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NPI Crosswalk Information



May 23, 2008 is the current deadline for NPI compliance. CMS has released this bulletin.
http://www.cms.hhs.gov/nationalprovidentstand/downloads/contingencytipsheet.pdf
it appears that a practice will have to identify all providers (Billing, Performing, Referring, PCP, Facility) by
their NPI and not include secondary identifiers, with exception of the Tax ID on claims sent
after May 23, 2008.

NPI Crosswalk errors and warnings
Most payers that assign their providers a Pin and/or Group number are requiring their
providers to link their NPI(s) to their Pin(s), sometimes called a Legacy Pin, a Practice
that has a Group Pin Assigned by Medicare has to have an NPI for their Practice. linkage is
as follows
Provider's Pin = Provider's NPI
Practice Group Pin = Practice NPI
Medicare started rejected claims on Oct 8, 2007

One issue that has come up is that a provider may be in a group with one payer but not with another.
Example, a provider enrolled with Medicare before forming a PA for his practice and then enrolled in BCBS after.
In this case Medicare set the provider up as a Sole Proprietor and BCBS set the practice up as a Group
and the provider up as a member of that group. Ideally the provider should enroll his practice with medicare.
But to keep the provider from being rejected, IntefaceEDI uses the presence of legacy Pins to determine if the
claim should be billed as a group provider claim. For Texas Medicare (04402), Medicaid (86916) and BCBS (84980),
IntefacedEDI will not send the practices NPI if a legacy PIN exists without a Legacy Group ID. So it is
recommended that a user check the Medisoft Provider information to verify the Default Pins, Default Group and Pins tabs.


For Medicare Part B and Part A
you have to log on to the NPPES website, if the provider applied online then they have a
user id and password for each of their NPIs. if the provider applied my mail, then they can
create a login for their NPI if they forgot their login information, they can call NPPES at
800-465-3203 or check the website for an updated phone number NPPES's website is
https://nppes.cms.hhs.gov/NPPES/Welcome.do
for individual providers, while you are editing your your NPI data, make sure you have your
UPIN in the list, make sure your Medicare Pins are identified as Medicare Pins, not Medicare
Unspecified, make sure they have the correct State also, make note of your Primary Taxonomy
Code, it has to be the same as the Taxonomy Code in the data. Providers with multiple
locations will have to get an NPI for each location, because the address should be the same
as the address in the data. the NPPES website can also be used to search for a provider's
NPI and see the status of the PIN/Provider setup

For Railroad Medicare

contact them to get on their Crosswalk, it is separate from the NPPES database.


For BCBS
go to http://www.bcbstx.com/provider/npi.htm , click on the “Share It” link, if you have a
practice NPI you will enter both NPIs, likewise if you have a BCBS Group Number, you will
enter both the Group Number and Individual PIN
any other questions, the provider should contact BCBS


For Texas TMHP Medicaid
check out this document Texas Medicaid Help

For Medicaid HMO/PPO like Parkland and Amerigroup
contact them to get on their Crosswalk, it is separate from the TMHP database.
It is believed that these insurance carriers do not assign a separate PIN to the
practice, i e put providers in groups. For this reason it is suggested
that a provider put his personal NPI on the crosswalk with these payers.