If your claims are being successfully processed with NPI/legacy pairs, begin sending a small batch of claims with NPI alone, according to the Centers for Medicaid and Medicare (CMS).

If the Medicare NPI Crosswalk cannot match your NPI to your Medicare legacy number, the claim with an NPI-only will be rejected. If the claim is processed and you are paid, continue to increase the volume of claims sent with only your NPI. If the claims are rejected, CMS advises you go into your NPPES record and validate that the information you are sending on the claim is consistent with the information in NPPES. Go to: https://nppes.cms.hhs.gov/NPPES/Welcome.do or call (800) 465-3203. If the information is different, make the updates in NPPES and resend a small batch of claims 3-4 days later. If your claims are still being rejected, you may need to update your Medicare enrollment information to correct this problem.

According to CMS, if you bill Medicare using a billing service or clearinghouse, you should work with them to establish a way to try sending NPI-only claims. It may be difficult for some of these 3rd party vendors to send small batches of your NPI-only claims and continue sending NPI and Legacy claims as well, so contact them and develop an alternative solution so you can try NPI-only.

Provided by Carol Monaco, American Osteopathic Association