Many supplier 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 section – even if they aren’t submitting the claims electronically. Seems strange, but it’s really accurate.
The job begins there. The client service people with Medicare DME do not explain why the denials are occurring very well and you end the call scrape your head still not sure how to get the claims paid. If they would just tell you in plain English language what the job 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 really getting the claims paid or apprehension how to resubmit them right. Meanwhile our eye doc was acquiring calls from all his other eye doc friends who were having the same job.
What we were told was that we had to link our NPI figure with the Type II or group NPI figure. This made perfectly no sense as both NPI figure were entered in the correct boxes on the claim form. I eventually figured out the job after a hunch I had which was a complete miracle that I could piece this jointly. It surely was not because they were explaining it well.
The job is that the provider’s national provider number must be linked to the NPI figure. It didn’t have anything to do with the NPI figure on the claim form as it was explained to us.
fortuitously it is a simple solution. This can be done reasonably easily by going to the NPI census taker web site, logging in, and adding the provider 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
