NPI Rejections

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Gavin Walker
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Joined: Wed Apr 04, 2007 10:11 pm
Location: Springfield, MO
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NPI Rejections

Post by Gavin Walker » Fri May 23, 2008 2:47 pm

We have noticed a significant increase in the amount of NPI related rejections.

If the payer requires NPI Only then you should delete out all PINS, Group IDs, Practice IDs, and qualifiers for that insurance carrier only. Some versions of Medisoft have a nasty habbit of populating the qualifier codes back in even after you delete them out. To double check, re-edit the insurance carrier and go back to the PINs tab. If everything looks good CLICK CANCEL. Medisoft v14 added a new option in Program Options -> Data Entry -> make sure Automatically Calculate blank PIN qualifiers is unchecked.

Many payers still require the legacy provider ID in addition to the NPI. To submit the legacy provider id edit your insurance carrier and go to the PINs tab and enter the PINs and Group IDs directly on this tab. Also, make sure you have entered the correct qualitier codes.

    0B = State License
    1A = Blue Cross Provider Number
    1B = Blue Shield Provider Number
    1C = Medicare Provider Number
    1D = Medicaid Provider Number
    1G = Provider UPIN Number
    1H = Champus Identification Number
    1J = Facility ID Number
    B3 = Preferred Provider Organization Number
    BQ = Health Maintenance Organization Code Number
    EI = Employer’s Identification Number
    FH = Clinic Number
    G2 = Provider Commercial Number
    G5 = Provider Site Number
    LU = Location Number
    N5 = Provider Plan Network Identification Number
    SY = Social Security Number
    U3 = Unique Supplier Identification Number
    X5 = State Industrial Accident Provider Number
Gavin Walker
Walker Tek Solutions, LLC
417-890-6777 x0
fax: 417-763-6386

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