What to do if Claims Are Rejected

What to do if your 837P and CMS-1500 Claims are Rejected

•     Check your record in the National Plan and Provider Enumeration System (NPPES)
  •         Validate that the legacy identifier sent on the claim is reported in the provider/supplier’s NPI Registry record. If the legacy identifier is not there, instruct the provider/supplier to add it.
     
  •         Validate that the Legal Business Name (if the provider/supplier is an organization) or the Legal Name (if the provider/supplier is an individual or a sole proprietorship) is correct.
     
  •         Validate that the correct Entity type was selected by the provider/supplier when applying for the NPI. Individuals obtain an NPI as Entity Type 1. Organizations obtain an NPI as Entity Type 2 NPI.
    
    (Note: If you enumerated through the EFI alternative, you should use the NPI Registry to check the content of the NPPES file. Make sure to have the Customer Service Representative at your Medicare contractor verify your TIN/EIN as the NPI Registry does not list this information.)
     
•     If these claims are still rejecting, call your Medicare Contractor
  •         Have a copy of the NPPES record in hand. A copy of the NPPES record can be obtained online at https://nppes.cms.hhs.gov. The Employer Identification Number or Social Security Number will not be shown on this print out.
     
  •         Have the claim reject number and message
     
  •         Be prepared to give the following information:
     

1.             Legal Business Name of the Organization
    
2.             Contractor Tracking Number (if known)
    
3.             Approximate date (month/year) when the 855 enrollment application was submitted
    
4.             Provider/Supplier Tax Identification Number or Social Security Number (SSN)
    
5.             National Provider Identifier (NPI)
    
6.             Medicare legacy Identifier
    
7.             Practice location on claim (i.e. where is the practice located (e.g. 100 Main St. New Orleans, LA)
    
8.             Contact Information where Provider/Supplier can be reached if further discussion is needed