When the claim form changed this Spring and NPI's were added, most providers thought that the only major change was the NPI numbers.  But, as many are finding out, the new claim form also includes "legacy" numbers and ID Qualifiers.  What are "legacy" numbers and ID qualifiers?  Legacy numbers are the provider number that insurance companies gave you prior to the NPI's becoming effective.  And, if you are required to enter a legacy number on the claim form, you need to add a two digit code (ID Qualifier) stating what kind of number you are reporting.  For a free claim form manual giving complete details; visit www.nucc.org and click on the 1500 Claim Form and 1500 Instructions.  There, you can see the most recent version of the claim form manual and prior editions. 

     Now, think about it; who would have given you a legacy number? The only insurance companies to give you legacy numbers are the companies you contract with in either par or non-par contract. On average, most clinics have three to six contracts; Medicare, Medicaid, Blue Shield and some HMO's.  For these contract payers, you need to either veiw their newsletter, website or call them to see if they want you to submit the legacy numbers.  For all the non-contract payers, you only need to use your NPI numbers.  Plus, each insurance company (contracted and non-contracted) may have you complete an update form to assist them in getting your NPI (s) into their system. 
    Finally, many solo providers are confused about whether they need one NPI number or two NPI numbers.  Here's the feedback we have received from the NPI enumerator service and other providers.  If your tax identification number type is a "solo proprietorships", you probably need only one NPI.  If your tax identification number is anything else; corporation, partnership, etc. you probably need two NPI numbers; one for the group and one for the individual.   Another sign you might need two numbers is if Medicare gave you an individual number and a group number.  To contact the NPI Enumeration System, click on the name and you will have phone and email contact information.  Plus, read this NPI article from Medicare.
    Still confused and need help from The Billing Answer? Just click on the link and fax back the form.