Having problems? Need help?

Cash flow / Claims interruptions problems?

In order for a payer to be able to continue successfully paying your claims once you begin using the NPI, their systems must be able to "match" your old legacy number to your new NPI number, a process which involves a number of complexities.  If a payer you do business with has asked you for your NPI, they have done so because they need it in order to facilitate claims processing.  Physicians should contact their payers if they are experiencing problems.

Physicians who bill Medicare

On March 1, 2008 Medicare stopped accepting claims submitted with just a legacy number.  Claims must contain either an NPI number accompanied by a legacy number OR they must contain just an NPI number.  After March 1, several physicians experienced cash flow and claims processing interruptions since Medicare was unable to successfully match their legacy number to their NPI number.  In many cases, Medicare requires physicians to re-enroll in order to help them establish a good "match."

If you are submitting claims with both an NPI and a PIN, unless Medicare is able to "match" the new NPI number(s) to your old legacy number(s) in their systems, your claims will reject.  What this means is an "individual" PIN should only be submitted on a claim along with an "individual" NPI (also known as a "Type I" NPI); and a "group" PIN must only be submitted with a "group" NPI (also known as an "organization" or "Type II" NPI).

Whether your practice is incorporated or not plays a significant role in whether Medicare can appropriately match your old legacy number to your new NPI number.

• Single Incorporated Physicians: For the purposes of Medicare, these physicians are considered a "group" and thus should have two Medicare pins and two NPI numbers – one each for themselves and one for their corporation.
• "Sole proprietors": Medicare considers these physicians to be single practitioners who are not incorporated and where the physician owns all the assets and is solely responsible for the liabilities. 
• Physicians in group practice: Physicians in a group practice with must have an NPI for themselves and the group would have one for itself.  

What to do if your claims began rejecting after March 1, 2008?  (PDF, 24KB)