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American Association of Oral and Maxillofacial Surgeons

Practice Management & Allied Staff News & Materials

Avoid NPI Related Claim Rejections - Only 35 Days Left to Comply!

April 22nd, 2008

AAOMS staff has recently heard from several members receiving NPI related claim rejections. This is the time to be submitting claims with both your NPI and legacy number (eg, Medicare UPIN, BCBS provider number, etc. preceded by the appropriate qualifier) and more importantly the time to be testing some claims using the NPI alone. This will allow Medicare and other carriers to validate your NPI number and ensure that there will not be any problems when legacy numbers are completely phased out and the NPI officially becomes the sole identifier on May 23rd. This is only 35 days away!

If claims containing the NPI only are processed and you receive payment, continue to increase the volume of claims sent with your NPI alone. For more information about what to do if your claim is rejected visit the CMS Web site.

Most importantly, keep in mind the instructions for completing boxes 32 and 33 of the CMS 1500 claim form. Providers should be familiar with the most recent instructions for completing the claim form as found on the National Uniform Claim Committee (NUCC) Web site. Note the name, address, etc. information listed in boxes 32 and 33 must be an exact match to that which was provided when the individual and/or organization NPI was obtained in order to avoid rejection. If rendering services at a hospital, the hospital's NPI and/or legacy numbers should be included in boxes 32a and b. To check how your information is listed in the NPI Registry Database, or to obtain the NPIs of other individual providers or organizations, visit the searchable database section of the National Plan and Provider Enumeration System (NPPES) Web site.