Flaw exposed in new Medicare ID system

The AMA and MGMA ask Medicare's acting chief to hold off on claims rejections until physicians can work out identification mismatches.

By David Glendinning, AMNews staff. Oct. 1, 2007.

Washington -- Thousands of physicians could see Medicare claims delays or rejections because of discrepancies between the program's new identification system and doctors' old ID numbers, said organizations representing physicians and practice managers.

The Centers for Medicare & Medicaid Services instructed carriers starting Sept. 4 to no longer accept claims from physicians whose new ID numbers could not be matched with their older "legacy" numbers in a "crosswalk" file designed to link the old and new IDs. Medicare is in the process of transitioning to a system in which all physicians who submit electronic claims to payers are identified by a national provider identifier, a 10-digit number that eventually will replace UPINs and all other identifiers.

Carriers have encouraged physicians to include both old and new numbers on claims to ease the transition to the new system, but mismatches between claims data and the crosswalk file are still possible.

Because delayed or rejected claims might mean reduced cash flow to practices, CMS should reverse the new policy until physicians and carriers can work out the discrepancies, the American Medical Association and the Medical Group Management Assn. wrote in a Sept. 11 letter to Acting CMS Administrator Kerry Weems.