NPI - Medicare Requirements

As of May 23rd, 2008, Medicare began requiring NPI only transmission on all paper and electronic claims. While all insurance carriers most likely will conform to Medicare's new requirements, it is possible that an insurance carrier, or multiple carriers, will not accept NPI Only claims. Some carriers also might still be requiring both the NPI and Legacy Numbers. MacPractice has released three versions of the CMS-1500 (08-05) form in order to address these three possible scenarios:

  • CMS-1500 (08-05) NPI and Legacy: Prints both NPI and Legacy Numbers if they are filled in; use this form only if requested.
  • CMS-1500 (08-05) Only Legacy: Prints Legacy Numbers only and leaves all NPI numbers blank; use only if insurance company requests it.
  • CMS-1500 (08-05) Only NPI: Prints NPI Numbers only and leaves legacy numbers blank; use this form unless requested to use a different form
Many carriers now accept NPI only claims, so it is recommended you set the CMS-1500 (08-05) NPI Only form as the Default Insurance Claim Form by going to Preferences and selecting Forms in the sidebar.
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