September 17, 2012
Correcting the Billing Provider's Information on Claims
The Centers for Medicare & Medicaid Services (CMS) addressed claims reprocessing requirements for claims that were affected by the 2010 Medicare Physician Fee Schedule (MPFS) update. These adjustments were required as a result of the Patient Protection and Affordable Care Act (ACA), which retroactively adjusted some Medicare payments dating back to date of service January 1, 2010. Because these payment adjustments were retroactive, a large number of Medicare fee-for-service claims were adjusted to reflect the correct payment amounts. As part of this adjustment action, CGS has identified internal system edits regarding corrections of claims specifically tied to the billing provider's NPI number.
Correcting the Billing Provider's NPI Number:
- In order to change the billing provider's NPI number on a claim you have already submitted, for any reason, submit an overpayment adjustment request using the Overpayment Refund Form. Please note: these instructions apply only to corrections to the billing provider's NPI number, not corrections to the rendering or ordering provider's NPI number.
- With your request for overpayment, specify that the billing NPI number will need to be corrected for a payment adjustment. In the "reason for request" on the Overpayment Refund Form, you may request an adjustment, for example:
"For ICN xxxxxxxxxxxxx, HICN 111111111a, DOS xx/xx/xx, we need to change the billing NPI from xxxxxx to xxxxxx. I understand that will result in an overpayment under the previous NPI.
After the overpayment/refund is processed, the claim will be adjusted to change the NPI and you will receive a payment with the corrected information. If the claim has already been refunded, please submit a copy of the overpayment letter or the remittance notice showing the offset when sending in the request for the adjustment to Overpayment Recovery. Any other method of correction that does not take into account the refund information for the NPI adjustments will be deleted.

