Legacy Provider Identifiers No Longer Allowed on Crossover Claims
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Legacy Provider Identifiers No Longer Allowed on Crossover Claims

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 required issuance of a unique national provider identifier (NPI) to each physician, supplier and other provider of health care who conducts HIPAA standard electronic transactions.  For a time, the Centers for Medicare and Medicaid Services (CMS) allowed transactions adopted under HIPAA to be submitted with a variety of identifiers:

  • the legacy provider identifiers only,
  • both the NPI and legacy provider identifiers, or
  • the NPI only

Beginning May 23, 2009, legacy identifiers are no longer allowed on any inbound or outbound 837 electronic transactions.  For coordination of benefits 837 crossover claims (in which the DME MAC sends processed claim information to a secondary/supplemental insurer), CIGNA Government Services (CGS) will include the supplier name, address and NPI as submitted on the incoming 837 claim file, as well as the Employer Identification Number/Social Security Number (EIN/SSN).  The EIN/SSN is required, and it must be associated with the reported NPI for the electronic transaction to be accepted. Additionally, the Taxonomy Code will be forwarded to the secondary/supplemental insurer only if it was submitted in the incoming file.  The taxonomy code is not used in Medicare processing, but if submitted, it must be valid according to the Washington Publishing Company Health Care Provider Taxonomy Code Set.

Secondary insurers may reject any claim which does not contain information required for their processing.  To be sure your claims are accepted by the beneficiary's secondary insurer, you must ensure that these items are submitted in accordance with the requirements of both Medicare and the secondary payers.  If you need information regarding the secondary payer's requirements, you would need to contact that insurer's electronic billing department.

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