Palmetta GBA Incorrect Claim Rejections- Group NPI and Rendering Provider NPI Do Not Match

Issue Identified 3/19/2018
Palmetto GBA is aware that certain Jurisdiction J Part B claims rejected incorrectly when the billing (group NPI) and rendering provider (individual NPI) combination were submitted correctly. Affected claims incorrectly rejected with:

  • Claim Adjustment Reason Code CO-16 (Claim/service lacks information or has submission/billing error(s) and
  • Remittance Advice Remark Code N290 (Missing/incomplete/invalid rendering provider primary identifier)

While Palmetto GBA continues to research the issue, a temporary workaround has been implemented to prevent claims from incorrectly rejecting.

Provider Action:
3/26/2018: When providers have confirmed that the group NPI and rendering provider NPI were submitted correctly, providers should resubmit the affected claims. This CPIL will be updated once the issue has been fully researched and resolved.

Information obtained from: https://www.palmettogba.com/palmetto/providers.nsf/ls/JJ%20Part%20B~AX8G6B0225?opendocument