NEW 999 File Rejection – Physician Opt Out

Indicates MD has Opted Out Medicare.

The intermediaries have now begun issuing 999 file rejections in relation to physician NPIs who are excluded by the Office of Inspector General (OIG). These 999 rejections messages will display as: “Exclusion condition violated on Element #9 (“NPI Number“)

This message indicates that the physician NPI is correct, however the physician has opted out of the Medicare Program and they are no longer allowed to order/refer for services billed to Medicare.  If you submit a claim that includes a physician that has opted out and it has caused your claim to return a 999 rejection, you should exclude the patient claim that contains this doctor’s NPI and resend the other patients that were rejected in the batch so that they do not have an interruption in reimbursement. 

Additional details on the recent change can be located here.  Sections 40.5 & 40.6