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MIR-2006-10AB, October 2006
NPI – Will You Be Ready?
GET IT
The compliance date, May 23, 2007, is only eight months away. It is every provider’s responsibility to make sure that a National Provider Identifier (NPI) is obtained if the provider is required to do so. If you are not sure, it is time to investigate. Get your NPI now so you have time to prepare before the compliance date. This includes sharing your NPI and appropriately testing it with payers to avoid a disruption in cash flow. To learn more on how to apply, visit www.cms.hhs.gov/NationalProvIdentStand/  on the Centers for Medicare & Medicaid Services (CMS) Web site.
SHARE IT
Have your NPI and don’t know what to do with it? Share it. Share it with health plans you bill and the colleagues who rely on having your NPI to submit their claims (e.g., those who bill for ordered or referred services). You should also share it with your billing service, vendor, or clearinghouse, if you have any of them as business associates. Find out when and how the health plans with which you do business will begin accepting the NPI in claims and other standard transactions.
USE IT
Once your health plans have informed you that they are ready to accept NPIs, begin the testing process. It is important to test before May 23, 2007 to avoid a disruption in your cash flow. Consider sending only a few claims at first as you test the ability of plans to accept the NPI. Fewer claims will make it easier to keep track of status and payment, as well as troubleshoot any potential problems that may arise during the testing process.
Information on Covered Entities Under HIPAA
CMS has posted a new “Frequently Asked Question” to the CMS Web site that addresses whether a health care provider is a covered entity under HIPAA if they receive health information electronically (e.g., an electronic remittance advice), but do not transmit any health information electronically. The link is listed below, or you can go to the www.cms.hhs.gov Web site and click on “Questions” in the blue banner. http://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_adp.php?p_faqid=7906&p_created=1158786931&p_sid=fY-kZcii&p_accessibility=0&p_lva=&p_sp=cF9zcmNoPSZwX3NvcnRfYnk9JnBfZ3JpZHNvcnQ9MjoyJnBfcm93X2NudD0yNTQxJnBfcHJvZHM9JnBfY2F0cz0mcF9wdj0mcF9jdj0mcF9zZWFyY2hfdHlwZT1hbnN3ZXJzLnNlYXJjaF9ubCZwX3BhZ2U9MQ**&p_li=&p_topview=1
New NPI Information for Medicare Providers
Clarification of the Taxonomy Requirement Outlined in CR5243
Effective January 1, 2007, institutional Medicare providers who submit claims for their primary facility and its subparts (such as psychiatric unit, rehabilitation unit, etc.) must report a taxonomy code on all claims submitted to their Fiscal Intermediary. CMS posted an FAQ that clarifies this requirement. The link is listed below, or you can go to the www.cms.hhs.gov Web site and click on “Questions” in the blue banner. http://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_adp.php?p_faqid=7896&p_created=1158064263&p_sid=KiZr-wii&p_accessibility=0&p_lva=&p_sp=cF9zcmNoPTEmcF9zb3J0X2J5PSZwX2dyaWRzb3J0PSZwX3Jvd19jbnQ9MSZwX3Byb2RzPTAmcF9jYXRzPSZwX3B2PSZwX2N2PSZwX3NlYXJjaF90eXBlPWFuc3dlcnMuYV9pZCZwX3BhZ2U9MSZwX3NlYXJjaF90ZXh0PTc4OTY*&p_li=&p_topview=1
Reminder to Supply Legacy Identifiers on NPI Application
CMS continues to urge providers to include legacy identifiers on their NPI applications. This will help all health plans, including Medicare, to get ready for May 23, 2007. If reporting a Medicaid legacy number, include the associated state name. If providers have already been assigned NPIs, CMS asks them to consider going back into the NPPES and updating their information with their legacy identifiers if they did not include those identifiers when they applied for NPIs. This information is critical for health plans and health care clearinghouses in the development of crosswalks to aid in the transition to the NPI.
New WEDI Early Adopters Series
The Workgroup for Electronic Data Interchange (WEDI) has developed a series of monthly 90-minute audiocasts that highlight the NPI-related planning, management, communication, and implementation activities. The first audiocast is scheduled for Wednesday, October 4, 2006 from 2:00-3:30 p.m. ET. Visit the WEDI Web site for more information and to register for this audiocast at http://www.wedi.org/npioi/index.shtml . Please note that there is a cost to register for this WEDI event.
Getting an NPI is free -
not having one can be costly.
CMS Learn Resource 200609-13
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