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March 27, 2018

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CMS to Reject Electronic Claims with Legacy Numbers

October 30, 2007:
The Centers for Medicare and Medicaid Services (CMS) has instructed contractors to begin rejecting Health Insurance Portability and Accountability Act (HIPAA) inbound claims if they contain legacy provider identifiers beginning January 8, 2008. However, if the shared system analysis work that will occur in January 8, 2008, is not completed, CMS provides an alternate date of April 4, 2008.

CMS requires that Medicare fee for service (FFS) claims contain a national provider identifier (NPI) but at the present time allows both NPI and legacy identifiers. When CMS ends its contingency, the legacy number will NOT be permitted on any inbound electronic or outbound electronic transactions (there are exceptions to the 835 remittance). Contractors will begin rejecting electronic claims, including direct data entry (DDE), that contain a legacy provider identifier for any primary provider as indicated above. Since the paper claims are not HIPAA transactions, these requirements do not apply to paper; however, providers should not send legacy numbers on paper claims once CMS ends its NPI contingency.

HIPAA required issuance of a national provider identifier to each physician, supplier, and other provider of health care who conducts HIPAA standard electronic transactions. CMS began to issue NPIs on May 23, 2005. The agency has been allowing transactions adopted under HIPAA to be submitted with the following identifiers:
  • NPI only
  • Medicare legacy only
  • NPI and legacy combination
Deborah C. Hall
Clinical/Technical Editor


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