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Dear Provider,
Do not let the implementation of the National Provider Identifier (NPI) disrupt your cash flow. The Health Insurance Portability and Accountability Act (HIPAA) requires all covered health care entities (practitioners and facilities) to apply for and obtain an NPI which is to be used in all HIPAA transactions. Your current unique billing (commercial and government payer legacy) numbers cannot be sent in your electronic transactions after May 23, 2007. This gives you less than one year to do a substantial amount of work.
The UHIN community of Payers, Providers, Government Agencies and Provider Associations urge you to start the process now. The following steps will help you complete the process:
- Verify all provider legacy numbers with all payers – this will help you as you build your crosswalk from your NPI number(s) to your existing legacy number(s).
- Apply electronically for the NPI(s) at: https://nppes.cms.hhs.gov
- Notify Payers of your NPI number(s).
- Work with your practice management (software) vendor to make sure the NPI number(s) are positioned in the correct field of the electronic transactions.
- Consider validating your transactions with a third party certifier such as Claredi.
- Set up electronic transaction testing with payers.
- Set up paper form testing with payers.
- Plan your “go live” date. Please note payers may choose to begin processing with the NPI numbers prior to the deadline of May 23, 2007.
The amount of work required for the NPI conversion is directly related to the number of payers to whom you submit claims. There is much to be done and some of this may take a considerable amount of time. Please do not wait to begin this process.
Here is an example of a time table that you may want to consider:
| 2006 |
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| May |
Verify your legacy numbers with ALL payers. |
| June |
Apply for your NPI numbers. This process takes approximately 20 minutes per provider, if you have all the items listed in the NPI Check List (see below). |
| July-August |
Work with your vendors to make sure the numbers you obtain will be put in the correct place in your electronic transactions. |
| August |
Notify payers and providers of your NPI numbers. |
| September |
Set up testing with your payers (testing may be very similar to the testing you did with the HIPAA transaction testing). |
| 2006/2007 |
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| October-February |
Test your electronic claims and CMS 1500 paper claims with payers. |
| March/May |
Test your UB04 paper claims with payers and test non- claim transactions such as Eligibility and Claim Status. |
| May 23, 2007 |
NPI deadline. |
We recommend that you use UHIN Standard #51 National Provider Identifier to help you understand how to accomplish some of these tasks (this standard can be found on the UHIN web site at www.uhin.com).
NPI Check List
Information you will need before you apply for your NPI
PROVIDER DEMOGRAPHICS
- Provider Name (legal name – the name reported to the IRS)
- Provider Date of Birth
- State of Birth (if Country is US)
- Country of Birth
- Provider Gender
- Social Security Number
- Domestic Address
PRACTICE INFORMATION
- Primary Practice Location Address
- Primary Practice Location Phone Number
- Mailing Address
- Taxonomy (provider Type)
- ALL Provider Legacy Numbers (commercial and government payer assigned billing numbers)
CONTACT INFORMATION
- Contact Person Name
- Contact Person Phone Number
- Contact Person E-mail
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