Next week Medicare begins new rejections

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Gavin Walker
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Next week Medicare begins new rejections

Post by Gavin Walker » Fri Aug 31, 2007 8:46 am

Beginning next week, Medicare Carriers will reject claims when the NPI/provider number combination does not match what is on the Medicare crosswalk (the numbers submitted to NPPES).

The first states to enact this edit are IL Medicare, MI Medicare, MN Medicare, WI Medicare, CT Medicare, and FL Medicare.

All Medicare plans will be using the same rejection reason codes for any claims that do not match the crosswalk.

If you have questions about rejections you are welcome to contact our Customer Service Department at 866-890-6777.

Thank you,
Gavin Walker
Walker Tek Solutions, LLC
417-890-6777 x0
fax: 417-763-6386

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Gavin Walker
Posts: 4625
Joined: Wed Apr 04, 2007 10:11 pm
Location: Springfield, MO
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Medicare begins new rejections

Post by Gavin Walker » Mon Sep 24, 2007 10:21 pm

When the claim is returned, a provider should first verify that the correct NPI was submitted. If correct, you will need to verify that your legacy identifier (PIN or NSC) number corresponds with the information on file with the National Plan and Provider Enumeration System (NPPES). NPPES data may be checked on line.

I just found out that Medicare will begin their rejections on a different schedule depending on the clearinghouse. The previous post was regarding GatewayEDI. Here is the schedule for when Medicare will start rejecting MedAdvant claims for this reason:

September 24, 2007

    Medicare - Arkansas (MR055)
    Medicare - Lousiana (MR048)
    Medicare - New Mexico (MR076)
    Medicare - Oklahoma (MR013)

October 8, 2007
    DMERC - Alaska (Jurisdiction D) (MR024)
    DMERC - Connecticut (Jurisdiction A) (MR030)
    DMERC - Illinois (Jurisdiction B) (MR031)
    DMERC - Alabama (Jurisdiction C) (MR032)
    Railroad Medicare - Palmetto GBA (MR018)
    Medicare - South Carolina (MR028)
    Medicare - Ohio (MR033)
    Medicare - West Virginia (MR056)
    Medicare - Texas (MR005)
    Medicare - Maryland (MR038)
    Medicare - Delaware (MR039)
    Medicare - Washington DC (MR040)
    Medicare - Virginia (MR022)
    Trailblazers (Central Flu Billing) (FLU01)

October 15, 2007
    Medicare - North Carolina (MR020)

October 22, 2007
    Medicare - Alaska (MR010)
    Medicare - Arizona (MR008)
    Medicare - Colorado (MR004)
    Medicare - Hawaii (MR057)
    Medicare - Iowa (MR036)
    Medicare - Nevada (MR007)
    Medicare - Oregon (MR011)
    Medicare - Washington (MR006)

October 29, 2007
    Medicare - North Dakota (MR083 / IR083)
    Medicare - South Dakota (MR084 / MR184 / IR084)
    Medicare - Wyoming (MR074)
    Medicare - Utah (MR046)
    Medicare - Minnesota (MR019)
Gavin Walker
Walker Tek Solutions, LLC
417-890-6777 x0
fax: 417-763-6386

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Gavin Walker
Posts: 4625
Joined: Wed Apr 04, 2007 10:11 pm
Location: Springfield, MO
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Medicare Crosswalk - Matching the NPI

Post by Gavin Walker » Wed Jan 09, 2008 9:26 pm

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 here.

** 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. 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 your state were in Alaska (AK) and your legacy number was 123456,
then on your eclaims you need to send K123456, and this is the legacy number you need registered on the NPPES system.

** Make sure your clearinghouse has 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.

Steps to Correct Rejections:

1. Check that your group/individual NPI and legacy numbers are on file correctly with you clearinghouse. Be sure you have a group NPI if you have a group legacy number.
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.
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.

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