NPI Crosswalking

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NPI Crosswalking

• HIPAA Collaborative of Wisconsin
• Fall Conference
• September 29, 2006
• Kerry Zajicek
• Epic Systems Corporation
• Verona, WI
• kerry_at_epicsystems.com

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Epic Systems Corporation
Inpatient. Outpatient. Every Patient
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Epic Systems Corporation

• The Basics
• Founded in 1979 in Madison, WI
• Employee Owned
• Develop all our products in house
• eHealth, Clinical, Access, Health Plan, and
  Revenue Cycle products
• 4 of 7 products tops in KLAS
• 58,000,000 EpicCare EHR patients in the country

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Epic Systems Corporation
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Epic Systems Corporation
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NPI White Papers

• Published early 2006
• NPI FAQ White Paper
• NPI Configuration Guide Supplement Spring 2006

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Configuring Your System to Print National
Provider Identifiers (NPIs) on Claims Checklist
for Setting Up National Provider
Identifiers Identity Configuration
Overview Configure Identity Identity-Enable
Master Files Create ID Types Assigning
NPIs Assign NPIs in Hyperspace View Assigned
NPIs Reporting NPIs on ClaimsEnable NPI for
Claims Report NPIs Using Programming
PointsDefine Your NPI Search PrecedenceCustomizi
ng Claim Forms for NPIs Where NPIs Print on
Electronic Claims ANSI Claim Without NPIs
Enabled ANSI Claim With NPIs Enabled Configuring
Profile Variables for ANSI 276 Claim Status
Request Messages Appendix A Importing
NPIs Appendix B NPI Format
Configuring Your System to Print National
Provider Identifiers (NPIs) on Claims
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Configuring Your System to Print National
Provider Identifiers (NPIs) on Claims

• Masterfiles/Tables
• ASP
• Inventory Balances
• Bed Charge Billing Procedure Table
• Billing Cost Centers
• CPT Code/REV Code Mapping
• Census Statistics
• Denial/Correspondence
• Hospital Beds
• Hospital Billing Fee Schedule Group
• Inventory Balances
• Business Group
• Bank Account
• Etc

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Configuring Your System to Print National
Provider Identifiers (NPIs) on Claims

• Masterfiles/Tables Billing Number Support Prior
  to NPI
• Provider
• Insurance Filing Information - PIN
• Group Number
• Claim Definition

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Configuring Your System to Print National
Provider Identifiers (NPIs) on Claims

• Masterfiles/Tables Billing Number Support Prior
  to NPI
• Provider
• Holds legacy IDs like Tax IDs, UPIN, Social
  Security and DEA numbers
• PIN
• Separate table that holds payor assigned IDs
• Highly configurable set up by financial class,
  health plan, location, and department
• Defines a set of conditions
• Linked to the each provider

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Configuring Your System to Print National
Provider Identifiers (NPIs) on Claims

• Masterfiles/Tables Billing Number Support Prior
  to NPI
• Group Number -
• Holds provider group numbers
• Highly configurable set up by financial class,
  health plan, location, department, form type, and
  programming point
• Defines a set of conditions
• Functions Independently

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Configuring Your System to Print National
Provider Identifiers (NPIs) on Claims

• Masterfiles/Tables Needed for NPI
• Approach
• Master Person Index
• Used to map tables in Epic to tables outside of
  Epic
• Ex provider ID in another billing system
• Used in the masterfiles needed to support NPI
• Now used to store NPIs, both Type 1 and Type 2
• Why use MPI?
• Already available
• Independent of other billing related
  masterfiles/tables
• Can keep legacy numbers as is, no conversion or
  true mapping needed

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Configuring Your System to Print National
Provider Identifiers (NPIs) on Claims
Identity Settings
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Configuring Your System to Print National
Provider Identifiers (NPIs) on Claims
Identity Settings
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Configuring Your System to Print National
Provider Identifiers (NPIs) on Claims
Viewing NPIs

• NPI can be viewed for providers, departments,
  POS, locations, and service areas in the
  appropriate master file record and on the
  following screens
• Provider Information (Provider)
• Department Information (Department)
• Additional Information (POS, Location, Service
  Area, Facility)

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Configuring Your System to Print National
Provider Identifiers (NPIs) on Claims
Viewing NPIs
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Configuring Your System to Print National
Provider Identifiers (NPIs) on Claims
NPIs on Claims

• Using the Master Patient Index allows our
  customers to store and keep both NPIs and Legacy
  IDs
• Using the Master Patient Index allows our
  customers to turn on NPIs and turn off Legacy IDs
  for use during dual use period and after the
  compliance date for only sending NPIs
• Turning on and off billing numbers can be
  performed by Health Plan
• Additional flexibility to handle special
  situations

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Loading NPIs
Importing NPIs

• NPIs can be imported into customers systems
  using our standard import tools
• All loaded NPIs are available to be used for any
  X12 or other transactions or forms
• 837
• 270
• 276
• 278
• 820
• 834
• Paper Claim Forms
• ePrescribing
• NCPDP Telecommunication Standard

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Crosswalking NPIs
Crosswalking Needs

• As seen, there isnt a need to map or crosswalk
  NPIs for billing purposes or for any paper or
  electronic exchange of information
• But NPIs and Legacy IDs can be extracted for
• Reporting purposes using our standard reporting
  tools
• To create a crosswalk table using a tool like
  Excel for exchange of NPIs
• Extracted by using standard tools
• Allows our customers to create a table by
  provider that lists their NPI and any Legacy
  number assigned to that provider for a specific
  Health Plan.
• Can then be used for exchange and dissemination
  of NPIs between providers and to Health Plans to
  assist in their NPI load or crosswalk

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Testing NPIs
Testing Components

• Claims
• Remits
• Eligibility
• Claim status
• Electronic Eligibility
• Driven by community decisions

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Testing NPIs
Testing Components - Sequence

• Unit testing
• NPI loading
• Desired process
• End to end testing
• Payer testing
• Paper claims
• Deciding implementation

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Testing NPIs
Trading Partner Testing

• Phased Approach
• First perform small volume testing that includes
  exchanging NPI
• Review crosswalks
• Performing specific unit testing
• Graduating to modifying production data to
  include NPI
• Send NPI to payers and receive 835s

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Testing NPIs
Trading Partner Testing

• Establish testing scenarios
• Send prior claim
• Get 835 with exact match
• Analysis of payment
• End to End Testing
• Collaborative process with payer

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Testing NPIs
Trading Partner Testing

• Stable test environment
• Use prior production claims
• Exchange of NPIs
• Non-employee and other challenges
• Business unit doing testing
• Automated results checking
• Patient level variables
• Copays, deductibles, out-of-pocket caps, etc
• Payer capabilities will vary
• Collaborative process with payer
• Reality

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Testing NPIs
Trading Partner Testing

• Were ready means
• Detailed expectations
• Feedback
• Spread out over time
• Each payer
• All payers
• Big bang concern

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Testing NPIs
Deciding Implementation

• Payer readiness
• Clearinghouse readiness
• Go-live decisions
• Big bang concern
• Freight train

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HIPAA Collaborative of Wisconsin
Questions