RNHCI Claims

Attending Provider Identifiers on RNHCI Claims

Effective September 24, 2012 Religious Nonmedical Health Care Institution (RNHCI) submitting claims to Original Medicare should report the name and NPI of their director of nursing in the Attending Provider fields on all claims.
Health care providers, including RNHCIs, have been required to use the NPI on electronic Medicare claim transactions since May 23, 2008. Medicare billing instructions have historically required RNHCI claims to report the RNHCI’s own NPI but have not required RNHCI’s to report an attending physician NPI. Due to the non-medical nature of RNHCI services, beneficiaries electing the RNHCI benefit do not have an attending physician.

The 837 Institutional claim format requires an attending provider name and NPI be reported in the 2310A loop, NM1 segment for all claims that contain services other than unscheduled transportation. If RNHCIs do not report this segment, their claims will be rejected by HIPAA-compliant translator edits.

In 2011, CMS issued CR 7542, which instructed RNHCIs billing Original Medicare to report their own facility NPI in this segment to satisfy the requirement. However, since that time, CMS has learned that other payers are not accepting claims submitted using the RNHCI facility NPI in this segment. The segment requires the provider to report the NPI of a person. The qualifier for a non-person entity is not allowed. This CR 7862 provides RNHCIs with an alternative method to satisfy the requirement.

Reference: http://cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM7862.pdf

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