NPI and HIPAA Compliance for Medisoft and Lytec
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated that the Secretary of Health and Human Services adopt a standard unique health identifier for health care providers. On January 23, 2004, the Secretary published a Final Rule adopting the National Provider Identifier (NPI) for this requirement. All HIPAA covered healthcare providers, whether they are individuals or organizations, must obtain an NPI to identify themselves in HIPAA standard transactions. Once established, a provider's NPI will not change. The NPI remains with the provider regardless of job or location changes.
Effective May 23, 2007, the Centers for Medicare & Medicaid Services (CMS) claims processing systems will only accept claims that include NPI numbers. At the same time, all providers completing electronic transactions, healthcare clearinghouses, and large health plans, must use the NPI to identify covered healthcare providers in standard transactions.
Now is the time to prepare and to ensure that providers using Medisoft can continue to send electronic claims after the May 2007 deadline! The link to apply for an NPI number is http://nppes.cms.hhs.gov/NPPES/Welcome.do
NPI Timeline Schedule
Medicare's implementation involving acceptance and processing of transactions with the NPI will occur in separate stages, as shown in the table below:
May 23, 2005 - Jan 2, 2006: |
Providers should submit Medicare claims using only their existing Medicare numbers. They should not use their NPI numbers during this time period. CMS claims processing systems will reject and not process any claim that includes an NPI during this phase. |
Jan 3, 2006 - Oct 1, 2006: |
Medicare systems will accept claims with an NPI, but an existing legacy Medicare number must also be on the claim. Note that CMS claims processing systems will reject and not process any claim that includes an NPI only.
Medicare will be capable of sending the NPI as primary provider identifier and legacy identifier as a secondary identifier in outbound claims, claim status response, and eligibility benefit response electronic transactions. |
Oct 2, 2006 - May 22, 2007: |
CMS systems will accept an existing legacy Medicare billing number and/or an NPI on claims. If there is any issue with the provider's NPI and no Medicare legacy identifier is submitted, the provider may not be paid for the claim.
Therefore, Medicare strongly recommends that providers, clearinghouses, and billing services continue to submit the Medicare legacy identifier as a secondary identifier.
Medicare will be capable of sending the NPI as primary provider identifier and legacy identifier as a secondary identifier in outbound claim, claim status response, remittance advice (electronic but not paper), and eligibility response electronic transactions. |
May 23, 2007 - Forward: |
CMS systems will only accept NPI numbers from all providers completing electronic transactions, healthcare clearinghouses, and large health plans. Small health plans have an additional year to be NPI compliant. |
What does this mean for Medisoft users?
In order to submit claims electronically after May 23, 2007 and in order to generate CMS 1500 printed claims, Medisoft customers must upgrade to Medisoft Version 11. Although Medisoft Versions 9 and 10 include a field that can store an NPI, these versions, along with prior Medisoft versions, do not include software that enables electronic claims submission with the required NPI nor will they be able to produce paper claims using the new required form. The NPI-ready features will be available to providers using Medisoft Version 11 via a Service Pack we will release during Q4 2006. These features will be included within Medisoft Version 12, which will be released in early 2007.
What about Direct Modules?
Per-Se will continue to support the published list of Direct Modules for Medisoft Version 11. Note that as we approach the Medisoft release following Version 12, we will no longer support Version 11 or the Direct Modules associated with Version 11.
What about our ProxyMed/Medavant?
Both the Stratus and the Phoenix platforms will support the mandated NPI changes. Please keep in mind that the Phoenix platform supports many additional payers, more remittance connections and Electronic Eligibility Verification services. Although the Stratus platform supports the NPI changes, customers must install Medisoft Version 11, Service Pack 3 or Medisoft Version 12 in order to be NPI-ready.
To view additional details about our clearinghouse's NPI Strategy, please click on the following link to get additional details http://www.medavanthealth.com/npi.aspx
Additional information and bulletins can be found at the Centers for Medicare and Medicaid Services website at http://www.cms.hhs.gov
Call our expert consultants about HIPAA planning and implementation at 800-955-0321 or click here |
