NPI Critical Dates

This special edition article: SEO802 (PDF), is being provided by CMS in order to clear up some confusion that providers are experiencing regarding the March 1, 2008 implementation of the NPI on professional claims, and the May 23, 2008 requirement for ONLY the NPI on all HIPAA electronic transactions and their paper versions.

The following charts illustrate expected claim results for different identifiers, or combinations of identifiers, submitted in the primary provider fields on the Medicare FFS 837P and CMS-1500.

Prior to March 1, 2008 Ð 837P and 1500 Claims, Primary Provider Fields

As of March 1, 2008 Ð 837P and 1500 Claims, Primary Provider Fields

May 23, 2008 and Beyond – All Providers, All Transactions**, Both Primary and Secondary Provider Fields

*Claims will reject when there is not a match on the Medicare NPI Crosswalk. You must correct any data which may be preventing an NPI/legacy match on the NPI crosswalk. The correction might require that you file a CMS-855 Medicare Provider Enrollment form with your Medicare carrier, A/B MAC, or DME MAC a process which can take a number of months to accomplish.

**HIPAA electronic transactions (837I, 837P, 837COB, NCPDP, 276/277, 270/271, and 835), paper claims and SPR remittance advice.