New NPI Information The May 23rd NPI deadline is fast approaching. While MedAvant is doing everything possible to minimize the impact to our customers, we anticipate some payers will experience processing problems depending on how strict they are with their NPI requirements. Similar to what we experienced when HIPAA was implemented, we are finding that many payers are still unsure as to how closely they will apply NPI edits on inbound claims after the May 23rd deadline. After May 23rd, with the exception of Medicare and payers that give us specific NPI requirements for all identifiers, MedAvant will continue to forward claims to the payers for processing even if the claims contain legacy identifiers. Given the uncertainty with many payers regarding their NPI requirements after the May 23rd deadline, we believe it is best to get the claims to the payer and have them make the determination on accepting or rejecting the claim. Medicare has indicated they will require full NPI compliance as of the May 23rd deadline. This means they will require NPI for both primary and secondary identifiers. The most common secondary identifiers are: Ordering Referring and supervising providers Facility ID’s If you generate a medicare claim containing one of these secondary identifiers, you must include the NPI or the Medicare claim will reject. MedAvant participated in the May 7th “Legacy Free” Day, requested by CMS. We experienced a 35% front-end rejection rate back to providers compared to a normal 4% front-end rejection rate for Medicare claims. Almost the entire increase in the rejection rate was due to claims not containing NPI in the secondary loops. It is critical that you make the corrections needed on your Medicare claims to populate NPI in the secondary loops when appropriate or you will experience large Medicare rejections beginning May 23rd. Click here to view the most common NPI Error messages experienced on the May 7th “Legacy Free” day.
New NPI Information
The May 23rd NPI deadline is fast approaching. While MedAvant is doing everything possible to minimize the impact to our customers, we anticipate some payers will experience processing problems depending on how strict they are with their NPI requirements. Similar to what we experienced when HIPAA was implemented, we are finding that many payers are still unsure as to how closely they will apply NPI edits on inbound claims after the May 23rd deadline.
After May 23rd, with the exception of Medicare and payers that give us specific NPI requirements for all identifiers, MedAvant will continue to forward claims to the payers for processing even if the claims contain legacy identifiers. Given the uncertainty with many payers regarding their NPI requirements after the May 23rd deadline, we believe it is best to get the claims to the payer and have them make the determination on accepting or rejecting the claim. Medicare has indicated they will require full NPI compliance as of the May 23rd deadline. This means they will require NPI for both primary and secondary identifiers. The most common secondary identifiers are:
If you generate a medicare claim containing one of these secondary identifiers, you must include the NPI or the Medicare claim will reject.
MedAvant participated in the May 7th “Legacy Free” Day, requested by CMS. We experienced a 35% front-end rejection rate back to providers compared to a normal 4% front-end rejection rate for Medicare claims. Almost the entire increase in the rejection rate was due to claims not containing NPI in the secondary loops. It is critical that you make the corrections needed on your Medicare claims to populate NPI in the secondary loops when appropriate or you will experience large Medicare rejections beginning May 23rd. Click here to view the most common NPI Error messages experienced on the May 7th “Legacy Free” day.
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