NPI DEADLINE FAST APPROACHING! HERE'S HOW TO KEEP GETTING PAID May 23, 2008 is right around the corner and as you know, all healthcare providers should be prepared to begin using their National Provider Identifier (NPI) on all electronic and paper claims sent to payers. The new NPI number will eventually replace all ‘legacy’ payer identifiers. However, for the time being, we recommend that you include both numbers on your claims to ensure continuous cash flow. Payers, other than Medicare, may begin enforcement of CMS’ NPI requirement at any time in order to process claims. Any payer has the option to reject or suspend claims that do not include a registered NPI. Therefore, we strongly encourage all providers to contact their insurance carriers to verify the carriers’ specific requirements and timeline. We have compiled a list of Frequently Asked Questions to help you make sure you are ready for NPI and the associated timelines.
NATIONAL PROVIDER IDENTIFER (NPI)
FREQUENTLY ASKED QUESTIONS (FAQs)
Does NPI only affect Medicare and Medicaid providers and their claims?
No. All healthcare providers who send or receive standard electronic transactions need to obtain an NPI.
If a provider does not already have one, they can apply for an NPI by calling the National Plan and
Provider Enumeration System (NPPES) at 800-465-3203, or send an email to
customerservice@npienumerator.com. Failure to obtain an NPI may be viewed as a violation of the good
faith provisions of CMS’ contingency guidance.
faith provisions of CMS’ contingency guidance.
What about NPI for those who file paper claims?
If a provider only bills claims on paper, providers need to be aware that some health plans, including
Medicare, are requiring the use of NPI’s on paper transactions (such as paper insurance claims). In
addition, if a provider refers patients to another provider who is filing claims electronically, that practitioner
will need to obtain the referring provider’s NPI in order to process the electronic claim. In short, all healthcare providers are encouraged to apply for and share their NPI.
will need to obtain the referring provider’s NPI in order to process the electronic claim. In short, all
healthcare providers are encouraged to apply for and share their NPI.
When will Medicare begin rejecting non-revised CMS-1500 (12-90) paper claim forms?
CMS announced that they will continue to accept the old HCFA forms until June 1st, 2007. This date is
tentative. CMS will announce a firm date for the termination of the form soon.
tentative. CMS will announce a firm date for the termination of the form soon.
What does an NPI look like?
An NPI is a 10-digit number. All characters are numeric. The first digit is always a 1, 2, 3 or a 4. The first
9 characters are the identifier and the last character is a check digit. The check digit helps detect invalid
NPI’s. For example, if a provider’s Tax ID is 123456789, he or she cannot start sending 1234567890 and
expect it to be processed as an NPI.
If a provider has applied for and received an NPI, what’s the next step?
Providers using our clearinghouse services (Stratus, Phoenix, or Claims Manager) need to notify us of
their NPI, regardless of claim processing platform.
What about insurance carriers?
Providers should contact their insurance carriers to find out what the carriers’ specific enrollment
requirements are. Some carriers may take this information over the phone; some may require notification
on letterhead or may have a form that needs to be filled out.
How do I get my NPI number?
If you don’t already have your NPI number, you can apply for an NPI number by calling the National Plan
and Provider Enumeration System (NPPES) at 800-465-3203 or send an e-mail to
customerservice@npienumerator.com.
.What if the provider starts billing NPI on claims without notifying the carrier first?
Carriers may reject or suspend payment on claims sent with an unregistered NPI.
I’ve heard about a May 23rd deadline but then I heard that it was moved. Which is correct?
rd deadline but then I heard that it was moved. Which is correct?CMS (the Centers for Medicare & Medicaid Services) announced a contingency plan on April 2, 2007. It
was determined that the percentage of providers outputting NPI information was too low. Providers and
payers now have additional time to comply (through 05/23/2008), as long as they are making a “good
faith effort”. This means that providers who were outputting both an NPI and a legacy Medicare ID should
continue doing so. Providers who have obtained an NPI, but haven’t been using it, should do so now as long as the payer and clearinghouse have been previously notified. We want to make sure that our customers don’t wait until they start getting rejected claims. They should take steps towards compliance now.
continue doing so. Providers who have obtained an NPI, but haven’t been using it, should do so now as
long as the payer and clearinghouse have been previously notified. We want to make sure that our
customers don’t wait until they start getting rejected claims. They should take steps towards compliance
now.
What about BCBS and other commercial carriers?
Many carriers will model their plans after CMS’. However, they do have the right to implement NPI edits at
any time within the next year. We encourage providers to output dual ID’s until they receive notification
that only the NPI will be required.
Are there any exceptions?
Currently, the only known exception is Delaware Medicaid, who implemented NPI edits on 02/12/2007.
They require NPI on all claims. If a legacy number is also supplied in addition to the NPI, the claim will be
accepted. However, legacy ID’s are not required.
What if a provider is filing electronically but through another clearinghouse or using free software
from Medicare?
Providers who are using another clearinghouse or print image software from Medicare need to do these
three things:
1) Notify their clearinghouse/Medicare that they intend to start outputting NPI.
2) Make sure that their software version and format has the ability to output NPI.
3) Re-map their electronic claim output in order for their clearinghouse/Medicare to be able to
“recognize” the NPI data within their files.
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