Denial code N290 AND N257

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Understanding Denial Codes: N290, N257

NPI: Troubleshooting Rejections

Denial Reason, Reason/Remark Code(s)

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

Resolution/Resources:

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 external link 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 external link 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/referring providers and attending/operating/other/service facilities

NPI numbers submitted in these fields must be valid. You may access the CMS NPI Registry to obtain these numbers.

reference

[1]: EDI_Enroll_AB_DDE_New.pdf (palmettogba.com)

[2]: Jurisdiction J Part A - Direct Data Entry (DDE) IDs, Access and Security Measures, and Password Procedures (palmettogba.com)

[3]: EDI Online Application (palmettogba.com)

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