National Government Services, Inc. Medicare Monthly Review Part A and B
A Combined Part A and Part B Newsletter

MLN Matters Number: MM5678
Related Change Request (CR) #: 5678
Related CR Release Date: August 31, 2007
Effective Date: October 1, 2007
Related CR Transmittal #: R1328CP
Implementation Date: October 1, 2007

Provider Types Affected
Physicians, providers, and suppliers submitting claims to Medicare contractors (carriers, DME Medicare Administrative Contractors (DME MAC), and Part A/B Medicare Administrative Contractors (A/B MAC)) for services provided to Medicare beneficiaries  

Provider Action Needed
This article is informational in nature and is based on Change Request (CR) 5678 which updates Chapter 80 of the Medicare Claims Processing Manual to delete references to the May 23, 2007 mandatory date for entry of the National Provider Identifier (NPI) on claims. The effective date for providers to use only the NPI on Medicare claims will be officially announced at a later date, as previously communicated to providers in the MLN Matters article corresponding to CR5595. That article is available at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5595.pdf on the CMS Web site.

Background
The National Provider Identifier (NPI) final rule, published in the Federal Register on January 23, 2004 ( http://www.access.gpo.gov/su_docs/fedreg/a040123c.html ; Health and Human Services Department Rules), established the standard for a unique identifier for each health care provider for use in health care transactions. Medicare contractors were to be required to enter NPI in certain items and fields of paper claim forms and electronic equivalents on or after May 23, 2007.

However, on April 2, 2007, the Department of Health and Human Services (DHHS) provided guidance regarding contingency planning for the implementation of the NPI. For some time after May 23, 2007, Medicare Fee-for-Service (FFS) will allow continued use of legacy numbers (Unique Physician Identification Numbers (UPIN) and Provider Identification Numbers (PIN)), as well as accepting transactions with only NPIs. The effective date for providers to use only the NPI only on claims and to cease entering UPINs and PINs will be officially announced at a later date, as previously communicated to providers in the MLN Matters article corresponding to CR5595. That article is available at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5595.pdf on the CMS Web site. This article reflects CR5678, which simply amends Chapter 80 of the Medicare Claims Processing Manual to reflect that the use of the NPI will be mandated for Medicare FFS claims at a future date.

Additional Information
The official instruction, CR5678, issued to your carrier, A/B MAC, or DME MAC regarding this change may be viewed at http://www.cms.hhs.gov/Transmittals/downloads/R1328CP.pdf on the CMS Web site.

If you have any questions, please contact your Medicare carrier, DMERCs, A/B MAC, or DME MAC at their toll-free number, which may be found on the CMS Web site at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip on the CMS Web site.

News Flash – New Medicare Learning Network (MLN) Catalog Available!
The August 2007 edition of the MLN Products Catalog is now available - the MLN Products Catalog is an interactive downloadable document that lists all Medicare Learning Network products by media format. The catalog has been revised to provide new customer-friendly links that are embedded within the document. All product titles and the word “download” when selected, will link you to the online version of the product. The word “hard copy” when selected, will automatically link you to the MLN Product Ordering page. To access the catalog, visit http://www.cms.hhs.gov/MLNGENINFO on the CMS Web site.