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NPI Not Required on Certain Claims

October 14, 2008:

Influenza or pneumococcal vaccine claims submitted as roster bills need not include a national provider identifier (NPI), according to the Centers for Medicare and Medicaid Services.

This announcement clarifies an already established policy. CMS adopted the August 2005 version of the CMS-1500 form in April 2007 to accommodate the NPI. However, the form does not require an NPI for influenza or pneumococcal vaccine claims submitted as roster bills.

To clarify and ensure compliance with its regulations, CMS has revised chapters 1, 18, and 26 of Pub. 100-04 of the IOM, or internet-only manual. This action was deemed necessary to delete erroneous information, resolve unclear language, and add references to AB Medicare administrative contractors where previously only fiscal intermediaries were recognized.

CMS has informed all Medicare contractors NOT to return claims as unprocessable when a provider does not enter his NPI information into item 24 J of the CMS-1500 form when submitting influenza or pneumococcal vaccine claims as roster bills. Medicare contractors have further been advised to refer to the revised internet-only manuals as applicable.


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