Physicians submitting NPI and legacy numbers

Use Both NPI and Legacy Numbers for Medicare Claims

Claims submitted by a physician office containing only an NPI will most likely be returned as unprocessable if a properly matching legacy number cannot be found.

From the beginning of Medicare’s Stage 2 NPI transition period on October 1, 2006, and until further notice, providers should submit both NPIs and legacy provider numbers on Medicare claims to ensure they are properly processed. During this period, claims submitted with only a NPI that Medicare systems are unable to properly match with a legacy number (e.g., Provider Identification Number (PIN), Online Survey Certification and Report (OSCAR) number), may be rejected, and providers will be required to resubmit the claim with the appropriate legacy number.

Ensure when submitting Medicare claims with dates of service on or after October 1, 2006, that billing staff submit both NPI and legacy provider numbers until further notice from the Centers for Medicare & Medicaid Services (CMS).

Physician providers may reference Change Request (CR) 5378, Transmittal 249, dated November 13, 2006.

More Relevant Questions

What Is a Legacy Number In Medical Billing

A legacy number in medical billing is a unique identifier assigned to patients in older systems. It serves to track patient records and facilitate billing processes, particularly when transitioning to newer electronic medical record systems.

What Is Legacy ID

Legacy ID refers to an identification number or code assigned to a particular item, record, or entity within a system. It's often used to maintain continuity or compatibility with older systems or processes.

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