Key Medicare NPI Implementation Dates
January 1, 2008 - As of this date, 837I electronic claims and UB04 paper claims without an NPI in fields identifying the primary provider (billing and pay-to) will be rejected. Legacy identifiers paired with NPIs in the primary provider fields on the claim will still be acceptable, as will legacy-only numbers in secondary provider fields (see clarification below).
March 3, 2008 - Medicare fee-for-service 837P and CMS-1500 claims must include an NPI in the primary fields on the claim (i.e., the billing, pay-to, and rendering fields). You may continue to submit NPI/legacy pairs in these fields or submit only your NPI on the claim. You may not submit claims containing only a legacy identifier in the primary fields. Failure to submit an NPI in the primary fields will result in your claim being rejected or returned because it can not be processed beginning March 1, 2008. Until further notice, you may continue to include legacy identifiers only for the secondary fields.
April 2008: Medicare has determined that using taxonomy codes has been unsuccessful in obtaining a one-to-one match on the crosswalk for these providers having one NPI tied to multiple OSCAR (Online Survey Certification and Reporting System) Certification numbers. As a result, the taxonomy code will no longer be part of the crosswalk criteria used to attempt to match an NPI and its OSCAR. Instead, the system will perform a one-on-one match check by bill type, then by revenue code, and then by facility zip code until a match is found. If a match isn't found by any of the three methods, Medicare will send an Additional Development Letter (ADR) for the facility to provide them with the Oscar number that goes with the subpart. The claims will suspend until the ADR is received and Medicare can process the claim.
May 23, 2008 - In keeping with the Contingency Guidance issued on April 3, 2007, CMS will lift its NPI contingency plan, meaning that only the NPI will be accepted on all HIPAA electronic transactions (837I, 837P, NCPDP, 276/277, 270/271 and 835), paper claims and SPR remittance advice. This rule also includes all secondary provider fields on the 837P and 837I. The reporting of legacy identifiers will result in the rejection of the transaction. CMS also will stop sending legacy identifiers on COB crossover claims at this time.
Last updated on May 28, 2008