Provider Action Needed
Impact to You
The Centers for Medicare & Medicaid Services (CMS) is issuing this Special Edition (SE) 0751 article to clarify the type of assistance that the NPI Enumerator can and cannot provide to health care providers.
What You Need to Know
CMS is providing this information so you and your staff will know what issues should be referred to the NPI Enumerator and to identify issues on which the NPI Enumerator will not be able to help you. This will save you valuable time in resolving your Medicare questions.
What You Need to Do
Please share this information with your office staff.
Background
The NPI Enumerator is responsible for assisting health care providers in applying for their NPIs and updating their information in the National Plan and Provider Enumeration System (NPPES). The NPI Enumerator's responsibilities include:
- Processing NPI applications/updates/deactivations
- Providing blank NPI application forms to health care providers upon request
- Assisting health care providers with questions or problems regarding the processing of their NPI applications, updates or deactivations (Web-based or paper)
- Resolving errors on applications/updates/deactivations
- Investigating potential duplicate applications/updates/deactivations to ensure the uniqueness of the provider
- Resetting web users' NPPES passwords
- Tracking NPPES accessibility and reporting NPPES inaccessibility issues to the CMS
- Maintaining a call center for health care providers' questions regarding NPI application processing
- Working with Electronic File Interchange Organizations (EFIOs) (approval of EFIOs, resolving problems with EFI files)
Health care providers needing the above types of assistance may contact the NPI Enumerator at (800) 465-3203, TTY (800) 692-2326 or e-mail the request to the NPI Enumerator at
CustomerService@NPIEnumerator.com. Please note that application processing times may vary based on current inventories. Please allow 15 working days to process your application/updates before contacting the NPI Enumerator.
Health care providers should not contact the NPI Enumerator for the following issues:
- The NPI Enumerator cannot provide assistance with the Medicare NPI Crosswalk and Medicare claims processing issues
- The NPI Enumerator does not generate, maintain or have access to the Medicare NPI Crosswalk
- The NPI Enumerator does not have the means/authority to alter/add/remove any information on the Medicare NPI Crosswalk
- The NPI Enumerator cannot report problems to CMS or to the Medicare Fee-for-Service contractors concerning the Medicare NPI Crosswalk or claims processing problems
- The NPI Enumerator does not send updates to the Medicare NPI Crosswalk
- The NPI Enumerator does not know how/when the Medicare NPI Crosswalk will be updated
- The NPI Enumerator cannot advise a provider as to how to complete the paper or electronic claim
- The NPI Enumerator cannot tell a provider how many legacy numbers to report on the NPPES record in order to assist in populating information on the Medicare NPI Crosswalk
- The NPI Enumerator cannot provide assistance with information disseminated or not disseminated via the NPI Registry or the NPPES downloadable file
- The NPI Enumerator cannot assist providers with questions regarding 'temporarily suppressed' information found on the NPI Registry or downloadable file
- Although the NPI Enumerator can confirm whether or not the information still exists in the provider's active NPPES record; this confirmation is limited to the health care provider or contact person on the provider's NPPES record. Third party sources, including Medicare contractors, cannot call the NPI Enumerator for confirmation of information in a health care provider's NPPES record. If this type of confirmation is needed, the third party should request the information from the provider directly.
- The NPI Enumerator cannot provide assistance with Medicare-related provider enrollment information
- The NPI Enumerator cannot determine how providers are enrolled with Medicare (e.g., as an individual or as a group)
- The NPI Enumerator cannot determine which identifiers (Unique Physician Identification Number (UPIN), Provider Identification Number (PIN), Online Survey Certification and Reporting System (OSCAR) or National Supplier Clearinghouse (NSC)) should be included on health care providers' NPPES records
- The NPI Enumerator has no way of knowing which type(s) of legacy number(s) were assigned to a provider by the Medicare contractor(s)
- The NPI Enumerator cannot tell a provider how many legacy numbers to report on the NPPES record in order to assist in populating information on the Medicare NPI Crosswalk
- The NPI Enumerator cannot provide assistance with NPI-to-legacy number linkages (i.e., how to properly link multiple legacy numbers to one NPI or how to properly link one legacy number to multiple NPIs)
The NPI Enumerator cannot provide assistance with questions related to:
- Defining subparts
- Which subparts should receive NPIs
- Where NPIs or legacy identifiers are to be placed in claims transactions
- Health Insurance Portability and Accountability Action (HIPAA) regulations or regulatory policies
- Proper use of NPIs in transactions with health plans
- Determining if the provider is a sole proprietor or an incorporated individual
Additional Information
CMS advises providers to read the information on the CMS NPI Web site. Included on this site are NPI Frequently Asked Questions and Answers that can assist you with issues for which the NPI Enumerator is not responsible.
In addition, the NPI Application/Update form itself is also a good source of information. Providers should refer to the instructions (they are part of the form) for clarification on information to be submitted in order to obtain NPIs or update their records. You can also refer to the 'Application Help' tab located on the NPPES Web site for additional assistance when you are online.
If you have questions, please contact our Provider Contact Center at our toll free number at (866) 332-7025 for Ohio and West Virginia or (888) 828-2092 for South Carolina.