Important Info for Medicare Billers Doing E-Billing

In October, Medicare implemented new NPI edits that have caused quite a few problems for several offices.  These problems have generated calls to Apex EDI tech support, and we have learned a lot about what needs to happen to fix the problems.  Unfortunately, due to privacy laws, Apex is not able to act on behalf of a provider with Medicare.  So, the burden is placed on the provider’s staff to resolve the issues.

We would like to provide some tips and suggestions on how to resolve these Medicare rejections. Things to be aware of: 

 ** The way your office’s information is setup with Medicare has to match
 exactly with how it is setup up in the NPPES system.  You must have
 your legacy number(s) match your NPI(s) along with your office name    and address.  Medicare calls this comparison the crosswalk and is causing
 most NPI related rejections.
 
 You can view your information with NPPES online at:
    https://nppes.cms.hhs.gov/NPPES/Welcome.do
 
 ** Any rejection notice that mentions "crosswalk," "NPI/legacy
 mismatch," or, for Noridian states, "NPI WITH NO 1C REF" is related
 to the issues discussed in this notice.

 ** If your office has a group Medicare number then a group NPI is also
 required.  This is not optional.
 
 ** Legacy numbers (the old Medicare provider numbers) are still required
 by most Medicare.  If you discover that your Medicare doesn’t require
 the legacy number, please let Apex know and we can easily stop sending
 that data.  Otherwise, you should be sending your legacy numbers in
 boxes 24J-shaded, box 33, and the UPIN in box 17a.

 ** Some states that deal with Noridian require a state identifier on the
 front of the legacy numbers.  These are as follows:
 AK = K; AZ = Z; CO = C; HI = H; ND = N; NV = V; OR = R; SD = S; WA = G
      and WY = W.
 
 For example, if I were in Alaska (AK) and my legacy number was 123456,
 then on my eclaims I would need to send K123456, and this is the legacy
 number I would need registered on the NPPES system. 

 ** Apex EDI hard codes the HCFA box 33 equivalent on electronic claims,
 so it is important to make sure you have provided Apex with your
 correct legacy and NPI numbers.

 ** Noridian has provided a good informational page at:
 
https://www.noridianmedicare.com/p-medb/enroll/npi/crosswalk_bypass_edits_lifted.html
 
 The pointers on this web page are specific to states that work through
 Noridian, however, it can be a good referance for all states.

 2. Be sure that you are sending the NPIs correctly in boxes 24J-shaded,
 box 33, box 32 (if needed), and have the UPIN and NPI in box 17a,b.
 If needed, have an Apex tech rep verify this information is being
 recieved from your office on your claims.

 3. Check the NPPES web site for corrrect provider information including,
 name, address, NPI, and legacy numbers. 

 4. Check with Medicare to make sure Medicare setup is the same as the
 NPPES setup.

 5. Correct any errors or mismatches you find.  Corrections are easier
 and faster on the NPPES website than with Medicare.  So, when possible
 use NPPES to make your information match what Medicare has on file
 instead of trying to make Medicare match what NPPES has on file.