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MIR-2006-9AB, September 2006
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Correction of Business Requirement 4320.19 as Contained in CR4320 Regarding National Provider Identifier Information (CR5217)
Provider Types Affected
Physicians, providers, and suppliers who submit claims to Medicare contractors (carriers, including durable medical equipment regional carriers (DMERCs) and DME Medicare administrative contractors (DME MACs), fiscal intermediaries (FIs), and regional home health intermediaries (RHHIs))
Impact on Providers
This article is based on change request CR5217, which instructs your Medicare carrier/DMERC/DME MAC, or FI/RHHI to provide specific National Provider Identifiers (NPIs) for those providers identified in electronic claims, such as a billing, pay-to, rendering or other provider, that have already obtained NPIs. Prior to May 23, 2007, providers should report the Medicare legacy identifiers of those providers enrolled to submit claims to Medicare, as well as their NPI.
| Note: Pending Medicare implementation of the UB-04 and the revised CMS-1500, providers are not to report NPIs on the current paper claim forms. |
If not already available, the following information will be posted on your local Medicare contractor’s Web site, or included in provider newsletters from your local Medicare contractor:
- Adjustments to edits to be applied when an NPI is included in an electronic data interchange (EDI) transaction; and
- Actions that can be taken by claim and 276 submitters to avoid rejection of their transactions as result of these edits, and information about how to correct and resubmit a transaction if the transactions are rejected as result of these edits.
Additional Information
CR4320, “Stage 1, Use and Editing of National Provider Identifier Numbers Received in Electronic Data Interchange Transactions, via Direct Data Entry Screens, or on Paper Claim Forms” can be located at http://www.cms.hhs.gov/transmittals/downloads/R204OTN.pdf  on the CMS Web site.
MM4320, the similarly titled Medicare Learning Network (MLN) article associated with CR4320, is found at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM4320.pdf on the CMS Web site.
CR5217 is the official instruction issued to your Medicare carrier/DMERC/DME MAC/FI/RHHI regarding changes mentioned in this article. CR5217 may be found at http://www.cms.hhs.gov/Transmittals/downloads/R235OTN.pdf on the CMS Web site.
If you have questions, please contact your local Medicare carrier/DMERC/DME MAC/FI/RHHI 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: MM5217
Related Change Request (CR) #: 5217
Related CR Transmittal#: R235OTN
Related CR Release Date: August 18, 2006
Effective Date: January 1, 2006
Implementation Date: November 20, 2006
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