Effective May 23, 2008, Medicare services will reject any claim containing a "legacy" Medicare ID.  This applies, whether the legacy ID is for the rendering provider, the billing provider, or any referring provider in the claim. 

Providers who are incorporated and have only one legacy provider ID MUST file forms with Medicare Provider Enrollment to have a group number assigned. 

In the past, if a single provider was incorporated, Medicare would normally issue a single provider number for him or her.  Effective May 23, this arrangement will no longer work.

If you are an incorporated provider and have a single provider ID for Medicare, you need to file form 855B with provider enrollment to have your corporation separately enrolled with Medicare.  Unless the deadline is extended, you will not be able to get claims paid without this additional enrollment after May 23, 2008.

What you Need to Do

Sole provider (Unincorporated).  Only a single NPI number is required.  You should immediately remove ANY LEGACY NUMBERS from your system (see below).

Sole provider (Incorporated).  Incorporated sole providers who have a single legacy Medicare ID must submit form 855B for the corporation, as well as an updated form 855I for the individual provider.  This should be done IMMEDIATELY.  You need to have an NPI number for the corporation and an NPI number for the individual provider.  Each of these MUST BE ENROLLED at Medicare and Medicaid.  Following is the relevant text from the Detailed Instructions document so you can determine whether this applies to your practice:

Thus, if you want your checks to be payable to your corporation, you should complete this enrollment process for Medicare.  In the past, this would not have been necessary.

Group Providers (All).  If the group already has a separate legacy provider number, you must have an NPI for the group and, of course, one for each individual provider.  You should IMMEDIATELY remove all legacy provider numbers from your system (see below).   

Removing Legacy Provider Numbers

If you are using Medisoft, the only way you can know whether your claims are NPI compliant is to remove any legacy provider numbers from your system.  Otherwise, you will not know whether your claims are currently being paid because of the presence of legacy provider numbers, or because the NPI information is correctly set up and entered.  So, as soon as possible, you should remove all legacy numbers from your system to be sure that claims will be paid without them. 

To remove your legacy numbers from Medisoft, you must do the following:

a) For each provider in the provider list, edit the provider record and remove any legacy numbers from the "Default PINS" tab, the "Default Group IDs tab", and the PINs tab.  On the PINs tab, it is essential that you blank out all four fields on the line -- the PIN, Qualifier, Group ID, and Group ID Qualifier.  This should be done for BCBS, Medicare, and Medicaid immediately.  Others are less critical at this time.

b) From the Referring Physicians list, for each referring physician, the Default PINS tab should contain the tax id number and "National Identifier" (NPI) only.  The UPIN and all other legacy information should be removed.  If the PINs tab contains any information, remove it.

Removal of these items now is essential so that you can know now that your claims are being processed based on NPI information and not based on any legacy information.  Otherwise, you may not find out about a problem until May 23, and as a result, you could be delayed in submitting any claims.

Medicare Provider Enrollment Contact Information

For our support customers, we are glad to help in any way we can with this process.  However, Medicare Provider Enrollment is your best resource.  They can be contacted by phone at (866) 582-3251.