Many providers are experiencing strange denials on their Medicare DME claims and when they call to check on them, they are being told to call the EDI department – even if they aren’t submitting the claims electronically. Seems strange, but it’s actually accurate.
The problem begins there. The customer service people with Medicare DME do not explain why the denials are occurring very well and you end the call scratching your head still not sure how to get the claims paid. If they would just tell you in plain English what the problem was and how to fix it, it wouldn’t be so bad.
When we first received denials from DMERC it was for one of our vision providers for glasses. My staff made several phone calls without receiving much help in actually getting the claims paid or understanding how to resubmit them correctly. Meanwhile our eye doctor was getting calls from all his other eye doctor friends who were having the same problem.
What we were told was that we had to link our NPI number with the Type II or group NPI number. This made absolutely no sense as both NPI numbers were entered in the correct boxes on the claim form. I finally figured out the problem after a hunch I had which was a complete miracle that I could piece this together. It certainly was not because they were explaining it well.
The problem is that the provider’s national supplier number must be linked to the NPI number. It didn’t have anything to do with the NPI numbers on the claim form as it was explained to us.
Fortunately it is a simple solution. This can be done fairly easily by going to the NPI enumerator web site, logging in, and adding the supplier number as one of the identifiers.
If you are receiving these strange denials I would recommend not even calling the DME carrier at first. I would check to see if you have your supplier number linked to your NPI number and if not, do so. If it already linked then you are having a different issue. Otherwise, once it is linked, just resubmit your claims!
We knew the implementation of the NPI numbers would cause many challenges in the future. Here’s one of these little challenges.
Copyright 2008 – Michele Redmond
