News Alert: NPI Information for TRICARE Providers

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Gavin Walker
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News Alert: NPI Information for TRICARE Providers

Post by Gavin Walker » Tue Jun 24, 2008 4:18 pm

Since May 23rd, 2008 in accordance with the NPI mandate, PGBA has been editing back claims which do not contain a billing or rendering NPI. These edits are:

NP1 - INVALID BILLING PROVIDER NPI
NP6 - INVALID RENDERING PHYSICIAN NPI


PGBA has given information edits only for the following provider identifiers: operating, referring, attending, pay-to, and service facility.

These informational edits are:

NP2 INVALID ATTENDING PHYSICIAN NPI
NP3 INVALID OPERATING PHYSICIAN NPI
NP4 INVALID REFERRING PHYSICIAN NPI
NP5 INVALID PAY-TO PROVIDER NPI
NP7 INVALID SERVICE FACILITY LOCATION NPI


Starting sometime in the next 75 to 90 days PGBA will require NPI for all provider identifiers. The above informational edits will be turned on as hard edits. This means claims getting these edits will be rejected. Plus PGBA will also start editing for NPI on the following provider identifiers and reject claims that don't have NPI's for these provider ID's: ordering, purchase service provider, and servicing provider.

The edits will be:

NPP - MISSING/INVALID PURCHASE SERVICE NPI
NPO - MISSING/INVALID ORDERING NPI
NPS - MISSING/INVALID SERVICING NPI


PGBA will still allow a dual use for provider ID's but will reject any provider identifier that contains legacy only.

For referring provider ID PGBA recommends the current CMS approved approach of making a good faith effort to obtain referring provider NPI.

If there are any questions regarding this bulletin, please contact the TRICARE EDI Help desk
Gavin Walker
Walker Tek Solutions, LLC
417-890-6777 x0
fax: 417-763-6386

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