NPI Provider Guide

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CalOHI Policy Memorandum 2006-79 Exhibit 2
NPI Provider Guide
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NPI Provider Guide

• Planning
• Assessment
• Enumeration
• Implementation
• Contingency Planning
• Education Training

Overview
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Planning

• Preparation
• Laws Regulations
• Project Plan
• Project Schedule
• High-Level Requirements

Overview
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Preparation

• Initial Project Meeting
• Senior Management
• Business Managers
• Technical Managers
• Partners
• Group
• Establish Project Team
• Secure Resource Allocation Approvals

Planning
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Laws Regulations

• Review HIPAA NPI Final Rule
• Review State Laws and Regulations Affected by NPI
• Review 45 C.F.R. Subpart D
• 162.402
• 162.404
• 162.406
• 162.408

Planning

• 162.410
• 162.412
• 162.414

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Project Plan

• Develop Project Remediation Plan
• Assessment
• Transition
• Enumeration
• Implementation
• Ensure Collaboration of Business IT Units

Planning
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Project Schedule

• Develop Project Schedule for
• Project Planning
• Impact Assessment
• Gap Analyses Requirements
• Design Specifications
• Remediation Implementation

Planning
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High-Level Requirements

• Develop High-Level Requirements for
• Communication Process
• Organization
• Business Partners
• Business User Training
• Technical Environment Assessment
• Transition
• Resources Costs

Planning
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Assessment

• Impact Assessment Gap Analysis
• Information Systems
• Software Vendor Issues
• Policies Procedures
• Data Flow
• Business Partners
• Business Partner Agreements

Overview
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Impact Assessment Gap Analysis

• Identify Impacted
• Business Units
• Information Systems
• Perform Gap Analyses
• Business Processes
• Information Processing

Assessment
Use the Gap Analysis to identify and map the gaps
between how legacy identifiers are processed and
managed versus how NPI will be processed and
managed.
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Information Systems Impact

• Identify Impacted
• Systems
• Databases
• Software
• Processes
• Evaluate Future Software Purchases

Assessment
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Software Vendor Issues

• When will NPI-ready software version be updated?
• What modifications need to be made?
• What costs will be associated with the updated
  software?
• Have any problems or limitations been identified?
  

Assessment
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Policies Procedures

• Identify Impacted Organization
• Policies
• Procedures
• Identify Impacted Business Partner
• Agreements
• Policies
• Procedures

Assessment
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Data Flow

• Identify Reports Affected
• State Reporting
• Outside Report Submissions
• Contracted Payers
• Federal / State Agencies
• Contact external reporting agencies for updated
  specifications

Assessment
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Business Partners

• Identify Impacted Business Partners
• Business Associates
• Trading Partners
• Clearinghouses
• Software Vendors
• Billing Services
• Other External Organizations

Assessment
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Business Partner Issues

• Do any payers qualify as a small health plan?
  (NPI Compliance May08)
• If so, will they take the additional year to
  comply?
• When do they plan to be ready to accept NPI?
• When do they plan to test for
• Accepting legacy identifier and NPI during
  transition period?
• Accepting NPI only?

Assessment
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Business Partner Issues (Cont)

• How will historic reporting between legacy
  identifiers and NPIs be supported?
• How will NPI paper-based transactions be handled?
• When will legacy identifiers stop being assigned?
  
• Will re-enrollment be required by payers?

Assessment
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Enumeration

• Strategy
• Subpart Strategy
• Identifier Management - Legacy
• Identifier Management - NPI
• Identifier Management Issues

Overview
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Strategy

• Identify existing Provider identifiers
• How will organization NPI be defined?
• Will subparts be necessary?

Enumeration
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Strategy (Cont)

• Which employed Providers will need enumeration?
• Organizational
• Individual
• Subparts
• Develop crosswalk tool to ensure accuracy of
  enumeration strategy
• Secure Approvals for Enumeration Strategy

Enumeration
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Subpart Strategy

• Review regulations contracts
• Determine granularity of subpart enumeration
• Identify potential qualifying
• Locations
• Departments
• Entities
• Secure approvals for location subpart strategy

Enumeration
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Identifier Management Legacy

• Identify how legacy identifiers are currently
• Obtained
• Maintained
• Disseminated
• Validated
• Identify affected policies procedures

Enumeration
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Identifier Management NPI

• Identify how NPI will be
• Obtained
• Maintained
• Disseminated
• Validated
• Update affected policies procedures

Enumeration
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Identifier Management Issues

• How will management of legacy Provider
  identifiers change during transition?
• How will you address billing for services in
  multiple locations/Tax IDs?
• Will someone else enumerate individuals?

Enumeration
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Implementation

• Strategy
• Issues
• Applying for NPIs
• Development Testing
• Claims Processing Issues
• Updating Information Systems
• Inserting NPI into Production
• Testing with Trading Partners

Overview
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Strategy

• Determine implementation strategy
• Determine transition strategy
• Crosswalk tables
• Intelligent logic queries
• Contract with a third party
• Determine migration strategy (transition to final
  NPI Solution)
• Communicate implementation plan

Implementation
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Dual Identifier Strategy

• Dual NPI-Legacy Identifier Strategy
• Provider obtains NPI
• Receiver able to receive Dual NPI-Legacy
  Identifiers
• Sender sends Dual NPI-Legacy Identifiers
• Receiver modifies internal systems to use NPI
• Receiver modifies internal systems to use NPI
• Discontinue Legacy Identifiers
• Contingency after deadline

Implementation
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Issues

• Issues to consider
• When will legacy identifiers cease being assigned
• When will legacy identifiers be rejected
• Historical records that use legacy identifiers
  only
• Crosswalk maintenance after compliance date for
  reporting purposes
• Billing issues created by missing NPI data
• When payers begin accepting / requiring NPI

Implementation
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Submit Applications for NPI

• Review NPPES NPI application instructions at
• https//nppes.cms.hhs.gov
• Determine Provider Application Process
• EFI (Electronic File Interchange)
• Individually
• Subpart
• Secure Necessary Approvals for Process
• Apply for NPI(s)

Implementation
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Development Testing

• For each impacted system or application
• Determine development strategy
• Create development plan
• Create testing and validation strategy
• Implement development strategy
• Test and validate changes
• Document findings

Implementation
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Claims Processing Issues

• NPIs validated as part of adjudication or claims
  submission
• Claims submitted with legacy ID and paid under
  NPI
• Duplicate claims
• Matching claims submitted after compliance with
  authorizations prior to that date

Implementation
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Update Information Systems

• Provider NPI Data Collection
• Move Information System Updates into Production
  Environments
• Load NPI Data into Information Systems
• Disseminate NPIs to Appropriate Entities

Implementation
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Insert NPI into Production

• Determine transitional or conversion strategy by
  Health Plan
• Coordinate Go-Live with
• Health Plans
• Business Associates
• Business Units / Departments
• Implement production system changes
• Address post-implementation issues
• Compile documentation of efforts

Implementation
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Test with Trading Partners

• Create Test Claim Files
• Process Test Claim Files
• Remediation
• Re-Test as Necessary
• Document Findings

Implementation
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Contingency Planning Issues

• Identify contacts for implementation issues
• Designate a complaint mechanism

Contingency Planning
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Create Curriculum

• Provider Staff
• Develop Curriculum
• Perform Education and Training

Education Training
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List of References
The following documents were used in the
preparation of this presentation.

• WEDI SNIP NPI Sub Workgroup. (2005). (HIPAA NPI
  White Papers).
• --- Impact of NPI on Health Care Providers
• --- Dual Use of NPI Legacy Identifiers
• --- Implementation Planning, Timing, and
  Sequencing
• --- NPI Subpart Designation for Organizations