NPI: CMS – NPI Update
Updated March 28, 2007
NPI: Get It. Share It. Use It.
Less than two months remain until the National Provider
Identifier (NPI) compliance date of May 23, 2007.
As the deadline for obtaining an NPI approaches, the Centers for Medicare & Medicaid Services (CMS) reminds providers of the following important NPI information:
Every Provider Needs an NPI
Even providers who do not bill for services may need to disclose
their NPIs to those providers who do bill (e.g., physicians who
order lab tests or refer patients for diagnostic testing must be
identified on the lab’s or testing facility’s claims). Providers
that plan to retire before the May 23, 2007 compliance date, but
have claims that will not be submitted until after the
compliance date, still need an NPI. Without an NPI, payment on
those claims may be delayed or denied. The same will be true for
Medi-Cal claims.
Reminder to Supply Legacy Identifiers on NPI Application
Providers are encouraged to include legacy identifiers, such as
the nine-digit Medi-Cal provider number, on their NPI
applications. This will help all health plans, including
Medicare, to get ready for the May 23, 2007 compliance dates. If
reporting a Medicaid legacy number, include the associated state
name. If providers have already been assigned NPIs and did not
include their legacy identifiers in the their application, CMS
is asking them to log back into the
National Plan and Provider Enumeration System (NPPES) Web site
and update their information. The legacy identifiers are
critical for health plans and health care clearinghouses in the
development of crosswalks to aid in the NPI transition.
Special Information for Medicare Providers
- Designation of Subparts – CMS reminds Medicare providers to read the Medicare Expectations on Determination of Subparts paper for more suggestions on how to determine their subparts and that no health plan, not even Medicare, can instruct a provider on how to enumerate subparts. This is a business decision that the organizational provider must make considering its unique business operations.
- Medicare Provider Enrollment and NPIs – CMS requires that providers and suppliers obtain their NPIs prior to enrolling in Medicare or updating their Medicare enrollment information. Providers and suppliers must enter their NPIs on the CMS-855 Medicare provider enrollment applications and must include a copy of their NPPES NPI notifications with each CMS-855 application they submit.
- Revised Date for Acceptance of NPIs on Paper Claims – Medicare will require the NPI on its paper claim forms. CMS has implemented the new CMS 1500 (currently HCFA 1500) claim form to accommodate NPI reporting. Transition to the new form will begin on January 2, 2007. For more details, and to learn more about the new form, review the Medicare Learning Network Matters (MLN; #MM5060) newsletter on the CMS Web site. It is anticipated that Medi-Cal will begin accepting the CMS-1500 on March 26, 2007.
- Medicare DME Suppliers and NPIs – CMS issued a special communication for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) suppliers regarding NPIs.
- Medicare Requires Taxonomy Codes on Institutional Claims– Effective January 1, 2007, institutional Medicare providers (e.g., hospitals, home health agencies and skilled nursing facilities) who submit claims for their primary facility and its subparts must report a taxonomy code on all claims submitted to their Fiscal Intermediary. To learn more, review MLN Matters (# MM5243) newsletter on the CMS Web site.
- Use of NPI on Medicare Claims Starting October 1, 2006 – Beginning October 1, 2006, Medicare can accept claims that only have an NPI on them. However, to facilitate further testing, Medicare strongly encourages providers to submit both legacy identifiers and their NPI on claims.
NPI Training Package
CMS has developed a training package on NPIs to assist providers
and their staff. This package includes useful presentations and
training materials for national and local medical societies. The
entire package will consist of the following five modules:
- General Information
- Electronic File Interchange (EFI)
- Subparts
- Data Dissemination
- Medicare Implementation
Currently, the first three modules are available on the NPI Training Package page of the CMS NPI Web site. Each module includes a PowerPoint presentation (with speaker's notes) and can be used alone or combined with other modules for a training session tailored to a particular audience. The remaining modules will be posted on the CMS NPI Web page as completed.
More information and education on the NPI can be found at the National Provider Identifier Standard (NPI) page of the CMS Web site. Providers can apply for an NPI online at the NPPES Web site or can call the NPI enumerator to request a paper application at 1-800-465-3203.
Getting an NPI is free – not having one can be costly.
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