In This Issue
Ensure Your Organization’s Claims Are Not Rejected -
A Primer on the National Provider Identifier
Ensure Your Organization’s Claims Are Not Rejected
- A Primer on the National Provider Identifier
By
Saurabh Desai
Beginning May 23, 2007, both public and private payors could begin
rejecting submissions and transactions that are sent without a National
Provider Identifier (“NPI”). All covered entities must be in compliance
with the NPI provisions by that date to ensure proper claim submission.
The
Health Insurance Portability and Accountability Act (HIPAA) of 1996
included a series of “administrative simplification” provisions to
improve the efficiency and effectiveness of the electronic transmission
of health information. The aim of the NPI is to reduce administrative
burden, simplify transactions, including claim submission and
coordination of benefits, decrease errors, and reduce fraud and abuse.
Before implementation of the NPI, providers who did business with
multiple payors, including both Medicare and private payors, would have
multiple identification numbers. The aim of the NPI is to create a
unique identification number for health care providers that will be used
by all health plans and Medicare.
All
HIPAA-covered entities are required to obtain an NPI. These entities
include health care providers who transmit any health information in
electronic form in connection with a transaction specified by HIPAA. All
nursing facility providers qualify as covered entities under HIPAA and
therefore must obtain an NPI. The NPI is a 10-digit number that includes
a check digit in the 10th position to reduce errors in claims submission
and ensure accuracy. It contains no imbedded intelligence, meaning one
cannot determine any information directly from a provider’s NPI,
including a provider’s state, region, or specialty.
NPIs
are issued by the National Provider System (“NPS”) based on information
entered into the system by organizations known as enumerators.
Enumerators process applications, assign numbers, and operate a call
center to answer questions about obtaining NPIs. The Department of
Health and Human Services has selected Fox Systems, Inc. as its
enumerator.
To
obtain an NPI, providers can apply online at https://nppes.cms.hhs.gov/NPPES/Welcome.do,
request a paper application by phone (1-800-465-3203) and mail it to Fox
Systems, Inc., or have a professional organization submit an electronic
file with the provider’s permission. The NPI will be assigned
automatically to all Medicare providers. Thus, Medicare providers do not
need to apply for an NPI. There is no charge to apply, nor is there an
annual fee.
All
covered entities must have been in compliance with the NPI provisions no
later than May 23, 2007. There is an exception for small plans, health
plans with annual receipts of $5 million or less, which have until May
23, 2008, to be in compliance.
Top
Danielle Barbour and
Saurabh Desai are summer associates for Poyner & Spruill. They
are both rising second-year law students and we are very lucky to have
them.
Danielle Barbour has
finished her first year of law school at the Emory University School of
Law. Her undergraduate degree is a Bachelor of Science in Health Care
Administration and Planning from Tennessee State University, where she
was inducted into the Phi Kappa Phi Honor Society.
Saurabh Desai has completed
his first year at UNC Law School. He received his undergraduate degree
from Duke with a double major in Chemistry and Public Policy Studies. He
also has a Masters of Healthcare Administration from UNC. Saurabh is an
avid outdoorsman and has completed three marathons.
Poyner & Spruill has had a
summer associate program since our merger in 1986. The program was
designed to provide an opportunity for summer associates to gain
practical legal experience performing substantive work for current
clients of the firm.
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