Denial Reason, Reason/Remark Code(s)
- N257: Information missing/invalid in Item 33 - Missing/incomplete/invalid billing provider supplier primary identifier
- N290: Information missing/invalid in Item 24J - Missing/incomplete/invalid rendering provider primary identifier
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..
- 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.
- 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.
- 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.