NPI Use in Transactions

1
NPI Use in Transactions

• For both commercial and Medicare Crossover
  business, BCBSNC has targeting three NPI phases
• Dual AcceptanceTrading Partners may send
  claims with NPI as long as PPN (Legacy Provider
  ID) is also sent. No processing using NPI.
  Started for commercial 1/2006. Started for
  Medicare Crossover 5/2006.
• Dual UseProviders that have registered their
  NPI(s) with BCBSNC may send transactions using
  PPN only, NPI only, or both. We recommend that
  if the provider wants to send NPI, the provider
  also send PPN. Started for commercial 10/2006.
• ComplianceTransactions with PPNs in fields where
  only the NPI is permitted will be rejected.
  Compliance is targeted for 5/23/2007.
• We have created and are using a crosswalk of the
  providers PPN to NPI relationships.

2
NPI Collection

• BCBSNC has never planned to use NPPES data.
  BCBSNC also chose not to collect directly from
  837s. We do work a report from 837s with Dual
  IDs.
• We have three methods for NPI collection
• PaperIn Q2 2006 we sent a set of request letter
  mailings directly to our providers, both
  participating and non-participating. We sent a
  second request to participating providers in
  early Q4 2006. We accept our letters back, or
  letterhead with appropriate signatures. We send
  confirmation letters once we have loaded our
  crosswalk.
• Web PortalProviders that already have secure
  access to our provider portal have been able to
  register their NPI(s) with BCBSNC online since 2Q
  2006. We send confirmation letters once we have
  loaded our crosswalk.
• MS Excel SpreadsheetCertain large providers
  already send spreadsheets with provider data
  changes. We added the ability to include NPI in
  the set of provider data. We email back once we
  load the data into our crosswalk.
• When an issue with loading NPIs occurs, our
  Provider Network team contacts the providers
  directly.

3
NPI Collection Discoveries

• Interesting comments
• What is an NPI?
• Why do I need a type 2?
• Why do I need a type 1?
• Why are you bothering me with something that is
  18 months away?
• My vendor/clearinghouse will make me compliant.
• The date will be extended.
• Let me concentrate on Medicare.
• Ill just get one (when there are multiple
  contracts), you keep working with me the same
  anyway.
• Medicare will tell me (force me) how to
  enumerate.
• Too many payers are asking me for the same thing.

4
NPI Testing

• BCBSNC does not have a testing environment that
  perfectly mirrors the data in our production
  environment. Therefore, we do not test trading
  partners transactions directly in a test
  environment.
• We use a 3rd party tool to confirm that
  transactions will pass standard HIPAA edits.
• We have conducted an NPI Pilot in 4Q 2006. We
  have included providers and trading partners with
  whom our EDI team has a relatively good
  relationship.
• Includes confirming crosswalk contents,
  transaction receipt, IG pass, crosswalk
  translation, internal formats mapping, arrival in
  the adjudication systems, payment, paper
  Notification of Payment, and 835 creation
• Tests internal business process changes
• Trading partner and provider expectations are met
• Once we declare victory in the pilot phase
  (estimate this Friday), we will start our
  migration phase.

5
NPI Testing Discoveries

• Many providers and trading partners said they
  would be ready in 4Q 2006 to participate in
  pilots. Only 8 actually were.
• Everything must align perfectly to be successful
• Provider must have NPI, must register NPI with
  BCBSNC
• Provider software changes to support 837 (vendor)
• Trading Partner software changes to support 837
  (clearinghouse)
• Trading Partner software changes to support 835
  (clearinghouse)
• Provider software changes to support 835 (vendor)
• Our Medicare Crossover trading partner is sending
  NPIs on some 837s. When a provider on the
  Crossover has an NPI that is not registered with
  BCBSNC, we call them (please register). Those
  providers have been shocked and perturbedthey
  are not sending NPI on their Medicare claims.

6
NPI Migration

• Phase 1Invitations
• We will contact providers where their
  clearinghouse or software vendor indicates
  readiness and invite them to start using NPI.
• Provide will contact us.
• Manual process with less verification.
• Phase 2Open for any provider that has
  registered.
• Automated loads from our NPI system to our EDI
  authorization system
• Formal announcement to provider community