Direct Data Entry (DDE) Screen Changes for National Provider Identification (NPI)
Per Change Request 4023, effective October 2, 2006 DDE and EDI providers can start billing claims with the NPI number. The Oscar provider number and/or NPI number and the physician Unique Physician Identification Number (UPIN) and/or NPI number can be submitted on claims between October 2, 2006 and May 23, 2007. Providers billing claims with only their NPI number, will have their claims returned to the provider, if their NPI does not have a one to one relationship with the Oscar number.
DDE users will see on claim page 01 the field labeled “Provider” has changed to “Oscar”. This field is where the Oscar/provider number is entered and a new field labeled “NPI”, to enter the provider’s NPI number. There is an added field on claim page 03, to allow the billing of the physician’s NPI number. This field is located after the UPIN number.
In addition to the claim, an NPI field has also been added to the following screens –
- DRG (Pricer/Grouper) Inquiry
- Claims Summary Inquiry
- Claim Count Summary
- Check History
- Roster Bill Entry
- Therapy attachments
- Ambulance attachment
- ESRD CMS-382 Form
An NPI field has also been added to the paper 050 (Claims returned to Provider) and 201 (Summary of Pending Claims) reports.
DDE users with access to only one oscar provider number will now need to enter the oscar provider number in the system when requesting information, such as claims inquiry. The system no longer will default to the oscar provider number.
Please note, WPS Medicare employees are unable to give the NPI numbers to providers. They can only verify if a number submitted on a claim matches the CMS crosswalk file. The NPI fields are not accessible by the Medicare staff, so please do not contact the Claims Correction line to update NPI information on claims.
Page Last Updated: Tuesday, 15-Jul-2008 10:34:12 CDT
