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NPI Implementation Update
As of January 1, 2008, appropriate National Provider Identification
(NPI) numbers and the Federal Employer Identification Number (FEIN) are
required on all claim submissions. Effective May 23, 2008, consistent with
the contingency plans established by CMS and Mercy Health Plans, we will
begin rejecting claims that are submitted without these required identifiers.
The different types of providers that may be associated
with a claim can be divided into two general categories: Primary and Secondary.
The primary provider identifiers must be on the claim for it to be processed.
The secondary provider identifiers may be required depending on the situation
(e.g., Operating provider identifiers are required if there is a surgical
procedure on the claim).
Primary:
- Professional (837P/CMS1500): Billing, Pay-To and Rendering
- Institutional (837I/UB04): Billing and Pay-To
- Rule Exception: The Billing provider will be used in the
absence of a Pay-To provider.
Secondary:
- Attending
- Operating
- Other
- Referring
- Ordering
- Supervising
- Facility
- Care plan oversight
- Purchase service
As noted above, the appropriate National Provider
Identification (NPI) numbers and the Federal Employer Identification
Number (FEIN) are required on all claim submissions.
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