National Provider Identification (NPI) Documents
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While CMS guidance is clear that May
23, 2007 was the final deadline for covered
entities, other than small plans, to comply
with HIPAA's NPI provisions; with consideration
of ongoing challenges nationally, CMS/OESS
outlined a relaxed approach to enforcement
of HIPAA's NPI provisions.
“Through May 23, 2008 CMS/OESS will
not impose penalties on covered entities
that deploy contingency plans if they have
made reasonable and diligent efforts to
become compliant and, in the case of health
plans, to facilitate the compliance of their
trading partners.”
With this in mind AHCCCS elected to deploy
an extension to our NPI contingency plan
which allowed for the continued dual use
of the NPI for service/rendering providers
through February 29, 2008 dates of processing
and for other data elements and transactions
as outlined on in the AHCCCS Contingency
Key Dates document below.
The contingency period
for dual use of the NPI for service/rendering
providers has now expired and AHCCCS will
enforce appropriate full compliance with
the NPI provisions for processing on and
after 3/1/2008. |
This section contains links to a page with information
regarding, and to documents related use of the National
Provider Identification (NPI) number. The
following documents are included in this section:
-
AHCCCS Dual
Use Definitions
-
Provider
Definitions
[Posted December 5, 2007,
PDF]
-
NPI -
Will You Be Ready? (NPI Preliminary Information)
-
CMS Enforcement Guidance Overview
[Posted May 15, 2007, PDF]
-
AHCCCS
NPI Contingency Key Dates
-
AHCCCS NPI
Contingency Planning Efforts
[Posted May 15, 2007, PDF]
-
AHCCCS
NPI Extended Contingency Planning Efforts
[Posted January 8, 2008,
PDF]
-
NPI Consortium
-
NPI Fact Sheet
-
NPI Provider
Type
-
NPI Recommendation
from NCVHS to DHHS
-
NPI Reporting
Requirements
-
Billing
Providers
[Posted January, 2008,
PDF]
- NPI Audiocasts
All documents are provided in
PDF format. To access the Adobe Acrobat Reader site
for a free, downloadable version of this program,
click here:
AHCCCS Dual
Use Definitions
Legacy Identifier:A “Legacy
Identifier” is any identifier previously used to
identify a health care provider prior to NPI.
After the compliance date as
stated in the AHCCCS Contingency Plan, only a NPI
may be used to identify a health care provider in
standard transactions. Legacy identifiers
include AHCCCS Registration Numbers, Health Plan
Registration Numbers, Medicare PINS, Blue Cross
provider numbers, and other identifiers.
AHCCCS Dual Use:
AHCCCS began accepting NPIs on claims and encounter
transactions as of 1/1/2007.
For processing on and after 3/1/2008, only the
NPI will be used for processing. If the NPI has
not been registered/enrolled by AHCCCS [NPI not
on file with AHCCCS] the transaction will fail.
Even though the "legacy identifier" may be included
on the transaction, the NPI will be the ONLY identifier
used to process transactions. AHCCCS will not attempt
to process the transaction using the NPI and if
the NPI is not on file, then check to see if the
Legacy Identifier is also on the transaction and
use it to process the transaction.
NPI Fact Sheet
NPI Fact Sheet
[PDF, 30Kb]
Effective January 23, 2004, the final rule regarding
the National Provider Identifier (NPI) was published.
CMS started assigning NPI numbers to providers last
May, and beginning in May 2007 NPIs will be required.
This document
contains additional facts related to NPI usage.
NPI Provider
Type
NPI
Provider Type
[PDF, 16.16Kb]
This
document contains
a list of NPI Provider Types, descriptions and an
indicator which states whether the Provider Type
requires an NPI.
NPI Recommendation from NCVHS to DHHS
NPI Audiocasts
AHCCCS Contingency Key
Dates
837 and Paper Claims Transactions
- Primary (rendering/service) providers
MUST use an NPI (if required for their
Provider Type), AHCCCS will enforce
submission of the NPI for processing dates
of 3/1/2008 and after.
- Secondary providers (referring,
attending, operating) (if required by the
transaction or submitted by the submitter)
MUST use a NPI (the NPI used by be a
syntactically valid NPI but does not have to
be known to PMMIS), AHCCCS will enforce
submission of the NPI for processing dates
4/1/2008 and after.
837 Encounter Transactions
- Primary (rendering/service) providers
MUST use an NPI (if required for their
Provider Type), AHCCCS will enforce
submission of the NPI for processing dates
3/1/2008 and after.
- Secondary providers (referring,
attending, operating) (if required by the
transaction or submitted by the submitter)
MUST use a NPI (the NPI used by be a
syntactically valid NPI but does not have to
be known to PMMIS), AHCCCS will enforce
submission of the NPI for processing dates
4/1/2008 and after.
NCPDP and Paper Claims Transactions
- Primary (rendering/service) providers
MUST use an NPI (if required for their
Provider Type), AHCCCS will enforce
submission of the NPI for processing dates
3/1/2008 and after.
- Secondary providers (referring,
attending, operating) (if required by the
transaction or submitted by the submitter)
MUST use a NPI (the NPI used by be a
syntactically valid NPI but does not have to
be known to PMMIS), AHCCCS will enforce
submission of the NPI for processing dates
4/1/2008 and after.
NCPDP Encounter Transactions
- Primary (rendering/service) providers
MUST use an NPI (if required for their
Provider Type), AHCCCS will enforce
submission of the NPI for processing dates
3/1/2008 and after.
- Secondary providers (referring,
attending, operating) (if required by the
transaction or submitted by the submitter)
MUST use a NPI (the NPI used by be a
syntactically valid NPI but does not have to
be known to PMMIS), AHCCCS will enforce
submission of the NPI for processing dates
4/1/2008 and after.
270/271 Transactions
- Providers MUST use an NPI (if required
for their Provider Type), AHCCCS will
enforce use of the NPI for processing dates
3/1/2008 and after.
On-Line Web Based Transactions (Claim Status
Lookup)
- Providers MUST use an NPI (if required
for their Provider Type), AHCCCS will
enforce use of the NPI for processing dates
3/1/2008 and after.
Provider Registration Records
- Provider records SHOULD contain valid
NPI information (if required for the
Provider Type), AHCCCS will begin the
suspension of any Provider records for lack
of an NPI beginning 3/1/2008 and after.
Provider Affiliation File
- Health Plans MUST submit with an NPI (if
required for the provider type), AHCCCS will
enforce inclusion of the NPI for processing
dates 3/1/2008 and after.
Validator
- Health Plans MUST submit encounter
related transactions with appropriate NPI
information (if required for the provider
type), but the AHCCCS Validator will
continue to accept both NPI and/or other
legacy identifiers on an ongoing basis due
to the need to support encounters for
Atypical Providers.
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