Import Message regarding NPI numbers
Thursday, May 1, 2008 - 01:25:08 PM
Import Message regarding NPI numbers
Date Range: Effective May 23, 2008
Details:
· Medicare and other payers will begin rejecting HIPAA inbound claims containing legacy provider identifiers for any primary provider.
· The following Medicare pre-pass edits will reject claims as an INVALID VALUE on the H99RAR04 report when the applicable Billing, Pay-to, or Rendering (claim or detail) provider loops contain an REF01 of 1C or 1G.
· The edits will be begin appearing as informational effective 1/7/08 until the final implementation date of 5/23/08, at which time they will reject claims if billing requirements are not met.
· Please note these messages are informational only the claims were received and processed successfully at the payer.
Submitter Actions:
· Do not remove your legacy provider or group numbers, these will be stripped from your file before the claim is forwarded onto the payer
· Make sure that you have a NPI number entered for all groups, rendering providers, referring providers, and service locations before 5/23/08
by KareoSupport to Electronic Claims
1 comments
Darrell Pruitt said:
This afternoon I was told today by Wilma Jaimes, a supervisor for BCBSTX at (800) 451 0287, that for dentists, the NPI number is not unconditionally required for processing claims after May 23, even though dentists were previously led to believe otherwise by BCBSTX in telephone conversations as well as printed publications.
The disincentive for a BCBSTX client to see a dentist of their choice who does not have a voluntary NPI number is that the patient will have to pay the dentist’s fees in full and then deal with legendary BCBS bureaucratic hoops and delays in payments when they file the claim themselves.
It is unknown whether this is spelled out in the contracts that BCBS signs with employers. If this very important information is not disclosed, or if the purchaser of the plan were foolishly told that there are no restrictions on who their employees could see, that could easily be interpreted as insurance fraud punishable by fines and/or imprisonment. If it is proven to be intentionally hidden, I think it would definitely mean imprisonment of BCBSTX officials, as well as accomplices such as certain leaders in the American Dental Association who encouraged dentists to sign up for the numbers without informing them of the business risks such as almost guaranteed delay of payments and capricious fines from the CMS.
Surely BCBSTX MBAs would not be so stupid as to try to cheat their clients. Darrell Pruitt DDS
Thursday, May 1, 2008 - 07:42:39 PM