (08/05) that the primary providers’ NPI must be submitted in.   The new CMS-1500 version (08/05) paper claim form does not have a corresponding box to indicate the XX qualifier.  The new edits are only used for electronic claims.  They are not used on paper claim forms. 

For a Medicare physician or other practitioner applying for an NPI:

• DO include your UPIN (if one was assigned) and your PIN when applying for an NPI.
• DO NOT include the PIN of your group practice or clinic if you are affiliated with a group practice or clinic.

For a Medicare group practice or clinic applying for an NPI:

• DO include your PIN
• DO NOT include the PIN’s or UPINs of any of the members of the group practice or clinic.

837 Institutional version 4010A1 Implementation Guide (IG)
837 Professional version 4010A1 Implementation Guide (IG)
835 version 4010A1 Implementation Guide (IG)

If you do not have an NPI, organizations and individual providers can obtain an NPI at www.nppes.cms.hhs.gov. 

National Provider Identifier (NPI) - Tip Sheet - this document contains additional NPI information and tips.

As Medicare implements the NPI number into its systems, several enumeration and billing errors have been identified that may result in claim rejections. Please view the following document for detailed information. National Provider Identifier (NPI) Informational Alert

CMS has a Web page dedicated to providing the latest NPI news for providers at www.cms.hhs.gov/NationalProvIdentStand/.