Medicare System to Include ‘Rendering Provider’ Field to Allow Correct Physician NPI Reporting for PCIP for CAHs Reimbursed Under Optional Method

Change Request (CR) 7686 instructs Medicare contractors to implement a system update to include the “Rendering Provider” field to allow correct physician National Provider Identifier (NPI) reporting for the Primary Care Incentive Program (PCIP) for CAHs reimbursed under the optional method. Upon implementation of CR 7686, CAHs reimbursed under the optional method should use the 837I version 5010A2 “Rendering Provider” field (loop 2310D) instead of the “Other Operating Physician” field (loop 2310C). The “Rendering Provider” field on the 837I must be populated by the eligible primary care practitioner’s NPI for the primary care services to qualify for the incentive bonus. Providers should continue to use loop 2310C, as well as the information that is required in loop 2310B defined as “operating physician,” for purposes of PCIP reporting until implementation of CR 7686. Effective July 1, 2012, providers should begin using loop 2310D. For more information, click here.