NPI and Medicare Crossover Claims

If you have not reported your National Provider Identifier (NPI) to Wellmark, your Medicare crossover claim payments may be affected in May.

The CMS NPI contingency plan will end on May 23, 2008. At that time, Medicare claims released for crossover to a secondary payer will report only the NPI as the Medicare provider identifier.

In addition, adjusted Medicare claims will no longer cross over to a secondary payer if the original claim was not submitted to Medicare with a valid NPI.

If the NPI reported on the crossover claim differs from the NPI Wellmark has on file, or if you have not reported your NPI to Wellmark, it may be difficult for us to identify you for payment purposes.

When this situation occurs:

• Claim payments for Medigap (e.g., Senior Blue^®) members will process with a default provider number. A separate check will be issued for each claim processed.
• Claim payments for Medicare “Carveout” (e.g., employer group coverage) and Federal Employee Program members will be delayed as we attempt to positively identify the provider on the claim.

CMS expects to include, on Medicare crossover claims, other legacy provider identifiers (such as Blue Cross and Blue Shield and Medicaid) submitted by the provider. However:

• Both numbers must be valid, matching the information in our provider records.
• Wellmark does not update provider records using claims information. Because this information is used to process claims and direct payment, a provider is required to report his or her NPI to Wellmark in writing.

To avoid delays in payment or the added administrative handling of individual checks, report your NPI today.

Please Note: Although CMS is lifting the contingency plan, Wellmark will continue to accept both NPI and legacy provider numbers on claims. We will notify you in advance when this changes.

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