National Plan and Provider Enumeration System (NPPES) FOIA-Disclosable Data to be Available on September 4, 2007
NPPES health care provider data that are disclosable under the Freedom of Information Act (FOIA) will be disclosed to the public by the Centers for Medicare & Medicaid Services (CMS). In accordance with the e-FOIA Amendments, CMS will be disclosing these data via the Internet. Data will be available in two forms:
- A query-only database, known as the NPI Registry
- A downloadable file
CMS has extended the period of time in which enumerated health care providers/suppliers can view their FOIA-disclosable NPPES data and make any edits they feel are necessary prior to our initial disclosure of the data. CMS will be making FOIA-disclosable NPPES health care provider/supplier data available beginning Tuesday, September 4, 2007. The NPI Registry will become operational on September 4 and the downloadable file will be ready approximately one week later.
CMS has posted several documents to help providers/suppliers understand what the downloadable file will look like, including a 'Read Me' file, Header File and Code Value document for the downloadable file on the CMS NPI Web page.
Important Information for Medicare Providers/Suppliers
Starting September 3, 2007, Medicare Carriers and DME MACs will begin transitioning their systems to start rejecting claims when the NPI and Legacy Provider Identifier cannot be found on the Medicare Crosswalk
Since May 29, 2007, Medicare Fiscal Intermediaries, as well as Part B CIGNA Idaho and Tennessee, have been validating NPIs and Legacy Provider Identifier pairs submitted on claims against the Medicare NPI Crosswalk.
Between the period of September 3, 2007, and October 29, 2007, all other Part B carriers and DME MACS will begin to turn on edits to validate the NPI/Legacy pairs submitted on claims. If the pair is not found on the Medicare NPI crosswalk, the claim will reject. Contractors have been instructed to inform providers/suppliers at a minimum of 7 days prior to turning on the edits to validate the NPI/Legacy pairs against the Crosswalk.
If you are receiving informational edits today, we strongly urge you to validate the NPPES has all of the NPI and legacy numbers you intend to use on claims and for billing purposes. If NPPES is correct and you continue to receive information edits, you should ask your contractor to validate the provider/supplier information in their system. If the contractor information is not correct, you may be instructed to submit an enrollment form or CMS-855. Please include all of your NPI/Legacy numbers in NPPES and all of your NPIs that are to be used in place of your legacy on the CMS-855. Please note that the NSC does not transmit NPI information to any contractors. If the information is different in the two systems, there is a very good chance your claim will reject. NPPES data may be verified at https://nppes.cms.hhs.gov.
Transcript for August 2nd Roundtable Now Available
The transcript for the August 2nd, Medicare FFS Q&A Session: Common Billing Errors, Roundtable (PDF, 167 KB) is now available on the CMS NPI page.
Reminder: Recent MLN Matters Articles
Several recent Special Edition MLN Matters articles contain important billing information for Medicare providers and suppliers including:
- View the MLN (PDF, 162 KB) on how to use the NPI correctly on Part A and Part B claims
- View Information (PDF, 94 KB) on use of the NPI on the new CMS 1500 and UB-04 Forms
Still Confused?
Not sure what an NPI is and how you can get it, share it and use it? As always, more information and education on the NPI can be found through the CMS NPI Web page on the CMS Web site. Providers/Suppliers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at (800) 465-3203.
Getting an NPI is free and not having one can be costly.