Preparing for NPI Only
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1 Preparing for NPI Only Taz Taylor
2 Agenda Administrative Notes NPI setup changes from 2007 Clearinghouse readiness and policies Doctor, Company and Facility Setup for NPI Referring Physician setup Insurance carrier EDI setup for NPI only claims CMS1500 setup for NPI only claims. NPPES website Summary Questions 2
3 Introduction Administrative Notes DO NOT put your phone on HOLD - Very Important! If you have a lot of background noise in your office, please mute your speakerphone or microphone. Feel free to ask questions, but limit them to the current topic. Hold other questions until the end of the presentation. This presentation will be available on the HealthSystems website 3
4 NPI Changes and Centricity setup Changes to NPI setup since last year Because all carriers should accept NPI, it is okay to populate the NPI field on the INFORMATION tab Many carriers are requiring ZIP +4 zip codes when claims are submitted with NPI numbers. Add these expanded zip codes now to the doctor, company and facility information areas. May 23, most carriers will require claims to contain NPI ONLY. NPI ONLY may require removing UPIN numbers from your doctors ID rows and information tab, and also from your referring doctors.
5 McKesson and Centricity EDI Clearinghouses For McKesson *and* Centricity EDI clients The clearinghouses will suppress legacy numbers, including UPIN numbers. This means your electronic claims will go to the carrier as NPI only with no changes to your system. HOWEVER any changes you have made already to send NPI only are still correct. HealthSystems recommends that you understand and make the appropriate setup changes to send NPI only data directly from your system. 5
6 Alabama Direct submitters (Medicare and Blue Cross/Blue Shield) If your office submits claims directly to Alabama Medicare and/or Alabama Blue shield, you will need to suppress or remove legacy numbers to comply with NPI only requirements. Remove the UPIN number from your doctors information and identification rows. Remove the UPIN number from all referring doctors. You must use the following EDI settings to suppress the legacy PIN and Group numbers. **Contact HealthSystems for custom report to remove all UPIN numbers from referring physicians.** 6
7 NPI Only What do I do? Obtain an NPI number for each provider Enter NPI numbers in correct locations in Centricity ** Register your NPI number(s) with your insurance carriers** Submit claims with NPI numbers If submitting directly to Alabama Medicare or BC/BS, remove the UPIN numbers from all locations and enter the correct EDI settings for these carriers. REVIEW your claim submissions for rejections **It is YOUR responsibility to confirm that the insurance carrier has your NPI numbers on file and associated with the correct doctors, company, etc.
8 NPI in Centricity NPI fields are found in: Doctor (Responsible Provider) Company Facility Physicians (Referring Provider)
9 Doctor setup Zip plus 4 here Doctor s NPI # here Remove the UPIN here 9
10 Company setup Zip plus 4 here Company NPI here 10
11 Facility setup 뙨 һ Zip plus 4 here Facility NPI # here (as needed) 11
12 Physicians / Referring Providers Remove UPIN here And remove any UPIN and description from ID rows
13 Referring Physician ID Row Within the ID row: Remove the UPIN number Set the qualifier to (none). 13
14 NPI Only How do I do it? Admin Edit - Insurance Carrier Select carrier and Modify (Edit) Go to the EDI tab, highlight the File Creator and Modify (Edit) Click the Creator Plug-In Settings button Go to All Payers (2) tab Select (check) Do Not Send PIN/EMC in REF Segments when NPI is sent in NM109 Go to Clearinghouses tab Unselect (uncheck) Requires PIN
15 NPI Only Insurance carrier EDI settings Admin-Edit-Insurance Carrier Select carrier and Modify EDI tab Modify row and click settings 15
16 NPI Only continued All Payers 2 Put check in Do Not Send PIN/EMC in REF Segments when NPI is sent in NM109 Clearinghouses Uncheck Requires PIN 16
17 NPPES Website (National Plan & Provider Enumeration System) Use the NPPES Website to lookup or verify NPI numbers. Click the Search NPI Registry Link 17
18 NPI Only on Paper Claims To send paper claims with only NPI, the report file must be changed The correct report file is CMS1500.rpt Requires updated Standard Paper Plugin Contact HealthSystems support to make this change 뙨 һ 18
19 Summary McKesson and Centricity EDI claims: Clearinghouse will remove all legacy numbers before sending claim to carriers. Do not remove any PIN or EMC numbers from Doctor ID rows *Optional set insurance carrier EDI settings to send NPI only.* Alabama Direct clients: Remove UPIN numbers from doctors and referring physicians. Modify your Alabama Medicare and Blue Shield carriers EDI settings to send NPI only. Contact HealthSystems for custom report to remove UPIN numbers. ENS, Navicure, and Availity clients Contact HealthSystems support for assistance All Clients: Do NOT remove doctors PIN, GRP or EMC numbers. Change to the CMS1500.rpt layout for paper claims Contact HealthSystems for assistance with this change. 19
20 HealthSystems.net/Support page 20
21 Questions and Answers 뙨 һ Thank you for attending! 21
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