National Provider Identifier (NPI)

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National Provider Identifier (NPI)

• National

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NPIGeneral Information

• What is an NPI?
• NPI stands for National Provider Identifier.
• It is a nationally assigned 10-digit unique
  provider identifier which contains no embedded
  intelligence about the provider.
• Replaces provider identifiers assigned by Health
  Plans.
• There are 2 categories of NPI
• Type 1 - Individual
• Type 2 - Entity

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NPIGeneral Information

• Who must get an NPI ?
• Individuals furnishing health care (Type 1) such
  as
• Primary Care Physicians
• Specialists
• Non-Physician Specialists
• Entities furnishing health care (Type 2) such as
• Hospitals
• Skilled Nursing Facilities
• Home Health Agencies
• DME Suppliers
• Ambulance

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NPI General Information

• Why do I need an NPI ?
• HIPAA mandates the use of NPI on all electronic
  transactions submitted by covered entities on or
  after May 23, 2007.
• You can no longer submit your BC or FPH unique
  provider ID after May 23, 2007 on electronic
  transactions.
• If you are not prepared to submit electronic
  claims using only your NPI by May 23, 2007 you
  must notify us or your claims may not be
  accepted.

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NPI General Information

• What if I dont submit electronically ?
• HIPAA allows Health Plans to require NPI on paper
  submissions. We will accept either your assigned
  BC/FPH unique provider ID or your NPI for paper
  claim submissions. However, we recommend you use
  your NPI.
• If you do not submit electronic transactions, you
  are not required to get an NPI, however we highly
  recommend and prefer you do.

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NPIGetting an NPI

• When can I apply for an NPI ?
• NOW !
• The earlier you get an NPI the better.
• How do I get an NPI ?
• Submit an NPI application to the NPI enumerator
• Once your application is processed you will
  receive notification of the assigned NPI from the
  Enumerator (KEEP this in a safe Place)
• What information do I need to apply ?
• The CMS NPI Viewlet contains a step by step
  tutorial on completing an NPI application.
• To access the CMS Viewlet go to
  http//www.cms.hhs.gov/apps/npi/npiviewlet.asp
• The Estimated time to complete an NPI application
  is 20 minutes.

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NPIHow to Get an NPI

• Methods of Applying
• Web
• Complete the application on-line at
  http//nppes.cms.hhs.gov
• The enumerator will respond with the NPI via
  e-mail.
• Paper
• Download and print the application at
  http//nppes.cms.hhs.gov
• Call 1-800-465-3202 for a paper form
• The enumerator will respond with a confirmation
  letter containing the NPI.

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NPIHow to Get an NPI

• Electronic File Interchange (EFI)
• Allows CMS Approved organizations (EFIO) to
  submit NPI application information for up to
  thousands of health care providers at one time.
• Anyone wishing to become an EFIO must complete an
  EFI Certification Statement form. The form will
  become available in the next few weeks. Please
  check the CMS website http//www.cms.hhs.gov/
• The EFIO must be associated with the health care
  provider they are submitting NPI application
  information for and must have permission to
  submit information on the providers behalf.
• The information is sent to the enumerator via a
  single or a series of electronic files.
• The health care providers will not need to apply
  themselves.
• CMS expects to have EFI available late Spring
  2006.

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NPISub-parts

• What is Sub-Parting
• Sub-parts, as defined by CMS, are components of
  an organizational health care provider that
  function as health care providers somewhat
  independently of their parent.
• These components might conduct their own HIPAA
  transactions, might be certified by the State
  separately from their parent, might be in the
  same location, or a might be in a different
  location from their parent.
• Who is Affected by Sub-parting
• Providers that apply for NPIs as Organizations
  (entity type 2)
• A covered organizational health care provider
  needs to determine if it consists of any
  sub-parts, and, if it does, it must determine if
  any of those subparts need to have their own
  unique NPIs in order to be identified in HIPAA
  standard transactions.

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NPISub-parts

• Where Do I Begin ?
• CMS recommends you begin the process by
  determining if Federal or State regulations exist
  that require your entity to have its own unique
  identification number for purposes of billing
  Federal or State Health Plans, such as Medicare
  and Medicaid.
• Many providers enrolled in Medicare are actually
  subparts.
• examples Swing Bed units, Home Health, SNF.
• Please refer to the following CMS and Medicare
  documents
• CMS Guidance of Sub-Part Determination can be
  found at http//www.cms.hhs.gov/NationalProvIdentS
  tand/Downloads/npi_fs_subparts_030606.pdf
• Medicare Expectations of Determination of
  Subparts can be found at
• http//www.cms.hhs.gov/NationalProvIdentStand/Dow
  nloads/Medsubparts01252006.pdf

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NPI Sub Parts

• More Info. On Sub Parts
• WEDI White Paper on Sub Parts http//www.wedi.org
  /npioi/public/articles/index.cfm?fuseactionlink

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NPI Register your NPI

• BCNEPA/FPH requires all NPIs to be registered
  prior to use.
• How do I register an NPI with BCNEPA/FPH ?
• Do it today, at the seminars NPI Registration
  Desk
• Phone BCNEPA/FPH Provider System Support at
  1-800-451-4447
• Fax the letter from the NPI Enumerator to
  (570)-200-6880
• Add your NPI on your Credentialing /
  Re-credentialing form
• Email your NPI Enumerator confirmation letter to
  RegisterNPI_at_bcnepa.com
• Will I receive confirmation when the registration
  is complete ?
• A confirmation letter is sent by BCNEPA/FPH once
  the NPI registration is complete.
• The letter contains critical billing information
  such as
• The date you may begin using the NPI
• The taxonomy code(s) assigned to you by
  BCNEPA/FPH.

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NPI Using your NPI

• Billing your NPI early will ensure a smooth
  transition by resolving issues prior to the May
  23, 2007 mandate.
• If you have an NPI, we encourage you use it BUT.
  There are some rules
• You can not use it prior to receiving a
  BCNEPA/FPH NPI confirmation letter or prior to
  the date in the letter.
• You must submit BOTH the NPI and the BC/FPH
  unique provider ID until otherwise instructed.

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NPI - Communicate your NPI

• Others need your NPI, communicate it !
• Your Billing Company
• Facilities
• People and places you refer patients to such as
• Other Physicians or physician groups
• Labs
• Hospitals
• Pharmacies
• Your Clearing House
• Health Plans

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NPI-WEDI NPIOI Audiocast

• The Workgroup for Electronic Data Interchange
  (WEDI) will hold an encore presentation of the
  National Provider Identifier Outreach Initiative
  (NPIOI) Audiocast.
• TARGET AUDIENCE
• Providers (Billing and Rendering)
• Provider billing Office Managers
• Provider Information Technology Staff
• WHAT
• HIPAA Compliance for National Provider Identifier
  (NPI) Dont Let the New HIPAA NPI Derail Your
  Claims Billing and Cash Flow
• Pat Peyton, Office of Financial
  Management/PIG/DPSE, Center for Medicare
  Medicaid Services (CMS) will be among the
  speakers.
• TOPICS
• NPI Overview
• Payer and Trading Partner Communications and
  Information Exchange
• WHEN
• Thursday, April 27, 2006
• 200 PM 330 PM ET

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NPI Taxonomy Codes

• The Provider Taxonomy is a unique alphanumeric
  code, ten characters in length
• Allows an individual, group, or institution to
  identify their specialty category.
• There are 3 levels of taxonomy codes
• Individual
• Group
• Institutional
• Only Levels 1 or 3 should be used when billing
  BCNEPA.

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NPITaxonomy Codes

• Bill only the taxonomy code(s) assigned to you by
  BCNEPA.
• The taxonomy code assigned by BCNEPA is
  communicated in the confirmation letter you
  receive during the NPI registration
• You may have multiple taxonomy codes assigned to
  you by BCNEPA.
• Example - Multiple specialty providers

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NPI Taxonomy Codes

• You may have different taxonomy codes
• The BCNEPA assigned taxonomy code can be
  different than reported during the NPI
  application process
• The BCNEPA assigned taxonomy code can be
  different than those assigned by other health
  plans (i.e. Medicare)
• You should have the flexibility to use different
  taxonomy codes
• More information on Taxonomy Codes including the
  list of codes can be found at www.wpc-edi.com/cont
  ent/view/515/229

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NPINew Claim Forms

• CMS 1500 form
• May be used beginning October 1, 2006
• Must be used after February 1, 2007
• Health plans are required to accept either
  version of the form as of October 1, 2006
• The new form is available at the National Uniform
  Claim Committee (NUCC) website.
• http//www.nucc.org/

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NPINew Claim Forms

• UB-04 form
• Replaces UB-92/1450
• May be used beginning March 1, 2007
• Must be used after May 23, 2007
• Health Plans required to accept either form as of
  March 1, 2007
• The new form is available at National Uniform
  Billing Committee (NUBC) website.
• http//www.nubc.org/ (subscription fees may
  apply)

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Questions