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WATCH YOUR CLAIMS

NHIC, Corp.

SECONDARY Provider “Informational” NPI Pre-Pass Edits on Ordering/Referring/Attending/Service Facility & Other Secondary Provider Fields

Beginning May 23, 2008, use of the NPI will be required on all Medicare claims billed for ordered/referred services.

For Medicare purposes, this means that:

submission of an NPI for an ordering/referring provider is mandatory effective May 23,2008.

Legacy numbers cannot be reported on any claims sent to Medicare on or after May 23, 2008.

"INFORMATIONAL" pre-pass edits M393 - M401 will check for the presence of an NPI in the SECONDARY provider loops. The Error Severity field on the Error Summary Report (ESR) will display the “Informational” error notice. Claims with informational errors will be accepted for processing unless they fail other prepass edits that would cause the claim to reject.

It is important to test your claims with only the NPI in the secondary provider loops now.

Informational edits help to identify NPI conflicts, which must be resolved prior to the May 23, 2008 deadline, or claims will reject.

NEW MEDICARE EDITS - The edits below will set when the NM1 segment is submitted in a secondary provider loop but does not contain the qualifier of “XX” in the NM108 field, or the NM108 is not submitted but an REF segment is found in the same loop.

M393 - edit will set when the NM1 segment is submitted in the 2310A loop (Claim Level Referring Provider).The error message generated on the ESR will state- " MISSING NPI IN 2310A NM109".

M394 - edit will set when the NM1 segment is submitted in the 2310C loop (Claim Level Purchased Service Provider). The error message generated on the ESR will state- "MISSING NPI IN 2310C NM109"

M395 - edit will set when the NM1 segment is submitted in the 2310D loop (Claim Level Service Facility Location). The error message generated on the ESR will state- "MISSING NPI IN 2310D NM109"

M396 - edit will set when the NM1 segment is submitted in the 2310E loop (Claim Level Supervising Provider). The error message generated on the ESR will state- " MISSING NPI IN 2310E NM109"

M397 - edit will set when the NM1 segment is submitted in the 2420B loop (Detail Level Purchased Service Provider). The error message generated on the ESR will state- "MISSING NPI IN 2420B NM109".

M398 - edit will set when the NM1 segment is submitted in the 2420C loop (Detail Level Service Facility Location). The error message generated on the ESR will state- "MISSING NPI IN 2420C NM109"

M399 - edit will set when the NM1 segment is submitted in the 2420D loop (Detail Level Supervising Provider). The error message generated on the ESR will state- " MISSING NPI IN 2420D NM109"

M400 - edit will set when the NM1 segment is submitted in the 2420E loop (Detail Level Ordering Provider). The error message generated on the ESR will state- " MISSING NPI IN 2420E NM109"

M401 - edit will set when the NM1 segment is submitted in the 2420F loop (Detail Level Referring Provider). The error message generated on the ESR will state- " MISSING NPI IN 2420F NM109"

For more information, please see MLN Matters Article MM 5647,

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5674.pdf

3/13/2008

Reference CR 5674 NHIC CORP