Update on NPI Implementation: CMS to Require NPI Number on Claim Forms for All Primary Fields, Effective Immediately
The Centers for Medicare and Medicaid Services (CMS) provided an update on the implementation process for using the National Provider Identifier (NPI) number (a standard health identifier for health care providers) at the recent Participating Physicians Advisory Council meeting.
CMS requires that an NPI number be reported on claim forms for all primary fields effective immediately. There are 13 places on a claim form where an NPI number should be reported. Three of these are identified as primary fields: the billing field, the pay-to field, and the rendering field; the other 10 places are considered secondary (e.g., referring physician, ordering physician), and do not require an NPI number until May 2008.
CMS announced that it will treat paper and electronic claims the same way. Therefore, providers need to start using their NPI numbers as soon as possible, on paper claims as well as electronic claims. UB-92 claim forms have been rejected since May 23; therefore, providers are advised to use the UB-04 claim form. The new CMS-1500 forms will go into effect July 1, 2007.
Currently, CMS is testing a crosswalk [from the old legacy numbers (e.g., UPIN) to the newly assigned NPI numbers] through a controlled testing process before going live. The testing is being conducted on claims with an NPI number only, claims with both NPI and legacy numbers, and claims with a legacy number only. CMS has been working with a few contractors to test the crosswalk process, including CIGNA Part B in Tennessee and Idaho, National Government Services (NGS) Part B in Indiana and Kentucky, and NGS Part A in Wisconsin. Based on the results of this controlled testing to date, CMS found 1 percent of the claims were rejected due to edits against the crosswalk.
Every Part A Fiscal Intermediary should be able to utilize the crosswalk testing by May 31, 2007. CMS plans to expand the testing to Part B carriers throughout the month of July. CMS pointed out that further direction will be provided through transmittals.
A total of 2.1 million NPIs have been issued so far, which is 91 percent of what CMS was expecting to issue by this time. Furthermore, 12.8 percent of active providers' Medicare legacy numbers are unmatched to an NPI number. CMS reported that nearly 34 percent of the overall claims are coming in with NPI numbers noted.
For additional information on the use of NPI numbers.
For more information on this contingency period, see the CMS notice.
Click here for additional background information on the NPI.
If you have any questions, please call Helen Olkaba at (800) 227-5463, ext 4132.