When submitting a claim for an ambulatory surgical center (ASC), please make sure to follow the Centers for Medicare & Medicaid Services (CMS) billing guidelines. The correct placement for a provider name and the CMS national provider identifier (NPI) is below.
Ambulatory surgical centers billing on CMS 1500s should list the NPI for the ASC in box 24J.
ONLY list the surgeon’s name and NPI in box 17 and 17b.
Inaccurate information in the claim fields may cause us to deny a claim or to pay incorrect amounts.
National provider identifier (NPI)
Previously, we have tried to research an incorrect NPI number submitted on claims. Without clarification to the correct NPI number, we have found there could be downstream impacts. This would include the physician quality reporting initiative (PQRI) or ensuring the correct servicing provider is paid accurately.
To be more efficient in our claims processing, we are changing how we research the incorrectly submitted NPI numbers.
Effective June 18, 2010, we will close the claim and request that the servicing provider submit the correct NPI number. We will communicate this information in a Further Information letter, which may have one of the following statements:
Professional claims
The NPI submitted with this claim does not match the servicing provider name as billed on this claim. Please resubmit with matching NPI and provider name.
The NPI submitted with this claim matches the billing provider name. However it does not match the servicing provider name, which is required. Please resubmit with the appropriate NPI and matching provider name.
The NPI submitted does not reflect the provider specialty per the National Plan and Provider Enumeration System (NPPES) that reflects the services billed. Please resubmit with the appropriate NPI for the servicing provider.
Facility claims
The NPI submitted per NPPES does not match the name billed on the claim. Please resubmit with appropriate and matching NPI and provider.
The NPI submitted per NPPES does not reflect the facility type for the services billed. Please resubmit with the appropriate NPI that reflects the facility type for services provided.
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