HOLLI W. HAYNIE

Medicare is in the process of instituting new National Provider Identifier (NPI) numbers for reimbursement that are required as part of the Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. NPI is a unique identification number for covered healthcare providers. It replaces the prior legacy provider identifiers used for many years. The deadline is May 23. These new numbers will act as a universal system used across all plans, making the numbers portable and presumably cutting down the confusion.

As physicians gear up for the deadline to switch from Medicare legacy numbers to the National Provider Identifier (NPI) number system, the biggest concern is the transition period that will cause headaches in claiming. They are working to ensure their new NPI numbers are in place and staff are prepared for filing claims in the correct format with the numbers.

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, for small health plans, the NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions.

From March 1 until the May 23 deadline, Medicare claims with both NPI and a Medicare legacy number will continue to be rejected if the pair is not found on the Medicare NPI Crosswalk.



From Center for Medicare and Medicaid Services:

Test your Medicare claims now! After you have submitted claims containing both NPIs and legacy identifiers and those claims have been paid, Medicare urges you to send a small batch of claims now with only the NPI in the primary provider fields. If the results are positive, begin increasing the number of claims in the batch. (Reminder: For institutional claims, the primary provider fields are the Billing and Pay-to Provider fields. For professional claims, the primary provider fields are the Billing, Pay-to, and Rendering Provider fields. If the Pay-to Provider is the same as the Billing Provider, the Pay-to Provider does not need to be identified.)

Providers submitting 837I and UB-04 claims must have an NPI in the primary field until May 23, 2008, at which time an NPI-only is required in all fields







Key Medicare NPI Implementation Dates



March 3, 2008-Medicare fee-for-service 837P and CMS-1500 claims must include an NPI in the primary fields on the claim (i.e., the billing, pay-to, and rendering fields). You may continue to submit NPI/legacy pairs in these fields or submit only your NPI on the claim. You may not submit claims containing only a legacy identifier in the primary fields. Failure to submit an NPI in the primary fields will result in your claim being rejected or returned as unprocessable beginning March 1, 2008. Until further notice, you may continue to include legacy identifiers only for the secondary fields.



May 23, 2008-In keeping with the Contingency Guidance issued on April 3, 2007, CMS will lift its NPI contingency plan, meaning that only the NPI will be accepted on all HIPAA electronic transactions (837I, 837P, NCPDP, 276/277, 270/271 and 835), paper claims and SPR remittance advice. This also includes all secondary provider fields on the 837P and 837I. The reporting of legacy identifiers will result in the rejection of the transaction. CMS will also stop sending legacy identifiers on COB crossover claims at this time.

Source: Center for Medicaid & Medicare Services



March 2008