Latebreakers: Medicare to reject claims without NPIs

October 8, 2007

CMS will begin rejecting Medicare claims that do not use NPI numbers.

CMS has announced that it will begin to reject Medicare claims without proper National Provider Identifier (NPI) numbers. Earlier this year, CMS delayed its requirement for using NPIs. Individual health and Rx plans have begun to contact R.Ph.s and other providers to specify exactly when claims will be rejected. CMS also said claims will be rejected if NPIs are not properly used. In some cases individual NPIs have been paired with Medicare Provider Identification Numbers (PIN) for organizations or organizations' NPIs have been used with individual PIN numbers. To help pharmacies trying to ensure they have a prescriber's correct NPI number, SK&A introduced its NPI Verified service. The program verifies all NPIs by phone. Pharmacists can also look up NPIs on-line with NCPDP's NPI database.