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Health Plan Categories
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National Provider Identification (NPI)
-- Will You Be Ready? --
| GET
IT. |
The compliance date, May 23, 2007, is only
2 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 NPI!
It’s easy and it’s free!
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| 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.
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| 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.
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Revisions to the National Plan and Provider Enumeration System (NPPES) Website
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.
Frequently Asked Questions (FAQs) Posted
CMS has posted new NPI FAQs on its website. 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
Form CMS-1500 (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 FORM CMS-1500 (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 FORM CMS-1500 (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 ¼” 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 16th Annual WEDI National Conference May 14 – 17 in
Baltimore, Maryland. Visit the WEDI website 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 website.
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. --
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