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Cahaba GBA is the Medicare Part A Intermediary for the states of Alabama and Iowa, and the Regional Home Health Intermediary (RHHI) for the states of Iowa, Nebraska, Kansas, Missouri, South Dakota, North Dakota, Montana, Wyoming, Colorado, Utah, Delaware, Maryland, Pennsylvania, Virginia, West Virginia and The District of Columbia. You are receiving this message because you are a member of this electronic mailing list.
NPI Edit-Effective May 14, 2007
Effective May 14, 2007, the Fiscal Intermediary Standard System (FISS) will begin editing the NPI/legacy ID information you submit on your claim against the NPI Crosswalk file. This editing will validate the NPI/legacy ID matches the information on the NPI Crosswalk.
If an NPI/legacy ID match cannot be located on the crosswalk, the claim will be sent to the Return to Provider (RTP) file with reason code 32103, (The NPI number on the claims is not present in the crosswalk file. This edit applies to the NPI number associated with the Oscar
Number.).
If you have claims in RTP with reason code 32103, verify the NPI submitted on the claim matches the NPI that was assigned by the National Plan and Provider Enumeration System (NPPES). Make the necessary correction to the NPI on the claim and F9 to continue processing. If the NPI that you submitted is correct, verify that your legacy identifier (OSCAR/PIN) number corresponds with the NPI on file with the NPPES at: https://nppes.cms.hhs.gov/NPPES/Welcome.do
If the NPI/legacy ID matches the NPPES information, there may be a problem with the crosswalk, and you will need to submit a Medicare enrollment application (i.e., the CMS-855). The CMS-855 application can be found at
https://www.cahabagba.com/part_a/enroll_update_your_records/enroll_packet.HTM
on our Web site. When submitting the CMS-855, attach a copy of the letter you received from NPPES showing your NPI number. It may take up to forty-five days to process the information submitted on the CMS-855. During this time, provider claims cannot be processed.
In addition, an edit will be in place for claims that are electronically submitted with only an NPI. If the NPI is not found on the Crosswalk, the claim will not be accepted and will be returned to the provider. The Audit Trail Report will display the message "APASS:2310E/NM109-NPI#
- Invalid." If the NPI/legacy ID do not match, the Audit Trail Report will display the message "Billing Provider NPI and Legacy Number Mismatch."
Note: At the time this notice was issued, the crosswalk used to edit electronically submitted claims has not been installed to properly edit the NPI/legacy ID. Until the crosswalk is installed, the Audit Trail Report will display the message, "APASS:2310E/NM109-NPI# - Invalid."
More information and education on the NPI may be found at
http://www.cms.hhs.gov/NationalProvIdentStand/ on the CMS NPI page, and
on the CMS Web site. Providers can apply for an NPI online at:
https://nppes.cms.hhs.gov/NPPES/Welcome.do