NPI numbers and old numbers – New rules from May 23, 2008 for billing medical insurance claims

On May 23, 2008, insurance companies were required to accept only NPI for all paper and electronic claims. Not only did you have to include the NPI number, but you also had to EXCLUDE the legacy numbers. Some insurance companies were not ready for the deadline and applied for extensions (such as NYS Medicaid). But Medicare was ready and if you put your PTAN (legacy) number on your claims, they will be rejected.

For those insurance companies that were ready before this deadline, make sure you don’t have the legacy number in the shaded area of ​​box 24J or box 32A & 33A. If your software is set up to automatically print the old number in this box, remove it. If you are submitting claims electronically, make sure your supplier has set it up to exclude the old number.

For the insurance companies that were not ready and applied for renewal, you must continue to include the legacy number until they comply. This makes it a bit messy. You need to make sure you submit the claims that require the legacy number, and those that don’t, without it. Crazy, but it’s what we humans have to do to keep the money coming in.

Another little silly thing to worry about is the NPI number entered in 24J. If you are set up with Medicare as an individual provider (not a group) and you only have a type I NPI, you must leave the NPI portion of box 24J blank. You cannot list the individual NPI number here. If you are an individual provider and put your NPI number in 24J, Medicare may deny your claims.

If you are a group with Medicare, you should continue to place the individual NPI providers in box 24J and the group NPI (type II) in box 33A. If you are not sure whether you are an individual or a group, you can tell by your PTAN number. If you have only one PTAN number, you are an individual. If you have a PTAN for the individual provider and a separate PTAN for the practice name, you are a group. Just when you thought it couldn’t get much more confusing!

If you want to keep your cash flow stable, it’s important to make sure you’re filing claims correctly. If you have questions about what a particular insurance company requires, give them a call. It’s better to get it right the first time than to have to resubmit!

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Copyright 2008 – Michele Redmond