Dynamic List Information
Dynamic List Data
Date
Subject
Medicare HETS Eligibility System - Information Bulletin - National Provider Identifier (NPI) & Medicare
User Community
HETS 270/271
Medicare HETS Submitters:
This note is to address erroneous information that submitters are relating to Medicare providers and/or suppliers. Specifically, CMS is aware that providers and/or suppliers are being told that their NPI is "terminated" in cases where the NPI is not associated with an active Fee For Service (FFS) Medicare provider or supplier.
The NPI is not terminated; the NPI is simply not associated with an active FFS Medicare provider or supplier and therefore should not request Medicare eligibility information.
HETS submitters are required to submit a valid FFS Medicare provider or supplier NPI number on each eligibility request. All NPI numbers submitted to HETS must be verified against the Medicare NPI Crosswalk. If an NPI number is ineligible for use with HETS that does not necessarily mean the NPI itself is "invalid" " it does mean, however that the Medicare NPI Crosswalk cannot successfully tie the NPI number to an active FFS Medicare Provider. The NPI number is not eligible for use with the HETS Eligibility System until the crosswalk issue is resolved.
When an NPI number cannot be fully matched in the Medicare NPI Crosswalk, the FFS Medicare provider or supplier will need to correct all issues with their Medicare provider enrollment record. Clearinghouses cannot resolve Medicare NPI Crosswalk issues for their customers " the provider or supplier will need to resolve these issues.
Medicare Customer Assistance Re: Eligibility (MCARE) Help Desk
1-866-324-7315
This note is to address erroneous information that submitters are relating to Medicare providers and/or suppliers. Specifically, CMS is aware that providers and/or suppliers are being told that their NPI is "terminated" in cases where the NPI is not associated with an active Fee For Service (FFS) Medicare provider or supplier.
The NPI is not terminated; the NPI is simply not associated with an active FFS Medicare provider or supplier and therefore should not request Medicare eligibility information.
HETS submitters are required to submit a valid FFS Medicare provider or supplier NPI number on each eligibility request. All NPI numbers submitted to HETS must be verified against the Medicare NPI Crosswalk. If an NPI number is ineligible for use with HETS that does not necessarily mean the NPI itself is "invalid" " it does mean, however that the Medicare NPI Crosswalk cannot successfully tie the NPI number to an active FFS Medicare Provider. The NPI number is not eligible for use with the HETS Eligibility System until the crosswalk issue is resolved.
When an NPI number cannot be fully matched in the Medicare NPI Crosswalk, the FFS Medicare provider or supplier will need to correct all issues with their Medicare provider enrollment record. Clearinghouses cannot resolve Medicare NPI Crosswalk issues for their customers " the provider or supplier will need to resolve these issues.
Medicare Customer Assistance Re: Eligibility (MCARE) Help Desk
1-866-324-7315