Denial Reason, Reason/Remark Code(s)
· M389, M390, M391, and M392. These messages are reminders.
o If you receive one of these messages and you are certain that your claim was submitted with an NPI, you may wish to contact your clearinghouse or billing agent to ascertain the reason behind the message. It is possible that the clearinghouse or billing agent removed the NPI prior to submitting the claim to Medicare. You may also want to call Palmetto GBA to ask about the message and how you can correct future claims.
The informational warnings consist of one or more of the following messages:
| Edit |
Field |
Description |
Explanation |
| M389 |
2010AA NM108 |
Billing Provider Identification Code Qualifier: Invalid value |
The edit sets when the 2010AA loop and NM1 are submitted but NM108 does not contain XX.
If the claim contains a 2300 REF01 = P4 and REF02 = 31 (VA claim), the edit does not set. |
| M390 |
2010AB NM108 |
Pay To Provider Identification Code Qualifier: Invalid value |
The edit sets when the 2010AB loop and NM1 are submitted but NM108 does not contain XX.
If the claim contains a 2300 REF01 = P4 and REF02 = 31 (VA claim), the edit does not set. |
| M391 |
2310B NM108 |
Claim Level Rendering Provider Identification Code Qualifier: Invalid value |
The edit sets when the 2310B loop and NM1 are submitted but NM108 does not contain XX.
If the claim contains a 2300 REF01 = P4 and REF02 = 31 (VA claim), the edit does not set. |
| M392 |
2420A NM108 |
Detail Level Rendering Provider Identification Code Qualifier: Invalid value |
The edit sets when the 2420A loop and NM1 are submitted but NM108 does not contain XX.
If the claim contains a 2300 REF01 = P4 and REF02 = 31 (VA claim), the edit does not set. |
Resolution/Resources:
Each NPI must match one Provider Transaction Access Number (PTAN) on the NPI crosswalk file.
· Step 1: if you use a clearinghouse or billing service, find out if they have had communication with Palmetto GBA about NPI claim rejections. They may have important information that will help you resolve these claims.
· Step 2: verify the information on file with the NPI Enumerator. Call the NPI Enumerator at 1-800-465-3203 or access their Web site to verify your information: https://nppes.cms.hhs.gov/NPPES/Welcome.do.
o Pay special attention to the following fields in your NPPES record:
- Each 'sole proprietor' should have an Individual (Entity Type 1) NPI, not an Organization (Entity Type 2) NPI.
- List your correct, current Railroad Medicare PTAN (PIN) in the 'Other Provider Identifiers' section of your NPI application, as a Medicare ID. This should include your Railroad Medicare IDs.
o If your NPI matches a PTAN that you no longer use (e.g., an old practice location), obtain and complete a new CMS-855 application and mail to your local carrier
· Step 3: if you are continuing to receive claim rejections after verifying information on file with the NPI Enumerator, verify the information you have on file with your local carrier. Changes in this information require that you complete a new CMS-855 application.
o Pay special attention to the Taxpayer Identification Number (TIN), which is used to report your income to the IRS on Form 1099.
· Step 4: be aware of NPIs submitted for ordering/referring providers and attending/operating/other/service facilities.
o Palmetto GBA will accept claims submitted with PTANs in these fields for claims submitted prior to May 23, 2008.
o If you are submitting NPIs in these fields, the NPIs must be valid. You may access the CMS NPI Registry to obtain these numbers: http://www.cms.hhs.gov/NationalProvIdentStand/06a_DataDissemination.asp.