Valid NPI for Medicare Advantage Claims

Valid National Provider Identifier (NPI) for Medicare Advantage Claims

A valid National Provider Identifier (NPI) number is required when submitting Medicare Advantage claims. Previously, CHPW placed a hold on claims and searched our claims system for a valid NPI for the attending provider. If a valid NPI was found, the claims were released from hold and processed as usual.

CHPW received notification that the Centers for Medicare and Medicaid Services (CMS) is implementing software changes to its systems for accepting and processing encounter data. CMS will validate the billing provider NPI submitted for all professional, institutional, and durable medical equipment (DME) encounters submitted by Medicare Advantage Organizations (MAOs), including CHPW, for all dates of service (DOS) from 01/01/2011 forward. Encounters with invalid NPIs will be rejected.

Read more about CHPW’s process for CMS claim submissions.

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Doctors in an emergency room with patient,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, you can call our Nurse Advice Line for help. They can help you decide if you should see a primary or urgent care doctor. The Nurse Advice Line is free and available 24/7 for members at 1-866-418-2920 (TTY Relay: 7-1-1).

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