National Provider Identifier and CMS 1500 Claim Form FAQ for PCC Practices
We've provided answers to your questions about the National Provider Identifier the new CMS 1500 claim form.
National Provider Identifier FAQ
What is an NPI?
NPI stands for National Provider Indentifier. In 2007, the NPI will become the standard, unique identifying number for health care providers. NPIs are ten-digit numbers, unique to a single provider or single health care business.
Do I need to get an NPI?
Under the National Provider Identifier Regulation, all health care providers must obtain a National Provider Identifier by May 23, 2007. A health care provider is any nurse, doctor, or other individual performing medical procedures or a company or practice that coordinates services and bills for them.
What is the purpose of the NPI?
The purpose of the National Provider Identifier (NPI) is to uniquely identify a health care provider in standard transactions, such as health care claims. NPIs may also be used to identify health care providers on prescriptions, in coordination of benefits between health plans, in electronic medical records, and in other ways.
When Will I Start to Use NPIs on Claims and Other Transactions?
HIPAA requires that providers, health plans, and clearinghouses use NPIs in their transactions by May 23, 2007. The compliance date for "smaller health plans" is May 23, 2008. As of the compliance dates, the NPI will be the only health care provider identifier that can be used for identification purposes in standard transactions by covered entities.
How do I get an NPI?
NPI registration is free and available online with the National Plan and Provider Enumeration System (NPPES).
Do I Need to Get an NPI for Every Individual Physician and for My Practice?
Yes.
- An individual provider, e.g. a physician, nurse practitioner, or physicians assistant, applies for one Type 1 NPI.
- An organizational provider, e.g. a group practice or corporation, applies for one Type 2 NPI in addition to applying for Type 1 NPIs for the individual providers who belong to the organization.
I have received my provider NPIs. Now what do I do?
Enter your NPIs into your Partner software!
- Enter each Type 1 individual NPI in the corresponding provider entry in the Providers Table in ted.
- Enter each Type 2 NPI in the corresponding "Office" entry in the Providers Table in the Table Editor, ted.
For help using the ted program, contact PCC support.
Register your NPIs with Contracted Payors
- Contact your payors and discuss switching from their insurance ID numbers to the NPI.
- Target your top payors by claim volume.
- Request the date by which the payor will accept claims submitted with only the provider NPI(s) reported.
Exchange your NPIs with Business Associates
- Request NPIs from your non-office places of service, notably hospital locations, and update the corresponding Places of Service table entries in the Table Editor, ted.
- Request NPIs for referring providers and update the corresponding Referring Providers table entries in the Table Editor ted.
When Should I Ask PCC to Configure My Claims to Reference My NPIs?
Contact PCC to switch a payor's claim configuration to use the NPI when:
- the payor has registered all NPIs for the practice, and
- the payor is ready to receive claims with the NPI.
I Have More Questions. Where Can I Go?
- The Centers for Medicare and Medicaid Services' National Plan and Provider Enumeration System (NPPES) describes in detail the NPI and provides free online registration.
- Search the Centers for Medicare & Medicaid Services FAQ for "NPI."
- Contact PCC Support
National Uniform Claim Committee and the CMS 1500 Claim Form FAQ
What are the changes to the CMS-1500 form?
You can get an overview of the new form from CMS' Medicare Learning Network bulletin.
Where can I purchase the new CMS-1500 form?
You should be able to purchase new forms from the same source you've always used for your CMS-1500 forms. If your current vendor does not supply the new form, PCC suggests going to New Medical Forms or Sunshine Forms to order the CMS-1500 (version 08-05) forms.
When can I start submitting using the new forms?
You need to update to Partner 10.2006 in order to submit the new form. Once an insurance company tells you they are accepting the new form, we can configure your claims to use the new CMS 1500 claim form specification.
When is the deadline for using the new forms?
April 1, 2007 was the initial deadline. In March, CMS announced a new implementation deadline of June 1, 2007. Incorrectly formatted claim forms from certain suppliers are the cause of the delay.
How do I know if my CMS-1500 (08-05) claim forms are formatted correctly?
To find out if your new CMS-1500 (08-05) forms are correct, look at the upper right corner of the form. There should be approximately a 1/4" gap between the tip of the red arrow above the vertically tacked word "CARRIER" and the top edge of the paper. If the tip of the red arrow is touching or close to touching the top edge of the paper, then the form is not printed to specifications. Also, "Approved OMB-0938-0999 FORM CMS-1500 (08-05)" should appear on the bottom of the form.
I have payors who are accepting these forms now. Can I start submitting them?
If you are already using Partner 10.2006, you can contact PCC and we will install the new CMS-1500 configuration on your system.
Do I need to do anything to get the new forms working?
You will need to call us and let us know which paper batches should use the new form. We will update the appropriate batches and have you test the form to verify that boxes line up properly.
My salesman told me I need to start using the new form now. Is PCC ready?
Your salesman is not correct. You do not have to use the new form until the deadline, which is 6/1/2007. If you wish to use the old HCFA-1500 and your supplier no longer has them, contact PCC for help finding an alternate vendor.
I am working on creating my new hcfaspec. Are there going to be new variables? Where do I find them?
There is no need to work on changing your hcfaspec. We will supply you with one already configured to print to the new form. There are new variables for the form, so you do need to make sure you are running Partner 10.2006.
