This BadgerCare Plus Update gives information about the use of National Provider Identifiers (NPIs) and Medicaid provider numbers on 837 Health Care Claim: Professional transactions submitted to Medicare for dual eligibles and the requirements for successful automatic crossovers. This Update also reminds providers to obtain an NPI and report it to BadgerCare Plus.
This information pertains to the use of National Provider Identifiers (NPIs) and Medicaid provider numbers on 837 Health Care Claim: Professional (837P) transactions submitted to Medicare for dual eligibles and the requirements for successful automatic crossover. Providers are reminded that they will need to obtain an NPI and report it to BadgerCare Plus.
Note: Providers submitting 837P transactions are reminded that they must continue to include their Medicaid provider number on the transaction in order for the claim to crossover to BadgerCare Plus.
Automatic Professional Crossover Claims
Medicare has announced that as of March 1, 2008, 837P claims submitted to Medicare without an NPI in fields identifying the primary provider (i.e., billing and pay-to) will be rejected.
Providers submitting 837P transactions to Medicare must continue to include their Medicaid provider numbers on the transaction in order for the claims to cross over to BadgerCare Plus. Electronic Medicare crossover claims submitted without the Medicaid provider number may be denied, may not crossover properly, or may process incorrectly.
Refer to the Wisconsin Medicaid Companion Documents for the 837P Health Care Claim Implementation Guide, loop 2000B/2010AA, “Subscriber Hierarchical/Billing Provider Name,” for guidance on where to indicate the billing provider number and loop 2320/2330E, “Other Subscriber Information/Other Payer Rendering Provider,” for guidance on where to indicate the Medicaid rendering/performing provider number on electronic Medicare crossover claims.
Submission of National Provider Identifiers to BadgerCare Plus
Providers are reminded that BadgerCare Plus will require all BadgerCare Plus-certified health care providers to obtain an NPI and report it to BadgerCare Plus. Refer to the July 2007 Updates (2007-53 and 2007-54), respectively titled “Wisconsin Medicaid Will Require National Provider Identifiers for All Health Care Providers,” and “Wisconsin Medicaid Is Now Collecting National Provider Identifiers,” for information on obtaining and reporting NPIs to BadgerCare Plus. BadgerCare Plus needs to have NPIs for all certified providers for NPI compliance.
