Medicare and NPI FAQ
(National Provider Identifier)
Effective May 23, 2008, all providers will be required to send their NPI number (National Provider Identifier) on all claims, both paper and electronic, as stated by the Centers for Medicare & Medicaid Services (CMS). Are you ready? Read on to find out all you need to know.
- What is an NPI Number?
The NPI number (National Provider Identifier) is a 10 character all numeric identification number that is assigned by the National Provider System (NPS) to uniquely identify a healthcare provider.
For the latest information about NPI and the requirements see:
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0679.pdf
http://www.cms.hhs.gov/NationalProvIdentStand/
- How does the NPI number differ from a Taxonomy Code?
A Taxonomy Code is a HIPAA standard code set that represents specialties. The Taxonomy code is maintained by the NUCC (National Uniform Claim Committee) and it is 10 Alpha/Numeric. An NPI number identifies a specific provider.
- What will happen if I continue to send my claims to CMS with the Legacy numbers on May 23, 2008?
CMS will reject all claims containing Legacy numbers for ALL providers reported within a claim as of May 23, 2008.
- Where do I get my NPI number?
Please visit the following website: https://nppes.cms.hhs.gov. There are two ways to apply for your NPI numbers from this website: 1) apply online or 2) print out the form and mail it to the NPI Enumerator’s office. This website also provides the NPI Enumerator phone number and address along with other helpful information.
- What do I do after I get my NPI number?
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Notify your payors - It is extremely important that you contact all of your payors to report your NPI information immediately. Payors have been using various methods to obtain NPI information and it is important that you contact each payor to determine which method will be required for reporting this information to them.
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Enter the NPI information into your AdvancedMD office key(s)
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Know your associates’ NPI numbers (referring physicians, etc.)
CMS has stated that ALL providers within a claim must include NPIs. Please remember to gather all of your associates’ NPI numbers, as you will need to enter this information into your AdvancedMD office key. A number of payors are deciding to only accept electronic claims that contain NPI information for all providers reported on a claim: Billing, Pay-to, Rendering, Referring, etc. For example, CMS has stated that all claims submitted to Medicare on and after May 23, 2008 must contain only NPI information for every provider reported within a claim, otherwise the claim will be rejected. You should also know that provider Federal Tax IDs such as Employer identification Numbers (EIN) and Social Security Numbers (SSN) are not considered Legacy ID numbers, and must be reported with NPI information as required by the HIPAA 4010A1 Implementation Guide standards.
- Where do I enter the NPI in AdvancedMD?
Professional Claims: NPI numbers can be established for both individual providers and groups.
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Go to Master Files | Providers/Groups | Providers (Professional).
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Select the Both option from the Show Provider field drop-down. Both the NPI number and Legacy number will print on claims. Select the NPI option if you want only the NPI number to print on claims.
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Enter NPI number in the NPI field.
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If you were issued a group NPI number as well, go to the Master Files | Providers/Groups | Groups and enter the group NPI number in the NPI field.
Institutional Claims:
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Go to Master Files | Providers/Groups | Providers (Institutional).
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Enter the provider NPI number in the NPI field.
Referring Providers:
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Go to Master Files | Referring Providers and select the appropriate referring provider.
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Enter the NPI information in the NPI field.
Turning on NPI:
Now that you have your NPI numbers in the Provider, Groups, and Referring Provider profiles you will need to turn this option on for each carrier.
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Go to Master Files | Carriers | Carriers and select the appropriate carriers.
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Select NPI in the Show Provider drop-down.
Once you have completed the above steps, your NPI numbers will be included on all of the claims you generate from your AdvancedMD Software.
- Is RelayHealth prepared?
Our clearinghouse partner, RelayHealth, has been prepared to accept and receive electronic transactions with NPI information since March 1, 2006. RelayHealth has the ability to send the NPI information to payors that have indicated they are ready to receive NPI on electronic claims and to not send the NPI information to payors that have indicated they are not ready to receive NPI on electronic claims.
- What about submitting the NPI on the new Paper formats?
AdvancedMD highly recommends sending both paper and electronic claims using your NPI numbers in order to prevent delays in payments. This also allows you time to correct any issues that may occur prior to the CMS May 23, 2008 deadline as well as any earlier deadlines other payors may have established.
AdvancedMD has provided the new CMS-1500 paper format your office key. If you would like to set the new CMS-1500 format as your claim format with you AdvancedMD office key, go to Utilities | System Defaults | Claims | HCFA. Select the CMS-1500 format in the Default Paper Claim Form drop-down. You can also specify your default paper claim form by carrier. Go to Master Files | Carriers | Carriers. Select the carrier and click the EDI/Other button. Select (STANDARD) CMS-1500 in the Primary Form drop-down. Click the Save button, Close the screen, and then click the Save button again. Secondary claim form default can be set as well by following the same steps above while in the Carrier – EDI other screen and using the “Secondary Form:” field.
AdvancedMD has also provided you with the new UB-04 paper format. The above information can also apply to the UB-04 paper format if you are billing Institutional claims.
- Are any changes needed if I have RelayHealth send my paper claims?
RelayHealth paper claim submitters: Effective 04/04/07 both professional and institutional paper claims that are sent electronically to our clearinghouse partner RelayHealth for printing, and forwarding to a specific carrier, will require you to make changes to the CPID numbers in your AdvancedMD office key.
The new paper CPIDs to be used for the CMS 1500 (08/05) form as of 04/04/07 are:
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CPID 4300 – may be used for professional Commercial health plan claims
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CPID 4301 – may be used for professional Medicare health plan claims
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CPID 4302 – may be used for professional Medicaid health plans claims
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CPID 4303 – may be used for professional Blue Cross Blue shield health plan claims
The new paper CPIDs to be used in production for the UB-04 claim form as of 04/04/07 are:
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CPID 4350 – may be used for institutional Commercial health plan claims
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CPID 4351 – may be used for institutional Medicare health plans claims
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CPID 4352 – may be used for institutional Medicaid health plans claims
- CPID 4353 – may be used for institutional Blue Cross Blue Shield health plan claims
- How will I know if my claims are being rejected?
Read ALL EDI Reports on the EDI Reports tab in the Claims Center. Claims that Exclude at Relay Health will also appear in the Exclusions tab. Claims that deny at the Carrier will show on the Carrier Forwarded Reports you receive in the EDI Reports tab.
- Will all Carriers be ready to receive NPI Only claims on May 23, 2008?
Most carriers will be ready but we have been told some will not. AdvancedMD recommends that you verify if your carriers are ready or not. You can do this by either calling your carriers, or you can look on RelayHealth’s website:
What if I have additional questions?
Please contact our Support Team at 800-700-9060 option 2 or send an email to support@advancedmd.com.
