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MIR-2006-12AB, December 2006
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services) |
Reporting the National Provider Identifier (NPI) on Physician Claims for Clinical Diagnostic Services Purchased Outside of the Local Carrier’s Jurisdiction
Provider Types Affected
Physicians billing Medicare carriers or Part A/B Medicare Administrative Contractors (A/B MACs) for diagnostic services purchased outside the local carrier or A/B MAC’s jurisdiction
Background
This article relates to Change Request (CR) 5289, in which the Centers for Medicare & Medicaid Services (CMS) provides specific instructions for physicians to modify their current reporting guidelines and requires physicians to begin reporting, as of May 23, 2007, a National Provider Identifier (NPI) on claims for clinical diagnostic services purchased outside of the local carrier’s jurisdiction. Previously CMS instructed physicians to report their provider identification number (PIN) on claims when billing for clinical diagnostic services purchased outside of the local carrier’s jurisdiction. (See Change Request 3630, Transmittal 415, issued on December 23, 2004 at: http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM3630.pdf  on the CMS Web site.)
As of May 23, 2007, physicians must begin using their NPI to bill the local carrier for a clinical diagnostic service purchased outside of the jurisdiction of the local carrier or A/B MAC. As of May 23, 2007, remember the following:
- When reporting the 2400 PS1 segment (Purchased Service Information) of the ANSI X12 837 electronic claim format, version 4010A, the billing physician must report their NPI.
- When submitting paper claims, physicians must report their NPI for both the purchased portion of the test and the portion of the test that they performed.
- Physicians may no longer report a PIN after May 22, 2007.
Prior to May 23, 2007, physicians may report the PIN, the NPI, or both PIN and the NPI.
Additional Information
For complete details, please see the official instruction issued to your Medicare carrier or A/B MAC, regarding this change. That instruction may be viewed by going to http://www.cms.hhs.gov/Transmittals/downloads/R243OTN.pdf on the CMS Web site.
To learn more about the NPI and how to apply for one, visit http://www.cms.hhs.gov/NationalProvIdentStand/  on the CMS Web site.
If you have questions, please contact your Medicare carrier or A/B MAC at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip  on the CMS Web site.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
MLN Matters Number: MM5289
Pub. 100-20, Transmittal# R243OTN, CR# 5289
Related CR Release Date: October 27, 2006
Effective Date: April 1, 2007
Implementation Date: April 2, 2007
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