Denial Reasons and Reason/Remark Codes
- N257: Information missing/invalid in Item 33 — Missing/incomplete/invalid billing provider supplier primary identifier
- N290: Information missing/invalid in Item 24J — Missing/incomplete/invalid rendering provider primary identifier
Each NPI must match one Provider Transaction Access Number (PTAN) on the NPI crosswalk file.
- Step 1: If you contract with a billing service, find out if they have had communication with Palmetto GBA about NPI claim rejections. They may have important information that will help you resolve these claims.
- Step 2: Verify the information on file with the NPI Enumerator. Call the NPI Enumerator at 800-465-3203 or access their website to verify your information.
- Pay special attention to the following fields in your NPPES record:
- Each "sole proprietor" should have an Individual (Entity Type 1) NPI and not an Organization (Entity Type 2) NPI
- List your correct, current Medicare PTAN in the "Other Provider Identifiers" section
- If your NPI matches a PTAN that you no longer use (e.g., an old practice location), obtain and complete a new CMS-855 application and mail it to Palmetto GBA. Applications are available from the CMS-855 form from the Enrollment Application Finder tool. We will be happy to assist you if you have questions about how to complete the application.
- Step 3: If you are continuing to receive claim rejections after verifying information on file with the NPI Enumerator, verify the information you have on file with Palmetto GBA. Changes in this information require that you complete a new CMS-855 application.
- Pay special attention to the Taxpayer Identification Number (TIN), which is used to report your income to the IRS on Form 1099
- Consider consolidating multiple PTANs into a single number to ensure a one-to-one NPI to PTAN match. You may collapse PTANs that are assigned to additional locations only if the additional locations are all assigned the same TIN and are within the same pricing locality. More information about consolidating multiple PTANs is available in the CMS MLN Matters article MM5906.
- Step 4: Be aware of NPIs submitted for ordering and referring providers, and attending, operating or other service facilities
- NPI numbers submitted in these fields must be valid. You may access the CMS NPI Registry to obtain these numbers.