NPI - National Provider Identifier - AdvancedMD Medical Billing, Scheduling & EMR Software

Medicare and NPI FAQ
(National Provider Identifier)

Effective September 3, 2007, 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). Medicare Carriers and DME MACs will reject claims if the Medicare NPI Crosswalk does not contain the NPI and Legacy Provider Identifiers. Since May 29, 2007, some carriers have been validating NPIs and Legacy Provider Identifiers. Between September 3, 2007 and October 29, 2007, all other Part B carriers and DME MACS will turn on the same edits. If the NPI/Legacy pair is not found in the crosswalk, the claim will be rejected.
Are you ready? Read on to find out all you need to know.
Note: For information on handling rejections, skip to question #9.

What is an NPI Number?

The NPI number (National Provider Identifier) is a 10 digit number that is assigned by the National Provider System (NPS) to uniquely identify a healthcare provider.
For more 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 consists of 10 alpha/numeric characters.

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 number from this website: 1) apply online or 2) print the form and mail it to the NPI Enumerator’s office. This website provides the NPI Enumerator phone number and address, along with other helpful information.

What do I do after I get my NPI number?

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.
Enter the NPI information in your AdvancedMD office key(s).
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. 2007 must contain only NPI information for every provider reported within a claim, otherwise the claim will reject. 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.

Go to Master Files | Providers/Groups | Providers (Professional) and select the appropriate provider.
Select the Both option from the Show Provider drop-down and click Save. 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.
If you were issued a group NPI number as well, go to Master Files | Providers/Groups | Groups. Enter the group NPI number in the NPI field on the Group Information screen and click Save.

Institutional Claims:

Go to Master Files | Providers/Groups | Providers (Institutional) and select the appropriate provider.
Enter the provider NPI number in the NPI field and click Save.

Referring Providers:

Go to Master Files | Referring Providers and select the appropriate referring provider.
Enter the NPI information in the NPI field and click Save.

Turning on NPI:
Now that you have your NPI number(s) in the Provider, Groups, and Referring profiles you will need to turn this option on for each carrier by going to Master Files | Carriers | Carriers, select the appropriate carrier(s) and select the “Use Provider NPI number” check box if the box is not already selected, and then click the Save button.
Once you have completed these steps, your NPI number(s) will be included on all of the claims you generate from your AdvancedMD Software.

Are any changes needed if I have McKesson send my paper claims?

McKesson paper claim submitters: Effective 04/04/07 both professional and institutional paper claims that are sent electronically to McKesson for printing and forwarding to a 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 is:

CPID 4300 – may be used for professional Commercial health plan claims
CPID 4301 – may be used for professional Medicare health plan claims
CPID 4302 – may be used for professional Medicaid health plans claims
CPID 4303 – may be used for professional Blue Cross Blue shield health plan claims
CPID 4315 – may be used for professional claims using McKesson’s Patient Direct process

The new paper CPIDs to be used in production for the UB-04 claim form as of 04/04/07 are:

CPID 4350 – may be used for institutional Commercial health plan claims
CPID 4351 – may be used for institutional Medicare health plans claims
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

Is McKesson prepared?

Our clearinghouse partner, McKesson, has been prepared to accept and receive electronic transactions with NPI information since March 1, 2006. McKesson has the ability to send the NPI information to payors that have indicated they are ready to receive NPI on electronic claims. They will not send the NPI information to payors that have indicated they are not ready to receive NPI on electronic claims.

What will happen if I do not send my claims with the NPI number on May 23, 2007?

CMS will reject all claims NOT CONTAINING NPIs for ALL providers reported within a claim. To review the Medicare NPI Implementation Timeframes, please visit:
http://www.cms.hhs.gov/NationalProvIdentStand/Downloads/Medicare_

NPI_Implementation_Timeframes.pdf

How will I know if my claims are being rejected?

Watch your electronic claim reports for rejections. These rejections will also appear on the Exclusions tab in Claims Center.

What should I do if my claims are rejected?

Ensure that all providers have both an NPI number and a legacy Medicare ID (or PIN).
Report accurate NPI and legacy number information to NPPES (https://nppes.cms.hhs.gov).
If NPPES has the correct information, validate that the carrier has the correct provider numbers in their system.
Check the Carrier master file for Medicare carriers to ensure that the Show Provider field is set to "Both". This will guarantee that both the NPI and legacy numbers are included on Medicare claims.
Check EDI/Other settings on Medicare Carrier master files to ensure Supplemental ID Source and Qualifiers are set to "Medicare Provider Number".