MedManagement Quarterly

Credentialing

        The May 23rd, 2008 compliance date to submit NPI only is here.  Some providers are still experiencing problems submitting claims. If you have multiple PTANs on file (this is common for providers that have multiple locations) and we are unable to link the NPI to the appropriate PTAN, Palmetto GBA will request additional information from you in order to process your claims. These requests may cause delays in processing your claims.

To avoid or minimize these delays, please take the following steps:

• Ensure that your NPPES data are correct and that the NPPES record(s) contains the Medicare legacy identifier(s) that was assigned to the provider to whom the NPPES record belongs. For example, a physician/practitioner applying for an NPI would list his/her Medicare PTAN in the "Other Provider Identifiers" section of the NPI application, but would not list the PTAN of the group in which he/she is a member. Palmetto GBA uses this information to build the Medicare NPI crosswalk, which is used to process your claims.
• If your NPI and NPPES information are correct and you continue to receive informational NPI messages, rejects or returns, verify that your Medicare enrollment information on file with Palmetto GBA is accurate.
• Consider consolidating multiple PTANs into a single number to ensure a one-to-one NPI to PTAN match. You may collapse PTANs that are assigned to additional locations only if the additional locations are all assigned the same tax identification number (TIN) and are within the same pricing locality.
• To view or edit your NPPES record, go to https://nppes.cms.hhs.gov or call NPI Enumerator at 1-800-465-3203