When billing insurance claims to Medicare, it can get a little tricky. Medicare has many rules which are not required by commercial insurance companies. Since NPI numbers were required on all claims in 2008 there has been some confusion. All providers are required to have an individual NPI number and some are also required to have a group NPI number. Then they must be entered in the appropriate boxes on the CMS 1500 claim form.
In most cases it is mandatory to have the rendering provider's individual NPI in box 24J when submitting CMS 1500 forms. However, there are a few cases when box 24J needs to be left blank in order to prevent denial of the claim. Make sure you file your claims correctly according to Medicare's rules.
Most Medicare carriers require that box 24J be left blank if the billing provider is an individual provider. In that case, the provider's individual NPI, or type I NPI would be entered in both box 24J and in box 33a. If this NPI is the same, Medicare requires that the NPI is NOT entered in 24J but that 24J is left blank.
I truly do not know why they do this, but it is the rule. So if you are submitting paper claims to Medicare for an individual provider who bills under just an individual NPI, or type I NPI, and Medicare has been denying your claims, that may be why. If the provider gets paid under a group NPI then you would put the individual NPI of the rendering provider in box 24J.
Copyright 2010 - Michele Redmond - Solutions Medical Billing Inc
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