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ARTICLE

Date ArticleType
3/6/2017 Payment/Reimbursement
CoreMMIS – Be Sure to Include the Attending Physician NPI on Claims

It has come to our attention, through the great work of Sherri Hampton, that there is a significant change in the system edits regarding the Physician NPI on nursing facility claims.  To avoid future recoupment from Medicaid, it is imperative that you check your claims to ensure the attending physician NPI is included on the claim.

Previously in Web Interchange the Physician NPI filed was a mandated field (meaning claims would not process without it).  Now with CORE MMIS the field is not mandated, but it is nevertheless a required for Long Term Care Room & Board claims.  This means that a claim could be processed and paid even if the NPI is not on the claim, but this also means that such claims are not considered accurate and without an NPI the claim could be subject to future recoupment.

We have asked the CORE MMIS team to place an edit mandating the use of the Attending NPI, but this will not be done immediately as not every provider type who submits claims on a UB format is required to submit the NPI.  Essentially, they are only mandating fields required for every provider type.  CORE MMIS team did feel pretty confident eventually they will have an edit in place to not allow the Long Term Room & Board Care claim to process without a physician NPI.  Until then, be vigilant to ensure the NPI is on your claims.

For crossover claims the attending Physician NPI is not required - only your typical LTC Room & Board claim require the NPI.