Important Provider ID Submission/Receipt and IG Edit Information on Stage 2 NPI Implementation for Electronic Submitters On October 2, 2006, CMS will initiate Stage 2 (October 2, 2006 - May 22, 2007) of the National Provider Identifier (NPI) implementation. During Stage 2, providers will be able to submit either the NPI or the Legacy ID (OSCAR, UPIN), or both the NPI and the Legacy ID in the 837 Institutional Health Care Claim and the 276 Claim Status Inquiry. In addition, the 277 Claim Status Response and the 835 Electronic Remittance Advice will begin reporting the NPI based on what providers submit on the 276 and 837 transactions respectively. During Stage 2, an NPI that is submitted on the 837 claim will be verified for correct format and validated against the Part A Crosswalk File. We strongly encourage providers to continue to submit the legacy provider number along with the NPI. This will facilitate the introduction of the NPI to the claim submission process while helping to ensure that claims are not rejected for a lack of provider identification. Stage 2 Provider ID Submission for Billing and Pay-To Provider Loops 2010AA/AB
Stage 2 Provider ID Submission for Attending, Operating and Other Physician Loops 2310A/B/C
New 837 Institutional Health Care Claim Edits for Stage 2 There will be several new edits implemented for 837 claims that pertain to provider identifiers. These edits are described in the tables below. If any of the following three errors are encountered, all claims for that provider batch will be rejected on the Inbound Reject Report (FSSD0123RZRJ).
If the following error is encountered, only the specific claim with the error will be rejected on the Inbound Reject Report (FSSD0123RZRJ).
Stage 2 NPI New Biller Testing Before submitting claims with a new NPI, we encourage providers to initiate New Biller Testing with Empire to be sure that all provider identifiers are being submitted properly and with the appropriate qualifiers. In addition to testing the submission of identifiers, it’s also important to test the accuracy of the CMS Crosswalk file to be sure that the correct NPI-Legacy combination is being used to process claims and claim status inquiries. Part A Fiscal Intermediary Standard System (FISS) DDE Claims There are edits similar to the ones described above for the 837 Institutional Health Care Claim that will also be implemented in Stage 2 for Part A DDE claims. Look for a future announcement regarding the actual reason codes associated with these new edits. New 276 Claim Status Inquiry Edits for Stage 2 If any of the following errors are encountered, all claim status inquiries for that provider batch will be rejected on the Inbound Reject Report (FSSD0123RZRJ).
Provider Identifiers on the 277 Claim Status Response When the NPI and legacy identifier are submitted on the 276 and the combination matches the combination found in the crosswalk, both the NPI (Qualifier ‘XX’) and legacy identifier (Qualifier ‘SV’) will be returned on the 277 in two iterations of the 2100C loop, segment NM108/09. When only the NPI is submitted on the 276 and that NPI is found in the crosswalk, only the NPI (Qualifier ‘XX’) will be returned on the 277 in the 2100C loop, segment NM108/09. Provider Identifiers on the 835 Electronic Remittance Advice The 835 will continue to be driven at the payee level by the Legacy ID as it is currently. One 835 can only report payments made on claims that correspond to a single Legacy ID. During this stage, the NPI will not be reported in the 1000B (Payee Identification) loop. Provider identification at the payee level will not change. There will, however, be a change in format of the 835 with the use of the NM1 (Service Provider Name) segment in the 2100 (Claim Payment Information) loop. This segment hasn’t previously been reported on the 835. In Stage 2, this NM1 segment will report the NPI as long as it was submitted on the associated claim.
If there are additional questions related to this information, please contact the IES Help Desk at 866-889-7322. |
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