Npi Numbers and legacy Numbers - New Rules As of May 23, 2008 For Billing curative assurance Claims

Health Insurance - Npi Numbers and legacy Numbers - New Rules As of May 23, 2008 For Billing curative assurance Claims

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On May 23, 2008 assurance carriers were suppose to accept Npi only on all paper & electronic claims. Not only were you required to include the Npi number, but you were required to Exclude the heritage numbers. Some assurance carriers were not ready for the deadline and applied for an prolongation (like Nys Medicaid). But Medicare was ready and if you include your Ptan (legacy) estimate on your claims they are being rejected.

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For the assurance carriers who were ready for this deadline, you must make sure you do not have the heritage estimate in the shaded area of box 24J or box 32A & 33A. If your software is set up to automatically print the heritage estimate in this box you need to remove it. If you submit claims electronically, make sure your seller has it set up to exclude the heritage number.

For the assurance carriers who were not ready and applied for an extension, you will need to continue including the heritage estimate until they have complied. This makes things a minute messy. You need to make sure you are submitting the claims that need the heritage estimate with it, and the ones that do not allow it, without. Crazy, but it is what we billing population have to do to make sure the money keeps coming in.

Another minute crazy thing to worry about is the Npi estimate entered in 24J. If you are set up with Medicare as an individual provider (not a group) and you only have a type I Npi, you must leave the Npi part of box 24J blank. You cannot include the individual Npi estimate here. If you are an individual provider and you put your Npi estimate in 24J, Medicare may reject your claims.

If you are a group with Medicare then you need to continue putting the rendering providers individual Npi in box 24J and the group Npi (type Ii) in box 33A. If you are not sure if you are an individual or a group you can tell by your Ptan number. If you only have one Ptan estimate then you are an individual. If you have a Ptan for the individual provider and a isolate Ptan for the practice name then you are a group. Just when you belief it couldn't get much more confusing!

If you want to keep your cash flow steady it is important to make sure you are submitting the claims correctly. If you have any request as to what a single assurance carrier requires, give them a call. Best to have it right the first time than to have to resubmit!

Copyright 2008 - Michele Redmond

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