FYI-Common Errors that May Result in Claim Rejections
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FYI-Common Errors that May Result in Claim Rejections

Errors in Employer Identification Number (EIN), or Tax ID (TIN).  As a reminder, providers that are organizations are required to report the EIN when they apply for an NPI (on-line, paper, and EFI).  That EIN might or might not also be the TIN.  With the revised CMS-10114 (to be used beginning July 10, for on-line, paper, and EFI), organizations that are subparts will be required to report the LBN of their "parent” and the "parent's” TIN.  The applicant will continue to be required to report its EIN.If the EIN error is on the Medicare record, the provider should submit a CMS-855 to correct.

Invalid or incomplete data within the ‘Other Provider Identifiers' section of the NPPES online application, such as:

  • The absence of the Medicare Identification Number/Provider Number,
  • Not having the ‘Type' listed as Medicare fora Medicare Identification Number/Provider Number, and or
  • Having extra Medicare Identification Numbers/Provider numbers that shouldn't belinked to the NPI of the applicant.

Delays in reporting Change of Ownership.  Whenever there is a change of ownership, the provider is responsible for reporting that change to the appropriate Medicare contractor within 30 days.  Providers are supposed to report that change on the CMS-855.

The Centers for Medicare and Medicaid Services (CMS) is currently working on a special edition MLN Matters article regarding verifying NPPES data and correct billing for Medicare claims.  This article will be announced as soon as it is available.

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