Valid National Provider Identifier (NPI) for Medicare Advantage Claims
A valid National Provider Identifier (NPI) number is required when submitting Medicare Advantage claims. CMS validates the billing provider NPI submitted for all professional, institutional, and durable medical equipment (DME) encounters submitted by Medicare Advantage Organizations (MAOs), including CHPW. Encounters with invalid NPIs are rejected.
CHPW follows the process below to ensure the encounters we submit to CMS include valid NPIs.
- We validate NPIs via data obtained from the CMS National Plan and Provider Enumeration System (NPPES), https://nppes.cms.hhs.gov/.
- We deny claims where the submitted billing NPI is not active in NPPES, using message code, “The submitted billing NPI number is not valid per the National Plan and Provider Enumeration System (NPPES)”. Providers may resubmit the claim(s) with a valid NPI.
Questions?
If you have questions for Community Health Plan of Washington, please contact our Provider Relations team at [email protected].
What kind of care do you need? Not every medical issue needs emergency care. If you have a medical issue that doesn’t seem to be life-threatening, but you’re not sure what to do, see if your local Community Health Center clinic or primary care doctor offers virtual care. If they do, they will tell you how to set up your virtual care appointment.
