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Back  RFI # 703: NPI validation for provider

Formal vs. Informal Help Informal Formal

Submitter

Nadine Farmer

Description

Each Medicaid provider is required to register their NPI with us. This registration data is used as the Provider identification criteria to uniquely identify that provider when a 270 transaction is submitted. If a provider registers as a single entity, the NPI # is used for validation. If a provider register with multi locations, then the NPI # plus Taxonomy code and zip code is used for validation. If a provider sends the NPI #, plus taxonomy code and zip when they are registered with a single entity, a AAA03 43 is “Invalid/Missing Provider Information" is returned because they were not registered as a multi location provider. Is this the correct response?

Submitter Assigned Keywords

NPI validation

Response

It would appear that the rejection using AAA03 = 43 (Invalid/Missing Provider Information) is not being correctly applied. Requiring a provider to not send information that is then rejected without being validated, yet is reported as being Invalid is not correct. In order to report an item as being invalid, it must be validated (it's mere presence is not invalid).

Recommendation

The system should have the intelligence to determine if the additional information is needed in addition to the NPI, and if it is needed, validate it, if it is not needed, ignore it.
Submission 11/6/2008
Status Date 1/8/2009
Status F - Final
Primary References
Document 004010x091A1
Section1.3.9
Page184
Set ID271
Loop2100B
Segment Position085
Segment ID901
Element Position