The following information has been crafted by Anthem Blue Cross and Blue Shield. 

 This information was expressly shared with the VPTA to place in publications and on the website to increase provider awareness of this important issue.  

Should you have any questions please contact Angela Brooks, PT at angelasbrooks@....

 

 

 

National Provider Identifier Effective May 2007; Begin Preparations Now

Effective May 23, 2007, the Health Insurance Portability and Accountability Act (HIPAA) will require the transition to the National Provider Identifier (NPI) – 10-position, unique numeric identifiers.  These standard NPIs will replace existing provider numbers – including Medicare, Medicaid and other physician identification numbers for health care professionals (including physicians and institutions).  All health care providers who are HIPAA-covered entities must obtain NPIs to identify themselves when requesting reimbursement for health care services rendered.   

 

Help Ensure a Smooth Transition – Contact CMS Now to Obtain NPIs

With just under a year until the new NPI requirements are implemented, health care professionals are encouraged to obtain their new NPIs now from the Centers for Medicare and Medicaid Services (CMS) if they have not already done so.  Visit the CMS Web site at http://www.cms.hhs.gov/NationalProvIdentStand or dial toll free at (800) 465-3203 to get started.  The National Plan and Provider Enumeration System Web site is www.nppes.cms.hhs.gov. 

One other way health care professionals can help ensure a smooth transition to NPI is to register their NPIs as soon as possible with Anthem Blue Cross and Blue Shield and other insurance carriers with which they contract.  By doing so, health care professionals provide vital information that insurance carriers need in order to process claims and issue accurate payments to health care professionals going forward once NPI is fully implemented.  Many carriers like Anthem are currently working collaboratively with the health care community to comply with the federal mandate and to ensure uninterrupted operations with these professionals. 

 

Assess System Capabilities Early

Preparation for NPI may also require health care professionals to assess and upgrade their existing systems or have discussions with their practice management vendors to ensure compliance with NPI requirements.  In addition, testing is a key component of the NPI preparation process.  A physician office or institution may be able to minimize problems by testing early with their vendors and any health insurance carriers.  By making preparations in advance of the upcoming implementation, health care professionals can further ensure a seamless conversion to NPI, minimizing any potential payment disruptions in their operations.

 

Become Familiar With NPI Terminology

As with any transition to a different process, new terms are common – such as NPI terms like enumeration, entity type 1 providers and entity type 2 providers.  Enumeration refers to the process of obtaining NPIs during the application and NPI number assignment process.  A health care professional who is an individual human being can apply for an entity type 1 NPI.  This includes, but is not limited to, physicians, dentists, chiropractors and behavioral health professionals.  An organization, such as a hospital, can apply for an entity type 2 NPI.  The definition of an organization includes, but is not limited to, hospitals, residential treatment centers, laboratories and group practices. 

CMS uses the term "eligible" to identify health care entities – such as physicians and hospitals – who should obtain NPIs.  Those individuals and organizations who are "not eligible" to receive NPIs include taxi services, home and vehicle modifications, insect control and health clubs.  Visit the CMS Web site for further details about NPI.

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