NPI# MISMATCHED FOR MEDICAID CLAIMS

DESCRIPTION OF THE ISSUE
Per Master claim set up in the software we have filed all the claims with provider’s group NPI#.  But per Medicaid records, provider was enrolled with Individual NPI#.  Hence claims did not reach Medicaid.

CONCEPT
Before transmission of any claims, the concerned carrier’s claims acceptance set up should be checked and verified.

SOLUTION
We had sample cross over claims which were processed by Medicaid.  Based on these sample claims we placed an enquiry with MCD executives as to why they haven’t received any of our MCD claims though we receive acceptance reports from our Clearing house agent.  They insisted that the claims should be filed with provider’s individual NPI.  Since the NPI records were missed, they haven’t received any of our claims.

Based on the given information we changed our Carrier’s claims submission master up from Group NPI# to Individual NPI# and transmitted all our claims.  The refiled claims were reached and processed for reimbursements

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