WARNING: Missing Referring Physicians' NPIs Can Be Costly!


PSA worked diligently throughout 2006, and has now completed our efforts to obtain the National Provider Identifiers (NPI) for all PSA billing clients.  We began testing and filing with NPIs in October 2006.  While obtaining 400 NPIs was daunting, and the testing phase is even more challenging, there is something even more concerning that REQUIRES YOUR IMMEDIATE ATTENTION.

Beginning May 23rd, 2007, NPIs will be required for all government (and many commercial) medical claims. This requirement extends beyond providing an NPI for the physician submitting the claim to include the referring physician’s NPI as well.  Even if you do not bill Medicare, NPI is a requirement, and it will be a critical element needed for claims processing.  Barring any relief from the government, you WILL NOT RECEIVE PAYMENT for claims filed after May 23, 2007, without the NPI of both the submitting and referring physicians.  We urgently need your help in gathering the NPI’s of your referral sources. Many of you have begun, and some have made significant progress…Thank You.  If you have not secured your referring physicians' NPIs, please do so as quickly as possible, and provide them to your PSA billing contact. The Medicare implementation date for mandatory submittal of claims with NPIs is May 23, 2007. However, early receipt of  referring physicians NPIs will allow PSA to begin testing claim submission and other transactions to ensure that your practice has no disruption in cash flow.

Tips for Collecting Referring Physicians' NPIs:

  • Check with your hospital administrator to obtain a listing of those physicians and their corresponding NPIs with privileges at their facility.  By gathering this list from every facility you cover, you will be able to gather the majority of the needed information with relatively little effort.   If you encounter resistance to sharing this data, be prepared to explain that your claims will not be processed without this information, and that it is critically important to your business.  Take it up the administrative ladder if you must; this is absolutely the best place to gather the masses quickly.  Your hospital contract(s) may also require that the hospital provide your group with certain information that enables you to bill for the services your group provides in the facility.

  • Inform your referring physician practices that you need their NPIs in order to receive payment on your claims, and that they will require it to receive payment on their claims, and encourage them to apply now if they haven’t already.

  • Have your marketing representative help in educating referring physician offices and assist with gathering their NPI numbers.  Make this a priority, and it is a great excuse to visit your clients. 

Claims submitted to PSA missing referring physicians NPIs, that REQUIRE it,
will be returned to your practice for resolution before filing.

For more information about collecting or submitting NPIs, please email psa@psapath.com.