New Fiscal Intermediary Shared System Edit to Validate Attending Provider NPI - Phase 2 - Revised

MLN Matters Number: MM12889 Revised
Related CR Release Date: October 6, 2022
Related CR Transmittal Number: R11633CP & R12107CP
Related Change Request (CR) Number: 12889 & 13219
Effective Date: April 1, 2023
Implementation Date: April 3, 2023 – CR 12889 and January 2, 2024 – CR 13219

Note: CMS removed type of bill 71X (Rural Health Clinic) claims as an exception and added over-the-counter (OTC) HCPCS K1034 claims, MAC adjustments, and claims with AB modifier on all lines to the exceptions list (pages 2-3). Substantive changes appear in dark red.

CR 12889 tells you about:

  • A new consistency edit that validates the attending provider NPI
  • Organizational NPIs can’t be used in place of individual NPIs, unless exception conditions are met.

Make sure your billing staffs are aware of these changes.

View the complete CMS Medicare Learning Network (MLN) Matters (MM)12889.

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