MIR-2007 04B, April 2007

NPI – Will You Be Ready? (PE200703-19)

GET IT
The compliance date, May 23, 2007, is only two months away. Covered health care providers have had 22 months to apply for their NPI – further procrastination could disrupt your cash flow. Act now if you still don’t have your National Provider Identifier (NPI)! It’s easy and it’s free!

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 business associates, such as a billing service, vendor, or clearinghouse. Pay attention to information from health plans with which you do business as to when they 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. 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 troubleshooting any potential problems that may arise during the testing process.

Revisions to the NPPES Web site
We are revising some of the language on the NPPES NPI Application Help page that relates to the selection of the Entity Type. Among other changes, our revision will remove a reference to “atypical services.” This reference is being removed because entities who furnish only “atypical services” are not eligible to apply for NPIs.

NPI Disclosures by Industry Entities to Industry Entities
A new guidance document is available at http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/NPIdisclosures.pdf on the CMS NPI Web page. This guidance relates to the disclosure of health care providers’ NPIs by health industry entities for the purpose of using NPIs in HIPAA standard transactions.

New Frequently Asked Questions (FAQs) Posted
CMS has posted new NPI FAQs on its Web site. Questions include:

• I have been told to protect my National provider Identifier (NPI) and I have been told to share my NPI - How am I to protect my NPI if I must share it with others?
• With whom should I share my NPI?
• Am I required to share my NPI with health plans, other providers, and any other entity that requests it?
• Does the National Plan and Provider Enumeration System (NPPES) handle applications for health plan identifiers, as it does for health care provider identifiers?
• May a health plan require that an individual health care provider obtain two NPIs if that provider has two separate business roles – for example, as a physician seeing patients at a group practice, and as a durable medical equipment (DME) supplier?

To view these FAQs, please go to the CMS dedicated NPI Web page at http://www.cms.hhs.gov/NationalProvIdentStand/ and click on Educational Resources. Scroll down to the section that says "Related Links Inside CMS" and click on Frequently Asked Questions. To find the latest FAQs, click on the arrows next to "Date Updated".

Important Information for Medicare Providers

Reminder to Use the NPI and Legacy Identifiers on Medicare Claims
Medicare is accepting the NPI on claims; however, providers should also submit their Medicare legacy identifiers on their claims until further instructions are released. 

Important Notice: Medicare Extends Date for Accepting Form CMS-1500 (12-90)
While Medicare began to accept the revised Form CMS-1500 (08-05) on January 1, 2007 and was positioned to completely cutover to the new form on April 1, 2007, it has recently come to our attention that there are incorrectly formatted versions of the revised form being sold by print vendors, specifically the Government Printing Office (GPO). After reviewing the situation, the GPO has determined that the source files they received from the NUCC’s authorized forms designer were improperly formatted. The error resulted in the sale of both printed forms and negatives which do not comply with the form specifications. However, not all of the new forms are in error.  

Given the circumstances, CMS has decided to extend the acceptance period of the Form CMS-1500 (12-90) version beyond the original April 1, 2007 deadline while this situation is resolved. Medicare contractors will be directed to continue to accept the Form CMS-1500 (12-90) until notified by CMS to cease. At present, we are targeting June 1, 2007 as that date. In addition, during the interim contractors will be directed to return, not manually key, any CMS-1500 form (08-05) forms received which are not printed to specification. By returning the incorrectly formatted claim forms back to providers, we are able to make them aware of the situation so they can begin communications with their form suppliers.

The following will help to properly identify whether their version of the form needs to be updated. The old version of the form contains “Approved OMB-0938-0008 CMS-1500 form (12-90)” on the bottom of the form (typically on the lower right corner) signifying the version is the December 1990 version. The revised version contains “Approved OMB-0938-0999 CMS-1500 form (08-05)” on the bottom of the form signifying the version is the August 2005 version. Checking the information at the upper right hand corner of the form is the best way to identify if that particular version is correct. On properly formatted claim forms, there will be approximately a one-quarter inch gap between the tip of the red arrow above the vertically stacked word “CARRIER” and the top edge of the paper. If the tip of the red arrow is touching or close to touching the top edge of the paper, then the form is not printed to specifications.

Upcoming WEDI Events
WEDI will host the 16 th Annual WEDI National Conference May 14 – 17 in Baltimore, Maryland. Visit the WEDI Web site for more details on this event, as well as others, at http://www.wedi.org/npioi/index.shtml on the Web. Please note that there is a charge to participate in WEDI events. 

Still Confused?
Not sure what an NPI is and how you can get it, share it, and use it? As always, more information and education on the NPI can be found at the CMS NPI page www.cms.hhs.gov/NationalProvIdentStand on the CMS Web site. Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203.

Getting an NPI is free - not having one can be costly .

CMS Learn Resource 200703-19