NPI Are You Ready? The presentation was created to assist Navicure clients in navigating the information received regarding NPI.
NPI Overview Getting an NPI is free - Not Having One Can Be Costly. The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses will use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty. Beginning May 23, 2008, the NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions.
NPI Checklist STEP 1 Acquire your NPIs IMMEDIATELY You can apply online at https://nppes.cms.hhs.gov/nppes/welcome.do. OR by phone: Providers can obtain a paper application by calling NPPES at 1-800-465-3203, Monday - Friday, 8:30 a.m. - 5:00 p.m. OR through the Electronic File Interchange (EFI): Providers can apply for multiple NPIs, through the EFI by visiting the http://www.cms.hhs.gov/nationalprovidentstand/ web site for information on this process.
NPI Checklist STEP 2 - Register your NPIs IMMEDIATELY With NPPES online at https://nppes.cms.hhs.gov/nppes/welcome.do. hhs *** Navicure is not authorized to complete this step on your behalf. Contact ALL your payers to confirm your NPI is registered with each. *** Navicure is not authorized to complete this step on your behalf. Contact Navicure via email* at enrollment@navicure.com to update your company profile. *NPI and any profile updates cannot be taken over the phone. Navicure will require that clients use their NPI prior to the deadline to ensure that everything is working properly before May 23.
Important Dates Beginning Monday, April 21, Navicure began a rollout to require NPIs in Navicure s system ahead of the May 23 rd deadline. We are doing this to ensure that all the information that Navicure and payers will be require on May 23 rd is acquired and registered with the parties by then. We do this not to put an added burden on our clients. Instead, it is to ensure uninterrupted cash flow come May 23. Starting Monday, May 12, Navicure will begin submitting claims to payers with NPIs EXCLUSIVELY no legacy numbers, except in instances where we know payers are not yet prepared to accept NPIs exclusively. We will do this to ensure that NPIs are correctly registered with payers when claims are submitted. Again, our intent is to ensure that cash flow is not interrupted on May 23 and thereafter. We will share a schedule for this rollout in the coming two weeks. Our intent is to have tested exclusive NPI submission with clients in every state by Friday, May 23.
Important Dates Navicure will require NPIs AHEAD of May 23 rd deadline Navicure will process claims to Medicare with NPIs exclusively and with both legacy and NPIs for commercial payers. 4/21/2008 OH 4/24/2008 GA, FL, VT, HI 4/28/2008 PA, TX, SD, WY 4/29/2008 NC, SC, WV, ID 4/30/2008 IL, AZ, IA, OR 5/1/2008 NY, CA, ND, MT 5/2/2008 MS, VA, ME, MN 5/5/2008 TN, KS, MO, OK, UT 5/6/2008 MA, NJ, CT, AK, NH 5/7/2008 RI, MI, AL, MD, WI 5/8/2008 NE, KY, IN, DE, NM 5/9/2008 CO, LA, AR, WA, NV 5/12/2008 DC, PR, VI
Helpful Information http://www.cms.hhs.gov/default.asp http://www.cms.hhs.gov/nationalprovidentstand/ https://nppes.cms.hhs.gov/nppes/welcome.do hhs CMS will Host NPI National Roundtable Q&A Session on May 19, 2008 CMS will host a national NPI Roundtable Q&A session to address questions from the Medicare provider community prior to May 23 rd. This Roundtable will be on May 19th from 2-3:30PM EDT. Questions will not be collected during the registration process for this call. There will be no presentations during this call; we will open the lines to take questions following a brief introduction. For registration details, visit http://www.cms.hhs.gov/nationalprovidentstand/downloads/listserv_wording_5-19-08_call.pdf on the CMS website. Use the Navicure Knowledge Base for payer contact information or Google is a useful tool as well.
Common Questions Will there be a temp or surrogate NPI? No temp/surrogate NPI will be issued Can I correct NPI on Navicure? Yes Any viewable data on Navicure can be updated. Box 33 of the Navicure 1500 form will update 24J What about Ordering/Referring/Attending? http://www.cms.hhs.gov/transmittals/downloads/r235pi.pdf Use the Navicure Knowledge Base for payer contact information or Use the Navicure Knowledge Base for payer contact information or Google is a useful tool as well.
Common Questions What is the difference between legacy, PTAN and NPI? Legacy previously issued payer credentialed provider number PTAN - Provider Transaction Access Number previously issued payer credentialed provider number NPI - 10-position, intelligence-free numeric identifier (10-digit number) NPI FAQ http://www.hipaadvisory.com/action/faqs/faq_identifiers.htm http://www.cms.hhs.gov/nationalprovidentstand/downloads/august07message.pdf Taxonomy Codes? The Provider Taxonomy is a unique alphanumeric code, ten characters in length. The Provider Taxonomy Code List allows a single provider (individual, group, or institution) to identify their specialty category. For payers who require the use of taxonomy codes it is recommended that Navicure clients confirm their provider profile reflects the information used in NPI registration. http://www.wpc-edi.com/codes/taxonomy
Common Questions Warning and Informational Messages WARNING! YOUR CLAIM WAS SUBMITTED WITHOUT A NPI M343 UNABLE TO IDENTIFY PROV INFORMATIONAL Until May 23 you might find informational or warning messages from Navicure or the payer. These will turn into rejection and cause payment issues if not corrected. To resolve please confirm NPI registration is on file with all payer and NPPES. Zip Code requirement some payers are using the zip+4 to assist in their internal crosswalk of NPI. Navicure rejection for invalid billing zip code: BILLING ZIP CODE - INVALID. MUST CONSIST OF 9 NUMERICS. Navicure rejection for invalid facility zip code: FACILITY ZIP CODE - INVALID. MUST CONSIST OF 9 NUMERICS. Can I still send my Legacy ID s to Navicure? Yes, If clients continue to send legacy ids, Navicure will strip off the legacy id before sending out to the insurance company if they are accepting NPI only. Some payers will continue to accept both.
Common Questions WEDI Bulletin----NPIs for Secondary Providers If the entity that is required to be identified in the secondary provider field (i.e., the ordering/referring/attending/operating/supervising/purchased service/other/service facility provider or prescriber) does not furnish an NPI, the billing provider must attempt to obtain that NPI in order to enter it on the claim. The billing provider may use the NPI Registry (https://nppes.cms.hhs.gov/nppes/npiregistryhome.do) to obtain the secondary provider s NPI or it may need to directly contact the ordering/referring/attending/operating/supervising/purchased service/other/service facility or prescriber in order to obtain the NPI. If the billing provider has exhausted all possibilities of finding the NPI of the ordering/referring/attending/operating/supervising/purchased service/other or prescriber, Medicare FFS is permitting the billing provider (in the X12N 837 transactions) or the service provider (in the NCPDP 5.1 transaction) to use their own NPI as the identifier for those secondary providers. Medicare will reject claims if Medicare policy requires a secondary identifier and there is no NPI present. For service facility location loop, if the billing provider is still unable to obtain the NPI of the entity, no identifier should be reported in that loop. View the transcript at http://www.cms.hhs.gov/nationalprovidentstand/downloads/transcript_for_april_17th_npi_roundtable.pdf on the CMS website.
Navicure Contact Information Please contact Navicure Client Services if you have any further questions and remember to monitor the Message Center in Navicure for any updates and important information received regarding NPI. Navicure Client Services 770-342-0800 clientservices@navicure.com enrollment@navicure.com