Coding Cues: NPI transition

May 2, 2008

We've been using the NPI on our electronic claims for several months without a problem. Suddenly we've begun receiving rejections from virtually every commercial insurer. Our clearinghouse indicates that the problem is the information contained in the NPPES (NPI) files, but we've scrutinized these files for each of our providers and corrected any misinformation and are still having problems with claims. Is there an issue we're unaware of?

Key Points

We've been using the NPI on our electronic claims for several months without a problem. Suddenly we've begun receiving rejections from virtually every commercial insurer. Our clearinghouse indicates that the problem is the information contained in the NPPES (NPI) files, but we've scrutinized these files for each of our providers and corrected any misinformation and are still having problems with claims. Is there an issue we're unaware of?

As the May 23 deadline for third-party payers to implement processing of claims using the NPI number approaches, commercial insurers are implementing software that accommodates this requirement, and various problems are arising. The edits may not be set correctly, so it may be an insurer problem (for instance, you should be seeing a "warning," not a rejection). Some practices are listing their legacy numbers in the NPPES file in the "Others" section because it allows entry of multiple numbers, rather than using the specific categories in the dropdown menu, triggering a rejection if the insurer software doesn't find an exact match with the information in a specific field. During this period, you-and your clearinghouse-need to work closely with the insurers you're getting rejections from. Take note of what "fixed" a problem with one insurer, so you can use that information with others as problems arise.

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