DME claims rejected due to NPI issue

Many providers experience strange denials on their Medicare DME claims, and when they call to check on them, they’re told to call the EDI department — even if they don’t file the claims electronically. It seems strange, but it is actually correct.

The problem starts there. The Medicare DME customer service folks don’t explain why the denials are going so well and you end the call scratching your head still not sure how to get the claims paid. If they just told you in plain English what the problem was and how to fix it, it wouldn’t be so bad.

When we first received rejections from DMERC, it was for one of our eyewear suppliers. My associates made several phone calls without getting much help actually getting the claims paid or understanding how to properly resubmit them. Meanwhile, our ophthalmologist was getting calls from all his other ophthalmologist friends who had the same problem.

What we were told was to link our NPI number to the Type II or group NPI number. This made absolutely no sense as both NPI numbers were entered in the correct boxes on the claim form. I finally discovered the problem after a hunch I had which was a complete miracle I could put this together. It certainly wasn’t because they explained it well.

The problem is that the provider’s national supplier number must be linked to the NPI number. It had nothing to do with the NPI numbers on the claim form as explained to us.

Fortunately, it’s a simple solution. This can be done quite easily by going to the NPI enumerator website, logging in and adding the vendor number as one of the identifiers.

If you’re getting these strange rejections, I suggest you don’t even call the DME provider in the first place. I would check if your supplier number is linked to your NPI number and if not then do that. If it’s already paired, you have another problem. Otherwise, resubmit your claims once it’s linked!

We knew that the implementation of the NPI figures would pose many challenges in the future. Here’s one of these little challenges.

Copyright 2008 – Michele Redmond

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