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NPI Rejections (October 3, 2007)

October 3, 2007

Dear Client,

Prime Clinical Systems Inc is receiving a higher than normal number of support calls due to claim rejections from Medicare, Medi-Cal or a clearinghouse for Rendering or Group Provider NPI.  Following are the steps we have been advised by Medicare to follow, which we feel will also apply to Medi-Cal and clearinghouses. 

First: Verify with Medicare EDI (213) 593-6850, Medi-Cal EDI or your clearinghouse the reason for the rejection. 

•  If rejections are not related to your NPI registration, call Medicare, Medi-Cal or the clearinghouse to find the reason for the rejection before opening a reference with Prime Clinical Systems, Inc.

•  If rejections are due to NPI registration issues, please do the following:

If you have registered with the National Plan and Provider Enumeration System (NPPES) and obtained your NPI number:

Print a paper claim for the insurance(s) and provider(s) which is rejecting.

•  Verify the correct information is printing in Box 24J, 25 and Box 33.

•  If the information is wrong, make the appropriate corrections. Check your documentation for help OR call Prime Clinical Systems, Inc.

•  Resubmit the rejected claims.

If the printed claims were correct, verify you are enrolled correctly by going to the NPPES website at www.nppes.cms.hhs.gov.

•  From the following, select: National Provider Identifier (NPI):

If you are a Health Care Provider, the National Provider Identifier (NPI) is your standard unique identifier.

•  From the following, select Login:

Want to View or Update your NPI data? ---------------->Login

•  Complete the login screen:Top of Form

Once you have logged in:

•  Verify the correct Provider Name, UPIN, Tax ID, etc. has been entered

•  If you bill to Medicare, under ‘Other Insurance Information’ you must have checked Medicare.  If not, your NPI information was not forwarded to Medicare and therefore will not be on file with them. Medicare has advised us this is one of the major causes for rejections.

If you make corrections to your NPI registration:

•  Medicare has suggested you wait 48 hours, call Medicare Customer Service at (877)527-6613 and verify they have received the corrected information before resubmitting claims.

•  Check with your Clearinghouse and Medi-Cal for the length of time you should wait to re-transmit claims, and whether you should call them to verify the corrected information has been received.

If you have not enrolled with NPPES:

•  Go to the NPPES website at the NPPES website at www.nppes.cms.hhs.gov

•  From the following, select National Provider Identifier (NPI):

If you are a Health Care Provider, the National Provider Identifier (NPI) is your standard unique identifier.

•  From the following, select Apply Online for an NPI :

Contact Medicare, Medi-Cal and your clearing house to verify whether or not you may transmit claims while you are enrolling for your NPI number.

•  If you may submit claims during your registration process modify the Utility/Insurance <NPI Support> field, changing the setting to N (no) for applicable insurances. 

•  If submitting without NPI information to Medicare: be sure to change both the Medicare and Medi-Medi insurance screens.

•  If submitting without NPI information for ALL your insurances: contact PCS support for assistance.

Questions regarding enrollment for NPI numbers should be directed to NPPES :

Questions on entering your NPI information in Intellect or OnStaff should be directed to Prime Clinical Systems, Inc. at (626) 449-1705.

Prime Clinical Systems, Inc appreciates the assistance you have given by following the above steps when applicable.  By first verifying your NPI registration and contacting the appropriate sources: you have helped reduce the number of reference calls, thereby assisting us and decreasing our response time for calls related to the function of the Prime Clinical Systems, Inc. software products.

Sincerely,

The Support and Training Department

Prime Clinical Systems, Inc.

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