Deadline draws near for NPI

Sunday, May 13, 2007

WASHINGTON - Medicare hasn't decided when it will begin rejecting claims without a primary National Provider Identification (NPI) number, but officials at a May 10 roundtable warned it could be as early as July 1.

That goes for electronic, paper, direct data system and CMS free billing software claims.

Medicare will also begin rejecting CMS form 1500-1290 on or after July 1. The form allows reporting of NPI and legacy identifiers together.

CMS officials also reminded callers that if they do not have an NPI already, they must develop a contingency plan. When CMS receives complaints about providers or health plans that don't have an NPI or contingency plan in place, it will evaluate each on a case-by-case basis.

"If we do receive complaints, we may ask providers for the date you received your NPI and when you shared it with your health plans and clearinghouses," said a CMS official. "For health plans, we'll look at your schedule for testing, the communication you've had with providers and your timeframe for completing crosswalks."

CMS has no authority over vendors, but officials said if they receive any complaints related to vendor behavior, the agency will try and facilitate a resolution.

With the May 23 implementation deadline less than two weeks away, providers are still looking for an NPI registry--information about one is currently in clearance--and they're still seeking clarification about when NPIs are needed.

One caller, a national provider that offers DME, enteral and IV services, wondered how many NPIs she needed.

"We have NPIs that we've obtained for each of our physical branches," said the caller. "We are now being told by some different payers, including Medicaid, that we need an NPI for each type of service, not (just) per physical location, so we could possibly need a few (numbers) for a physical location. Is that correct?"

Said an official: "The final rule makes it clear that it is your decision (to have more than one NPI) and I do believe that Medicaid sent a letter out to the states that cautioned them about forcing providers to obtain NPIs for subparts they didn't want them for."