Author Topic: NPI and Medicare  (Read 2598 times)

catooch

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NPI and Medicare
« on: July 12, 2008, 11:48:14 PM »
Hi,

I work for a small chiropractor's office where there is only one doctor.  Recently our medicare claims were rejected due to an NPI error.  They told us that the doctor's SS# was linked to his NPI number.  So we are in the middle of submitting all this paperwork to have his NPI number linked to his tax ID#.  Weeks have gone by and we are still not able to process any claims to Medicare until this gets straightened out. Now secondary insurance companies are not paying because Medicare being there primary hasn't paid yet.  I feel very overwhelmed as to what's ahead of me once(or if) this gets straightened out. 

Any advice?...............................  :o

Michele

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Re: NPI and Medicare
« Reply #1 on: July 14, 2008, 12:33:09 PM »
You are probably thru the worst of it, getting to the bottom of the problem and taking the steps needed to correct it.  Now you just need to wait for Medicare/NPI to get it all straight.  Then things should go pretty easy.  You should call Medicare now and ask if it will be necessary to resubmit or are they going to reprocess all claims.  If they are going to reprocess you don't need to do anything further, except check regularly to see when the information is updated.  If you need to resubmit, just be ready to do so as soon as you hear the word.

It seems so overwhelming when you are in the middle of it, but a couple months from now it will just be a blimp in the past!  :)  Your doctor is lucky to have someone like you fixing the problem.


Good luck
Michele
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Christine_1

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Re: NPI and Medicare
« Reply #2 on: July 31, 2008, 09:41:40 PM »
We are having the same problem. Once NPI was implemented our claims stopped getting to Medicare. After several weeks of trying to find out why, we were told the same thing about the SSN. So we had to go to our FI (BCBS of Tenn) and change our tax id # to the dr's SSN. It has been 30 days and still has not been changed. 90% of our pt's are medicare, and we have had 0 payment from them in 2 months. Don't know how long we can go on. I am also wondering when this does get straight how will it affect our secondary payments. When medicare crosses them over the #'s will not be the same. I look for this problem to continue for a while. It is frustrating just waiting and having the dr on your back for something you have no control over. Just venting! Thanks

Michele

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Re: NPI and Medicare
« Reply #3 on: August 01, 2008, 06:34:56 AM »
We have had this problem with a few of our providers.  When they originally signed up for Medicare they did under their ss#.  Then somewhere along the line they started using a Tax ID#. 

This may not work for you but for one of my providers in particular I am submitting the claims under her ss# while we are waiting for the paperwork to be processed.  This is not an ideal situation, but it is necessary for her.  Since she is a PC under her tax ID# Medicare is considering her non par from May 23rd until the date she signed a new participating provider agreement.  However, under her ss# she is par so we are submitting claims that way.  Any claims that are crossed over to the secondaries may get sent over under her ss# though and then the 2ndary may not recognize her.  We will just have to fix those as they arise.  It is better than the other option.

I do know of others who also sent in under the ss# during the wait.  I can't guarantee it will work for you, but you may want to look into it.

Good luck
Michele
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vinitkc

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Re: NPI and Medicare
« Reply #4 on: August 01, 2008, 10:38:53 AM »
The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses will use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty.

(Content for this section courtesy of Centers for Medicare & Medicaid Services)


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appleandmoses

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Re: NPI and Medicare
« Reply #5 on: January 06, 2009, 01:23:09 PM »
Hi, I bill for one doctor. I use Medisoft as my billing software.   My claims for Medicare started to get rejected in Feb of 2008 because Medicare said the claims were tied to his SSN, too.  We have applied and received a group NPI number now.  However, Medicare keeps rejecting the claims becuase it sees us under our individual NPI and not as a group.  Does anyone know how to make the changes to my Medisoft program so I can submit my claims under my group NPI to Medicare? We haven't been paid for almost a year.   :'(

Thanks!
Hopeless

Michele

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Re: NPI and Medicare
« Reply #6 on: January 06, 2009, 07:24:41 PM »
It's going to depend on how you batch and submit your claims to Medicare.  If you do it thru Medisoft then there should be a place in the provider file to input the group NPI.  If you use a separate program to batch and submit then that program must either have the NPI in it, or be pulling it from Medisoft.  But there should be a place in Medisoft for the individual NPI and the group NPI. 

If you have an electronic vendor then you should contact them and ask them where you need to change it. 

You just need to find where your electronic system is pulling the NPI from and make sure you have the group loaded.

Good Luck!  :)

Michele


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