Author Topic: weird Medicare denial?  (Read 2607 times)

Christy

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weird Medicare denial?
« on: June 23, 2014, 04:21:11 PM »
anyone have any insight as to why Medicare would deny a claim for having the same NPI in box 24J and also in box 33a?

it's a sole provider with one type 1 NPI.

Medicare stinks!

thanks!

Michele

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Re: weird Medicare denial?
« Reply #1 on: June 23, 2014, 04:32:04 PM »
What state are you in?  A while back we had that issue here in NY.  If the NPI in 24J was the same as the one in 33a then they wanted 24J left blank.  Not sure if they still do, our clearinghouse handles it on their end.
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Christy

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Re: weird Medicare denial?
« Reply #2 on: June 23, 2014, 04:36:15 PM »
thanks, Michele!

New York also!

I filled in both fields, and when it carried over thru Office Ally, 24J went blank. This is for one of my providers. I do the same for another provider, and it goes through with no problem?!?!?


ugh!

PMRNC

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Re: weird Medicare denial?
« Reply #3 on: June 23, 2014, 05:13:50 PM »
I'm in NY too.. 24J Blank in your case.
Linda Walker
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Christy

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Re: weird Medicare denial?
« Reply #4 on: June 23, 2014, 06:05:07 PM »
the claims were denied for 24J being blank (although it wasn't actually blank- there is some sort of problem in the transmittal between Office Ally and Medicare....

CMS says that both 24J and 33A need to be completed...

http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2842CP.pdf


Michele

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Re: weird Medicare denial?
« Reply #5 on: June 24, 2014, 09:17:10 PM »
We use OA too and ours go through ok.  Did you get it resolved?
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RichardP

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Re: weird Medicare denial?
« Reply #6 on: June 27, 2014, 05:46:40 PM »
Here is a bit more background for those who might be interested.

it's a sole provider with one type 1 NPI.

Edit:  I have deleted my comment here because I got it backwards and don't have time at the moment to craft a correct comment.  Basically, I was arguing that a CMS Form with the EIN box checked in Box 25 of the CMS 1500 should have a Type II NPI Number in Box 24J.  That is incorrect.  The Type I NPI Number (who did the work) goes in Box 24J.

But, for Christy's situation - if the CMS 1500 Form has an EIN on it, or if the EIN box in Box 25 is checked, there must be a Type II NPI Number in Box 33a and a Type I NPI Number in Box 24J.  Christy, regarding the CMS 1500 Form where the NPI Number(s) in Box 24J are disappearing, is there an EIN on that Form, or is the EIN box in Box 25 checked.  If the answer to either is yes, you must have a Type II NPI Number in Box 33a.

Our experience with our MAC has been that, if the sole provider is conducting his business with an Employer Identification Number (EIN), then he must have both a Type I (for his person) and a Type II (for his EIN) NPI Number.  Perhaps your Sole Provider has an EIN but only has a Type I NPI Number??
« Last Edit: June 29, 2014, 11:54:24 PM by RichardP »

Christy

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Re: weird Medicare denial?
« Reply #7 on: July 08, 2014, 11:02:54 AM »
thanks for the replies. I am still working on this, will post back.

Richard- a provider can have an EIN and only a type 1 NPI. At lease in NY, they can. I bill for sole proprietors with an EIN and just a type 1 NPI to Medicare with no problems.....

RichardP

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Re: weird Medicare denial?
« Reply #8 on: July 08, 2014, 01:56:49 PM »
Richard- a provider can have an EIN and only a type 1 NPI. At lease in NY, they can.

Thanks for that.  We have been processed by the Palmetto MAC and have recently been required to switch over to the Noridian MAC.  Noridian rejects quite a bit of stuff that Palmetto accepted.  So - perhaps it depends on the MAC?

I just know that, when the NPI stuff first started, we had a sole provider with an EIN.  Based on info published at the time, we billed with his Type 1 and Type 2 NPI Numbers.  Billing was rejected, and we were told to only bill with the Type 1 NPI Number.  We did this, and got paid for a time.  Then, inexplicably, they started rejecting our billing.  Inquiries yielded the answer that we needed to bill with both the Type 1 and Type 2 NPI Numbers (which we had initially done and it was rejected).  So we switched back to using both - for our Sole Provider who has an EIN - and have had no problem with payment since.  We have other Sole Provider clients with EINs for whom we have been billing with both NPI Types since the beginning with no problem.  We long ago stopped looking for the logic behind any of this.  We just do what they tell us to do, until they tell us to do something different.

Michele

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Re: weird Medicare denial?
« Reply #9 on: July 10, 2014, 10:19:30 AM »
We have providers in NY who use Tax IDs and only an individual NPI.  Our understanding is that if they have a Tax ID under their name (not a legal entity such as a professional assoc or a corporation) they do not need a group NPI.
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Christy

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Re: weird Medicare denial?
« Reply #10 on: July 10, 2014, 11:43:18 AM »
ha ha Richard! Yes, we need to do whatever Medicare tells us to do, logical or not..... :-\

OK- so the issue was that the provider  (LCSW)was enrolled with Medicare as only able to refer/order services, but NOT provide services. She enrolled herself in 2012 and her claims were denied for 2 years and she never knew why until I figured this out.

So the problem was OUR fault, but Medicare gave me SO many different reasons for the denial. And I could not believe the rudeness of the claims reps- talking over me, yelling at me?!?! it was awful.

The provider line was so much better, the rep there fixed the problem and we were good to go within 24 hours.

So, the snafu was that Medicare expected 2 NPIs on the claims when they thought my provider was just ordering the services. But, she actually performed the services....hence, one NPI.

ugh!!!!!