CMS now says NPI must match IRS data

A few clarifications and updates. Re: "Every aspect of a doctor's data must match in both databases, including exact name spellings, use of initials and even any blank spaces in the data." The two primary databases that impact Medicare crosswalk logic are NPPES (the NPI database, which providers can update online) and PECOS (the Medicare enrollment database, which is based on information from providers' 855 forms, which Medicare contractors update by hand, often months after the forms are submitted). Medicare keeps advising providers to submit these complex enrollment forms to fix NPI problems, without informing them that their claims will continue to be rejected for weeks or months. The IRS data matchin applies only to organizational providers, and only to the Employer Identification Number (EIN or sometimes "TIN") and Legal Busines Name. Medicare has not revealed which IRS data source they are using, so providers need to rely on the information in letters which were to begin mailing last week.

Also, the "exact name spellings, use of initials and even any blank spaces in the data" is correct in terms of what providers have reported in the past, but a new document has come to light that suggests that the crosswalk logic may be more sophisticated than that, perhaps in response to such complaints. Still, Medicare has refused to publish the crosswalk logic and has not announced any plans to accelerate 855 processing or to prioritize NPI crosswalk error problem resolution.

A copy of the crosswalk logic, with an analysis of new IRS matching requirements, can be found online using a Google search or other search engine query.