National Provider Identifier "only" Information Update  09/01/2009

WARNING:  Recent additions of the Corporation or Group NPI may cause payments to be erroneously paid as "OUT OF NETWORK"  - Check Your Vouchers Carefully.

Notice: On October 1, 2009 many clearing houses will require that all legacy numbers be removed from incoming claims. Please DO NOT remove these numbers from the provider tables. The software will do this for you automatically.

1. If you are receiving any "Corporate Crosswalk Error" you must Authorize your NPI numbers with BCBS EDI by using the web based authorization system or by emailing the spreadsheet from the link below. The login and password of the web based system is your BCBS legacy provider number. https://secure.bcbsm.com/bcnnpi/ or you may elect to load this spread sheet and email to: pedmnpiexcelsubmission@bcbsm.com

    Call (248) 486-2292 for assistance from BCBS-EDI. Web NPI Help: BCBS-EDI NPI Help Page

    You must separately authorize NPI's for all the BCBS categories which may be referred to by BCBS-EDI as:      "BL"  = BCBS,  "CI" = Commercial, "MA" = Medicaid and "BN" = Blue Care Network. Please see the BCBS-NPI letter for more details.

2. Register your NPIs with Rail Road Medicare by calling (866) 899-5227 and request the NPI form. The original forms must be filled out and mailed ASAP.

3. Register your NPI with Health Plus of Michigan and any other carrier that does not go directly through the BCBS, THIN, Availity, Emdeon or Health-Point (Anthem) clearing houses.

To check and verify that the NPI numbers are properly associated with legacy numbers,

Click here to use the National NPI search tool or type "NPI" and <Enter> from the Office Medicine MAIN MENU.

4.   DO NOT REMOVE YOUR LEGACY ID NUMBERS - THE SOFTWARE WILL DO THIS AUTOMATICALLY. 

Loading National Provider Numbers Procedure Steps:

For Attending Physicians – General Information Screen.

1. Under the Dictionary/Tables Maintenance Menu, select Provider File Maintenance
2. Bring up each provider number and enter the NPI numbers
3. Enter the NPI specific for this Physician in field #13 “NPI-Main”
4. Enter the Corporation NPI in field #14.
5. Enter the Personal NPI ( if needed ) in field #15

Attending Physicians – Carrier Specific Information

1. For each insurance company with specific requirements regarding the NPI number, perform the following:
2. Click the “INSURANCE” button under each provider.
3. Select the insurance company code as required.
4. Enter the Taxonomy code in field #10, the Physician NPI number in field #11, and the NPI Group/Corp (if any) in field #12

5. Note: Medicaid requires only the individual NPI - Load this into both field #10 and Field #11.

Note: If your practice has a Tax-ID number - You are required to have a CORP ( level 2 ) NPI number. If your practice has multiple locations, you may need a CORP NPI for each location.

  DO NOT REMOVE YOUR LEGACY ID NUMBERS - THE SOFTWARE WILL DO THIS AUTOMATICALLY. 

For Referring Physicians – General Information Screen.

1. Under the Tables/Dictionary Maintenance menu, select referring physician maintenance.
2. Pull up every referring physician as needed and add the NPI number to field #25 with a qualifier of "XX"

Note: Use the little green drop down arrow to search the NPI national database. Copy the NPI number from the website by highlighting the number and then using "Control C",  close the website and paste the number into field #25 with "Control V"

Escape Key to save this record - Perform on each referring physician as needed.

Tip: If you have hundreds of attending physicians to load, use the "Batch Provider PIN UPDATE" utility program located on the Dictionary Tools Menu.

Facility Codes also require an NPI. Fill in the NPI for each facility in the facility table.

To check and verify that the NPI numbers are properly associated with legacy numbers,

Click here to use the National NPI search tool or type "NPI" from the MAIN MENU.

Billing for e-prescribe incentives

STEP 1: Did you bill one of the CPT or HCPCS G-codes listed in Table above for the patient you are seeing? NO: You do not need to report this measure for this patient for this visit. YES: Proceed to Step 2.

STEP 2: You should report one of following G-codes (or numerator codes) on the claim you submit for this Medicare patient for this visit. • If ALL of the prescriptions generated for this patient during this visit were sent via a qualified e-prescribing system: REPORT G8443 • If NO prescriptions were generated for this patient during this visit: REPORT G8445 • If SOME or ALL of the prescriptions generated for this patient during this visit were printed or phoned in as required by state or federal law or regulations, due to patient request, or due to the pharmacy system being unable to receive electronic transmission; OR because they were for narcotics or other controlled substances: REPORT G8446

Note: G8443, G8445 and G8446 must be defined in the procedure code dictionary with a 0.00 Charge amount and the flag "Q" in the flags field.