May 14 , 2008

Provider Announcement

Medicare Eligibility Submitters

Effective Thursday, May 22nd, 2008 all Eligibility transactions sent to ENS, INGENIX must contain NPI-only and the NPI must be registered with Medicare. Any X12 transactions submitted to ENS, INGENIX with the only a Legacy Medicare ID or a Legacy Medicare ID + NPI will be rejected in the 271 response by CMS with a 2100B AAA03=43. In addition, GUI submitters will only be able to enter NPIs on the screen as of 5/22. If the NPI sent on Eligibility requests is identified as a non-Medicare NPI by CMS during weekly Eligibility audits, transactions submitted via ENS with that NPI will begin rejecting at ENS, INGENIX until we have received proof of NPI Medicare registration from the provider. X12 submitters will receive a 271 response with a 2100B, AAA=79 and GUI submitters will receive the text equivalent, "Invalid Participant Identification".

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