Report Both NPI and Medicare Legacy Identifier On Claims

Since October 2, 2006, you have been encouraged to submit both the NPI and Medicare legacy identifier (PIN) on your claims. During this timeframe you were not penalized for invalid NPI/legacy ID combinations.

Medicare carriers will begin editing the NPI/legacy ID combinations for validity against the NPI crosswalk file. Where a match cannot be located on the crosswalk, claims will be rejected or returned to you.

When the claim is returned, you should first verify that the correct NPI was submitted. If correct, you will need to verify that your legacy identifier (PIN) number corresponds with the information on file with the National Plan and Provider Enumeration System (NPPES). NPPES data may be checked on line at: https://nppes.cms.hhs.gov.

If your NPPES information is correct and you have included and matched ALL Medicare legacy identifiers with a corresponding NPI in NPPES, but you are experiencing provider identifier problems with your claims that contain an NPI, you may need to submit a Medicare enrollment application (i.e., the CMS-855). Please contact Customer Service at 877-527-6613 if you need more information.