Update your NPI information before the Medicare transition to Noridian July 9, 2013 Medicare Medicare, NPI, Noridian 0 According to a new report by the U.S. Department of Health & Human Services Office of the Inspector General, 58 percent of the databases used to determine provider identities and help to prevent the occurrence of fraud are inaccurate or incomplete. The National Plan and Provider Enumeration System (NPPES), which houses National Provider Identifier (NPI) numbers, is not always consistent with information in the Provider Enrollment, Chain and Ownership System (PECOS). The national revalidation effort by the Centers for Medicare & Medicaid Services (CMS) is a big step in improving the accuracy of Medicare provider enrollment data. This effort has helped bring awareness to physicians of the importance of updating their records in a timely manner when addresses, organizational structure, key contacts, phone numbers, etc. change. However, few physicians think to update their NPI record to ensure it stays as current as their enrollment. Accurate data in NPPES could help expedite the revalidation process. Transition of the Medicare Administrative Contractor from Palmetto to Noridian will occur on September 16, 2013. According to Noridian, the number one reason for problems during similar transitions is inaccurate NPI data in the NPPES system. While every effort is being made to ensure a smooth transition, if a question is raised about an enrollment record, accurate data in NPPES may help resolve it without further intervention becoming necessary. Accurate information in NPPES is also important for proper claims administration. When CMS implements edits for ordering/referring physician information, the NPPES database maintains the search tool that rendering providers will use to find the NPI necessary for claim payment in the event they cannot reach the ordering physician. A key to finding the correct physician is accurate information in that database. Protect yourself from the possibility of delays, or potential occurrences of fraud, by ensuring your information is current. Add the updating of NPPES to your list of items to check each time you make a change, or at least annually. Updates can be made on the NPPES website. Comments are closed.
