Can CMS provide a default NPI for MAOs and other entities to use when submitting unlinked chart review records?


No, CMS does not provide a default National Provider Identifier (NPI) for unlinked chart review records. CMS released clarifying guidance on NPI fields in the December 21, 2017, Health Plan Management System (HPMS) memo “Encounter Data Record Submissions—NPI Submission Guidance—Frequently Asked Questions (FAQ).” This information is also included in Section 3.5.2 of the Encounter Data Submission and Processing Guide.  Default NPIs can be used when the provider is considered atypical, when the service was provided outside of the country by a foreign provider, or when a beneficiary submits a claim for member reimbursement.

Source: User Group Q&A Documentation from March 23, 2017

Last Updated: 03/23/2017